Background Characteristics Of Women Research Articles

Anaemia prevalence and socio-demographic factors among women of reproductive age (WRA): A geospatial analysis of empowered action group (EAG) states in India

Anaemia remains a major nutritional-related health concern for women under reproductive age (WRA) in developing nations like India as well as the Indian EAG states. According to NFHS round-5, EAG states constitute 57% of WRA having any form of anaemia, higher than many other states of India and other developed and developing nations. This study aimed to assess the frequency of anaemia among the WRA in India's eight EAG states. Also, it attempts to analyse the causes associated with anaemia by the women's background characteristics with spatial correlation with its co-variates across 291 districts of the EAG states. One of the most current Demographic and Health Survey's (DHS) cross-sectional data is the NFHS-5th (2019–21) round taken, conducted by the IIPS under the administration of MoHFW, India. This study only included 315,069 women under reproductive age (WRA). The variables related to anaemia among women's (WRA) background socio-demographic characteristics were assessed using bivariate statistics and multinominal logistic regression analysis to comprehend the spatial correlation between women and their determinant factors. Among the EAG states, the overall prevalence of anaemia was 57%, varying from 42.6% in Uttarakhand to 65.3% in Jharkhand. Multinominal logistic regression analyses reveal that the chances of anaemia are remarkably more prevalent in younger women (15–19 years of age), women living in rural areas, no educated and primary level educated women, women belonging to the middle to poorest wealth quintile, women no longer living together, women of the Christian religion, women who are not exposed to reading newspapers, underweight BMI women, and scheduled tribe women. Mainly, the prevalence is observed in the North-eastern and southeastern states of Bihar, Jharkhand, Odisha, Chhattisgarh, some parts of Madhya Pradesh, Uttar Pradesh, and Rajasthan, which is shown by the hotspot map. According to the findings of this study, numerous factors like family, socioeconomic, educational, awareness, and individual characteristics such as caste and domicile all lead to a risk of anaemia. The WRA suffers from anaemia as a result of their socioeconomic background and awareness, which leads to a lack of nourishment, and they seek nutrient deficiencies. To overcome this anaemia, multiple discipline policies and initiatives need to be taken targeting women's wellness and nutritional status by increasing women's education and socioeconomic status.

Compliance with the World Health Organization's 2016 prenatal care contact recommendation reduces the incidence rate of adverse birth outcomes among pregnant women in northern Ghana.

Children born with adverse birth outcomes (ABOs) have a greater risk of mortality, stunting, and poor cognitive development. In 2016, the World Health Organization (WHO) recommended at least eight antenatal care (ANC) contacts before delivery for a healthy mother and baby. We examined the association between compliance with this recommendation and the risk of ABOs, such as low birthweight (LBW) and preterm birth (PTB), in the Tamale Metropolitan Area of the northern region of Ghana. We conducted a cross-sectional study in the Tamale Metropolis of the northern region of Ghana. We analysed a systematic random sample of 402 postnatal women aged 15-49 drawn from five public health facilities. We gathered information electronically on their birth outcomes, specifically their birthweight and gestation at delivery, using a structured questionnaire. Information on women's background characteristics, including the number of ANC contacts made before delivery, was also collected. The association between the number of ANC contacts and ABOs was investigated using regression models. We found that 37.6% (95% CI: 32.9, 42.4) of our sample had at least eight ANC contacts before delivery. We estimated that 18.9% of babies were born prematurely and 9.0% were born LBW. ABOs were found in 22.9% (95% CI: 19.0, 27.3) of babies. A minimum of eight ANC contacts before delivery reduced the risk of ABOs (adjusted IRR = 0.43; 95% CI: 0.25, 0.73), PTB (AOR = 0.28; 95% CI: 0.14, 0.58), and LBW (AOR = 0.36; 95% CI: 0.14, 0.91). In the current study's setting, about a quarter of newborns have ABOs, jeopardising their survival, health, and development. Compliance with at least eight ANC contacts prior to birth was associated with a reduced incidence rate ratio of ABOs. However, less than four out of every ten pregnant women make at least eight ANC contacts before delivery. Efforts are needed to increase coverage of eight contacts among pregnant women before delivery to reduce the risk of ABOs in the study setting.

Understanding Unmet Need for Family Planning through Background Characteristics of Women: Evidence from National Family Health Survey and District Level Health Survey

Understanding Unmet Need for Family Planning through Background Characteristics of Women: Evidence from National Family Health Survey and District Level Health Survey

Induced abortion incidence and safety in Burkina Faso in 2020: Results from a population-based survey using direct and social network-based estimation approaches.

This study aims to estimate induced abortion incidence and safety in Burkina Faso using direct and indirect methods, overall and by women's background characteristics. Data come from a nationally representative survey of reproductive aged women (n = 6,388). To address social desirability bias in abortion reporting, we asked about respondents' closest female friends' experience with abortion. The one-year abortion incidence in 2020 for respondents was 4.0 (95% CI 2.2-5.9) per 1,000 women aged 15-49 while the adjusted friend incidence was 22.9 (95% CI 15.8-30.0). Although not significant, abortion incidence was higher for adolescents, unmarried women, those with higher education, and those in urban areas among both respondents and their friends. Approximately nine out of ten abortions were unsafe (90% respondents, 95% friends), with respondent and friend findings suggesting higher risk of unsafe abortion among older women, less educated women, and women residing in rural areas. Despite recent increases in contraceptive use and continued legal restrictions, abortion remains common in Burkina Faso and is largely unsafe, with evidence of potential disparities.

Evaluation of a pilot program that integrated prenatal screening into routine antenatal care in western rural China: an interrupted time-series study

BackgroundWe evaluated a large-scale pilot program in Shaanxi Province, western rural China, which integrated prenatal screening interventions for congenital abnormalities into routine antenatal programs. MethodsWe surveyed 1,597 mothers who gave birth between 2009 and 2016. Adopting the interrupted time-series design, we evaluated the program's impact on awareness, coverage, and cost, by comparing two counties with only supply-side policies, and two counties from the neighbouring province with no policies; and among the two counties with both supply- and demand-side policies and the two counties with only supply-side policies. We adjusted the sampling procedure and women's background characteristics. We conducted subgroup analyses by women's education. FindingsAfter one year of implementation, the coverage of prenatal foetal aneuploidies and B-ultrasound screening rose by 25.0% and 23.5%. The program's supply-side policies attributed to 17.2 percentage points (90%CI 7.8–26.6%) and 27.3 percentage points (90%CI 16.2–38.5%) in coverage, and contributed to a higher median cost of 796.5RMB (90%CI 595.5–997.5). These significantly affected women with secondary education and above. However, the program's demand-side measures, that is, vouchers, seemed to be effective only in the mountainous regions, which raised awareness, and increased coverage of prenatal foetal aneuploidies screening by 28.6 percentage points (90%CI 13.4–43.8%), while not increasing costs. These significantly affected women with primary education and below. Education-related inequalities widened post-program in counties with only supply-side policies, but no inequalities existed in counties with demand-side policies. InterpretationShaanxi's program made a pilot study to other provinces of China to integrate antenatal services. Government subsidies might be more effective in targeting specific geographic locations and people with primary education and lower.

The duration of gestation at previous induced abortion and its impacts on subsequent births: A nationwide registry-based study.

Previous induced abortions have been associated with adverse birth outcomes. However, only a few studies have considered the possible influence of gestational age at induced abortion. Therefore, this study aimed to identify the impacts of gestational age during prior induced abortion(s) on subsequent births among first-time mothers in Finland. First-time mothers (n=418690) with singleton births between 1996 and 2013 were identified from the Finnish Medical Birth Register and linked to the Abortion Register. Logistic regression analysis was used to estimate the risk (odds ratio [OR] and 95% confidence interval [CI]) of birth outcomes such as prematurity, low birthweight, perinatal death and small for gestational age (SGA). Higher risk was determined for extremely preterm birth (OR 2.28; 95% CI1.53-3.39) and very low birthweight (OR 1.62; 95% CI1.22-2.16) in women having had late-induced abortion(s) (≥12 gestational weeks) compared with women having had early-induced abortion(s) (<12 gestational weeks); after adjusting for women's background characteristics, abortion method and interval between the pregnancies. When the analysis was limited to a single abortion, an increased risk was found for extremely preterm birth (OR 1.71; 95% CI1.02-2.81). Higher risks were found for extremely preterm (OR 4.09; 95% CI 2.05-8.18) and very low birthweight (OR 2.65; 95% CI 1.61-4.35) among women with two or more late-induced abortions compared with those with two or more early-induced abortions. Worse outcomes were seen after a late-induced abortion compared to an early-induced abortion for both medically and surgically induced abortion. The risk of subsequent adverse birth outcomes is very small if any, but the risk is higher with increasing gestational age at the time of induced abortion. Our study supports reduction of unintended pregnancy and offering abortion services without delay and as early in gestation as possible.

Contraceptive discontinuation in Egypt as fertility returns to its 2000 level

Purpose The similarity of family planning (FP) indicators from EDHS2014 to that of EDHS2000 is alarming for policymakers and researchers who consider it as an echo of the past and a threat, which the FP programme has to face to prevent its progression. In 2000, the total fertility rate (TFR) was 3.5, the contraceptive prevalence rate was 56.1% and the discontinuation rate was 29.5%. In 2014, these indicators were 3.5, 58.5 and 30.1%, respectively. Although the change in the all method discontinuation rate is not large, it is a result of great changes in the method specific discontinuation rates, which was masked by changes in the contraceptive method mix. This study aims to present a comparison between contraceptive discontinuation rates in 2000, 2008 and 2014, discuss the reasons for discontinuation by methods and background characteristics of women and calculate the impact of eliminating discontinuation for reasons related to method and service provision on fertility. Design/methodology/approach Single/multiple decrement life tables were applied to the calendar data of the EDHS2008 and EDHS2014, to examine various net rates of contraceptive discontinuation by reasons and the status after discontinuation. The TFR estimated in the absence of method failure and abandonment while in need of births occurred within 24 months after discontinuation using installed Stata command tfr2. Findings The study estimates the impact of discontinuation on the TFR in 2014 to be an increase of about 20%. The TFR of 3.5 would have been only 2.8 if discontinuation due to method failure and method/service-related reasons were eliminated. Improvement regarding discontinuation behaviour is evident by increased switching, from 43.6 to 54.3% and the drop in the proportion of abandoning use while in need from 56.4 to 45.7%. Differentials suggest that discontinuation is expected to increase among vulnerable groups as desired fertility continues to rise. The increase in the share of “desire to become pregnant” – as a reason for discontinuation is a recent trend observed during the period between EDHS2008 and EDHS2014 and is recognised as a challenge by the national population strategy. Originality/value This study confirms that contraceptive discontinuation is an important part of the overall fertility increase observed by EDHS2014. The rising trend of increased desired family size and the shift away from using the intra uterine device may be considered as major challenges facing the FP programme in Egypt.

Understanding the endorsement of wife beating in Ghana: evidence of the 2014 Ghana demographic and health survey

BackgroundDomestic violence (DV) has become a global burden. The high occurrence of intimate partner violence (IPV) across the globe has implications for the socioeconomic wellbeing and health of children and women.MethodsData for the study was from the 2014 Ghana Demographic and Health Survey (GDHS). The association between approval of wife-beating and background characteristics of women was examined by the use of a Binary Logistic Regression model.ResultsA higher proportion of respondents were from urban areas (53.7 and 52.2% women and men respectively). The ages of women ranged from 15 to 49 (mean = 30, SD = 9.7) whilst the age range of men was 15–59 (mean = 32, SD = 12.5). Twenty-four percent of the men and 23% of the women were within the richest wealth category. The results showed that few women (6.3%) and men (11.8%) had attained higher education. Both women (AOR = 1.3; CI = 1.01–1.24) and men (AOR = 2.2; CI = 1.72–2.76) aged 15–24 had higher odds of approving wife-beating than those aged 35–49 (reference category). Poorest women (AOR = 2.7; CI = 2.14–3.38) and men (AOR = 1.7; CI = 1.11–2.69) alike had higher odds of approving wife-beating, as compared with those in the richest wealth status (reference category). As compared to research participants with higher/tertiary education, both women (AOR = 5.1; CI = 3.52–7.51) and men (AOR = 4.2; CI = 2.37–7.16) without any formal education were found to be at higher odds to approve wife-beating; however, this observation seems to decline as one’s educational status advances.ConclusionAge, wealth status, level of education, frequency of listening to radio, frequency of reading newspaper/magazine, frequency of watching television, ethnicity, and religion were found to be significantly associated with Ghanaian men and women’s approval of wife-beating. Policies, interventions, and campaigns must target Ghanaians without formal education and young adults on the need to uphold human rights in order to dissuade them from endorsing intimate partner violence. Mass media has also proven to be a protective factor against domestic violence approval and, as such, much progress can be made if utilised by human rights activists, especially through radio, magazine and television broadcasting.

Reporting sterilization as a current contraceptive method among sterilized women: lessons learned from a population with high sterilization rates, Rajasthan, India

ObjectiveMeasuring current use of contraception relies on self-reported responses from survey respondents. Reporting validity may be affected by women's interpretation of the question and may vary by background characteristics of women. The study aims to understand levels and patterns of underreporting of female sterilization in a population with high sterilization rates. Study designData came from the Performance Monitoring and Accountability 2020 survey conducted in Rajasthan, India, in early 2017. In addition to a conventional question to ascertain current contraceptive use, the survey included a probing question; women who did not report sterilization as a current method were asked if they were ever sterilized. Women were defined as sterilization users based on either question. Among sterilized women, we estimated the percent who reported sterilization as a current method. Multivariable logistic regression analysis was conducted to assess differential reporting across background characteristics. ResultsAmong women who were ever sterilized, 78% reported currently using any contraceptive method(s), and 77% reported sterilization as the current method. Women in the lowest household wealth quintile or in general caste were less likely to report sterilization as a current method. Time since sterilization was not associated with correct reporting of sterilization. ConclusionThis study demonstrates, in a population with high sterilization, that sterilization as a current contraceptive method would be substantially underestimated using conventional survey questions. It highlights the importance of context-specific questionnaire adaptation to measure and monitor contraceptive use and provides implications in measuring current use of contraception in populations with high rates of sterilization. ImplicationsThe paper examined reporting of sterilization as a current method among sterilized women. Only 77% of sterilized women reported sterilization as a current contraceptive method. In a population with high sterilization, inclusion of a probe question in surveys is recommended to understand reporting quality and accurately measure contraceptive prevalence rates.

Correlates of institutional deliveries among teenage and non-teenage mothers in Nepal.

IntroductionGlobally, maternal age is identified as an important predictor of institutional service utilization during delivery. This study aims to assess the correlates of institutional delivery among teenage and non-teenage mothers in Nepal by using the data from Nepal Demographic and Health Survey 2011.MethodsThe study population consisted of 5391 women of reproductive age (15–49 years) who had given birth to a child within five years before the survey. Out of them, 381 (7.07%) were teenage mothers. The association between the background characteristics and institutional delivery was assessed separately for the teenage and non-teenage mothers using chi-square test and multiple logistic regression analysis.ResultsAfter adjusting for background characteristics, teenage mothers were found more likely to deliver at a health facility [AOR: 2.25; 95% CI: 1.10 4.59] in comparison to the non-teenage mothers. Place of residence, occupation, socioeconomic status, and frequency of ANC visits were associated with institutional delivery in both the teenage and non-teenage mothers. However, educational status, parity, birth preparedness and women autonomy had statistically significant association with institutional delivery among the non-teenage mothers only. None of the background characteristics were significantly associated with institutional delivery in teenage mothers only.ConclusionsThis study identified a significant difference in institutional delivery service utilization among the teenage and non-teenage mothers. While the association of most of the background characteristics with institutional delivery was uniform for both teenage and non-teenage mothers, the association with educational status, parity, birth preparedness and women autonomy was significant only for non-teenage mothers. Considering this difference in the interaction of women’s background characteristics with institutional delivery between teenage and non-teenage mothers might help in identifying the pain points and devise targeted interventions to encourage institutional delivery in teenage mothers or non-teenage mothers or both.

Sense of coherence in pregnant and new mothers – A longitudinal study of a national cohort of Swedish speaking women

BackgroundPrevious research shows inconsistent results about the stability of SOC during the childbearing period, and few studies have focused on longitudinal measures. There are contradictory results regarding the association between SOC and birth outcome. The link between levels of SOC and parental stress needs to be further explored. AimThe aim of this study was to investigate changes in SOC from early pregnancy to one year after birth and associations with background characteristics, birth outcome and parental stress. MethodsA longitudinal survey of a national cohort of Swedish speaking women during 3 weeks in 1999–2000. Data were collected by questionnaires in early pregnancy, 2 months and 1 year after birth. ResultsSOC increased from pregnancy to 2 months after birth but decreased 1 year after birth. SOC was associated with women's background characteristics, emotional wellbeing and attitudes, but not with labour outcome. Women with low SOC reported higher parental stress after one year. ConclusionSense of coherence is not stable during the childbearing period and is associated with women's sociodemographic background, emotional health and attitudes, but not with reproductive history or birth outcome. Parental stress is negatively correlated with SOC, and some important characteristics are similar in women having low SOC and high parental stress. Identifying women with low SOC in early pregnancy could be a means to prevent later parental stress.

Effects of Women’s Autonomy and Male Involvement on Reproductive and Child Health (RCH) Service Utilization in Uttar Pradesh

Introduction: Effective utilization of reproductive and child health (RCH) services is important to reduce morbidity and mortality among mothers as well as children under-five. After International Conference on Population and Development (ICPD), 1994 India has increasingly integrated male participation in women’s reproductive health to improve the women’s health care during pregnancy and child birth. This study examined effect of women’s autonomy and male involvement on RCH services utilization in Uttar Pradesh State of India. Methodology: State level data of Uttar Pradesh from National Family Health Survey (NFHS-3), India for currently married women and men aged 15 - 49 years was considered. The study was restricted to couples whose youngest child was born during the three years preceding the survey (N = 2685). Pearson chi-square test was used to determine the association of background characteristics with woman’s autonomy and male involvement in RCH utilization. Logistic regression was used to understand the effects of male involvement and women’s autonomy, using both computed indices after controlling for socio-economic and background characteristics of women and their husbands. Subsequently, the exercise was extended using individual component of both the indices. All findings were reported for 95% CI and p < 0.05. Results: Findings show that except religion, other socio-economic and demographic variables such as age of women, place of residence, number of living children, caste/tribe, women’s work status, education, wealth index, household structure and exposure to mass media, husband’s age, education, and occupation were statistically significant and associated with women’s autonomy and male involvement. Multivariate analysis indicated women’s autonomous decision making and support from their husbands (male involvement) significantly influenced their utilization of RCH services after controlling for all socio-economic and demographic variables. Conclusion: To improve RCH service utilization and overall health status of women and children male involvement and women’s autonomous decision-making should be addressed in all future RCH programs in the State.

Consumption and drinking frequency of alcoholic beverage among women in Ghana: a cross-sectional study

BackgroundThe consumption and drinking frequency of alcoholic beverage are identified with various individual factors. The aim of this study was to identify background characteristics of women associated with the consumption and drinking frequency of alcoholic beverage.MethodsData was extracted from the 2008 Ghana Demographic and Health Survey. The data consisted of women’s (aged 15–49 years) background characteristics and their reported history of consumption and drinking frequency of alcoholic beverage. A weighted sample size of 4916 women was used in the present study. Binary logistic regression and multinomial logistic regression were applied to examine the independent association between the covariates and the consumption and drinking frequency of alcoholic beverage respectively.ResultsOut of the 4916 women that were included in the study, 17.5% consumed alcoholic beverage in the past week. Factors that were found to be associated with women who consumed alcoholic beverage in a binary logistic regression model were age (15–19 years up to 45–49 years), region (Central, Greater Accra, Volta, Ashanti, Northern, Upper East, and Upper West), ethnicity (Ga or Dangme, Mole-Dagbani, Grussi, Gruma or Mande), wealth quintile (middle), and employment status [past 12 months] (those employed). In the multinomial logistic regression model, drinking frequency of alcoholic beverage was associated with women in the Central (none), Greater Accra Region (none and 4 or more times), Eastern (none and 2–3 times), Brong Ahafo (none), Upper East (none), those who attained primary education (4 or more times), Ga/Dangme ethnic group (none), those of middle wealth quintile (none), and those employed (4 or more times).ConclusionsIn the country, about 2 in 10 women consume alcoholic beverage and the drinking frequency of alcoholic beverage varied among women in the country. Hence, the maintenance of moderate alcoholic beverage consumption among women, where applicable, should be encouraged.

Women's attitudes towards fertility and childbearing – A study based on a national sample of Swedish women validating the Attitudes to Fertility and Childbearing Scale (AFCS)

ObjectiveA delay in childbearing has been reported in high-resource countries. Factors reported to impact postponement include being mature enough, completing studies, and receiving a good salary. Other reasons are the partner relationship, efficient forms of contraception, value changes, housing conditions, and economic uncertainty. The aim of the study was to validate the previously developed instrument Attitudes to Fertility and Childbearing Scale (AFCS) in a sample of Swedish women and to relate the components to the women's socio-demographic characteristics. MethodsFour hundred and twenty-four women, 20–30 years of age, who were not mothers answered and returned the questionnaire. Statistical analysis was conducted; construct validity using principal component analysis (PCA), Student's t-test, and ANOVA was performed between the three components and women's background characteristics. ResultsThe two components with highest loadings were Importance for future and Hindrance at present, indicating a time conflict. The third component was Female identity. The youngest women, single women, students, and women living in large cities were more likely to score high with the component Hindrance at present. Women having a partner were more likely to score high on Importance for future and Female identity. ConclusionIn this population, age, occupation, residential area, and civil (marital) status play a role in the attitudes towards fertility and childbearing. Fertility in relation to individual differences and age needs to be informed and discussed in society as well as in sexual and reproductive health care.

Attitudes of circumcised women towards discontinuation of genital cutting of their daughters in Kenya.

Female genital cutting (FGC) is widely practised in Kenya. However, its prevalence has declined over the last two decades (38.0% in 1998 KDHS, 32.2% in 2003 KDHS and 27.1% in 2008-09 KDHS), implying changes in behaviours and attitudes of Kenyans towards FGC. This study provides an overview of changing attitudes of women towards FGC in Kenya. An extensive literature review was undertaken and 2008-09 Kenya Demographic and Health Survey data were used to focus on the present scenario. Analyses were based on a national sample of 2284 circumcised women. About 68% of these women wanted to discontinue FGC, and attitudes towards discontinuation were found to vary with women's background characteristics. Surprisingly, 92.5% of circumcised women of the North-Eastern province still wished to continue FGC, and for Muslims the percentage was 72.2%. About 36% of circumcised women responded that their daughters were already circumcised. Only 13% of circumcised mothers intended their daughters to be circumcised in the future. The study shows that the attitude of Kenyan women, irrespective of their circumcision status, has been changing gradually towards the discontinuation of circumcision of their daughters.

Social determinants of under-five mortality in Ethiopia: Event history analysis using evidence from Ethiopian Demographic and Health Survey (EDHS)

Background: Under-five mortality is one of the indicators of the millennium development goals (MDGs) for the child mortality reduction goal. Understanding the social determinants of under-five mortality is helpful to narrow the gap between different social classes. Therefore, this study focused on the social determinants of under-five mortality inEthiopiausing EDHS 2011 data. Methods: The data source for this analysis was the 2011 EDHS which was undertaken over a five-month period from 27 December, 2010 to 3 June, 2011. The sample was selected using a stratified, two-stage cluster design. Samples of 16,515 women of reproductive age were interviewed. The questionnaire used to collect information from these women who had among other things such as background characteristics of women, birth history of these women and the survival of each birth at the time of the interview. Births that had occurred to women in the last 10 years prior to the date of the interview were extracted for the analysis. Descriptive statistical methods were used to describe the distribution of the characteristics of the data. Kaplan Meier plots and incidence rates per 1000 person years were used to compare survival across different categories of the risk factors. The effect of the risk factors on survival was analyzed using Cox proportional hazards regression. Data management and analysis were carried out using STATA 10. Results: A total of 23,581 under-five children were included in the study. The under-five mortality incidence rate in Ethiopia for the last ten years was 29.6 per 1000 person years. Maternal education beyond primary level of education reduced the risk of under-five mortality by about half. A significant reduction in risk of under-five mortality was observed among births to mothers residing in richest households. The hazard ratio (HR) was higher for under-five mortality among boys than daughters, twins than singleton, teen age mother than higher ages and short births than optimal. Conclusions: Empowering mothers with education and making them productive for improving their income are important aspects for reducing under-five mortality. Emerging regions were disadvantaged on the incidence of under-five mortality; however, there was a positive result in narrowing the urban-rural under-five mortality risks. Being teenage mother at birth, short birth interval and twin births were identified risk factors for increased under-five mortality in Ethiopia. Interventions targeted at empowering women and much effort in emerging regions are required. Preventing teenage motherhood and promoting optimal birth spacing are also required to reduce under-five mortality in Ethiopia.

Cesarean section delivery among primiparous women in rural China: an emerging epidemic

The purpose of this study was to describe the trends and determinants of cesarean section (CS) delivery rates in rural China. Data on rural primiparous women aged 15-49 years (n = 10,754) were obtained from 3 nationwide representative surveys in 1993, 1998, and 2003. The CS rate per 100 births and odds ratios by women's background characteristics were calculated with the use of logistic regression. The CS rate increased from 1% in 1991 to 17% in 2002. After age adjustment, CS was most common among more educated women, who lived in Eastern China, who had high household income and health insurance, who used antenatal care, and who gave birth at a high-level hospital. This development over the 10-year period may indicate very high CS rates in the near future; the epidemic of the use of CS that has been observed in urban China is likely to occur also in rural China. Further studies on the reasons and consequences of such excessive use of operative delivery are needed.

Unsafe abortion in urban and rural Tanzania: method, provider and consequences

To describe unsafe abortion methods and associated health consequences in Tanzania, where induced abortion is restricted by law but common and known to account for a disproportionate share of hospital admissions. Cross-sectional study of women admitted with alleged miscarriage: 278 in rural Tanzania and 473 in urban Tanzania. Women who had undergone a clandestinely induced abortion were identified by an empathetic approach and interviewed in detail about the procedure. Information about complications was obtained from the patient file. Sixty-two per cent in rural Tanzania and 63% in urban Tanzania stated that they had had an unsafe induced abortion. The abortion had been induced by an unskilled provider in 46% of rural women and 60% of urban women. Herbs and roots had commonly been used for induction, in 42% of rural and 54% of urban women. The method most often associated with abortion complications was catheter/roots, whereas the method least often associated with complications was herbs. The large number of women identified as having had unsafe abortion together with the prevalent use of herbs calls for attention.

Resource allocation of in vitro fertilization: a nationwide register-based cohort study

BackgroundInfertility is common and in vitro fertilization (IVF) is a widely used treatment. In IVF the need increases and the effectiveness and appropriateness decrease by age. The purpose of this study was to describe allocation of resources for IVF by women's age, socioeconomic position, area of residence and treatment sector (public vs. private) and to discuss how fairly the IVF resources are allocated in Finland.MethodsWomen who received IVF between 1996 and 1998 (N = 9175) were identified from the reimbursement records of the Social Insurance Institution (SII). Information on IVF women's background characteristics came from the Central Population Register and the SII, on treatment costs from IVF clinics and the SII, and on births from the Medical Birth Register. The main outcome measures were success of IVF by number of cycles and treated women, expenditures per IVF cycles, per women, per live-birth, and per treatment sector, and private and public expenditures. Expenditures were estimated from health care visits and costs.ResultsDuring a mean period of 1.5 years, older women (women aged 40 or older) received 1.4 times more IVF treatment cycles than younger women (women aged below 30). The success rate decreased by age: from 22 live births per 100 cycles among younger women to 6 per 100 among older women. The mean cost of a live birth increased by age: compared to younger women, costs per born live birth of older women were 3-fold. Calculated by population, public expenditure was allocated most to young women and women from the highest socioeconomic position. Regional differences were not remarkable.ConclusionChildren of older infertile women involve more expense due to the lower success rates of IVF. Socioeconomic differences suggest unfair resource allocation in Finland.

Familles nombreuses et couples sans enfant

espanolIndependientemente del sexo y de la edad, la esperanza de vida no ha dejado casi de aumentar en Francia desde principios de los anos 50. Al nacer las mujeres ya han ganado 14,6 anos de esperanza de vida entre 1950 y 2005 y los hombres 13,3 anos. A lo largo de las dos ultimas decadas, la diferencia entre la esperanza de vida de los dos sexos se ha estabilizado e incluso ha empezado a reducirse y dicha reduccion se debe fundamentalmente a una aceleracion de los progresos masculinos y a una relajacion de los progresos femeninos antes de los 60 anos, faciles de percibir en ambos casos. En las edades mas avanzadas, en cambio, los progresos se han mantenido a un ritmo mas rapido para las mujeres que para los hombres. A pesar de que la mortalidad tumoral esta disminuyendo tanto para las mujeres como para los hombres, los canceres siguen siendo la principal causa de los decesos, por delante de las enfermedades cardiovasculares, para las que la mortalidad ha disminuido considerablemente. En las edades avanzadas, la sobremortalidad excepcional debido a las altas temperaturas de 2003 no hizo mas que interrumpir brevemente una evolucion muy favorable, fundamentalmente vinculada al retroceso de la mortalidad cardiovascular. Los progresos venideros dependeran de los exitos de la lucha contra el cancer y del control de las enfermedades neurodegenerativas. francaisQuels que soient le sexe et l’âge, l’esperance de vie n’a quasiment pas cesse d’augmenter en France depuis le debut des annees 1950. A la naissance, les femmes ont ainsi gagne 14,6 ans d’esperance de vie entre 1950 et 2005 et les hommes 13,3 ans. Au cours des deux dernieres decennies, l’ecart d’esperance de vie entre les sexes s’est stabilise et a meme commence a se reduire. Cette reduction tient pour l’essentiel a une acceleration des progres masculins, mais un essoufflement des progres feminins avant 60 ans est egalement perceptible. Aux âges les plus eleves, en revanche, les progres se sont poursuivis a un rythme plus rapide pour les femmes que pour les hommes. Bien que la mortalite tumorale soit en baisse aussi bien pour les femmes que pour les hommes, les cancers arrivent desormais au premier rang des causes de deces, devant les maladies cardio-vasculaires pour lesquelles la mortalite a considerablement diminue. Aux grands âges, la surmortalite exceptionnelle due a la canicule de 2003 n’a interrompu que brievement une evolution tres favorable, essentiellement liee au recul de la mortalite cardio-vasculaire. Les progres a venir dependront des succes remportes dans la lutte anti-cancereuse et dans le controle des maladies neuro-degeneratives.