Reproductive Health Survey Research Articles

Contemporary patterns of adolescent sexuality in urban Botswana.

In Botswana, as in other areas in southern Africa, there is a growing concern about the risks associated with adolescent sexuality. To facilitate the design of policies that can address these problems, it is necessary to gain a thorough understanding of contemporary patterns of adolescent sexual behaviour, and the factors that affect them. This paper examines these issues using data from the 1995 Botswana Adolescent Reproductive Health Survey in conjunction with data from focus group discussions. The results suggest that adolescents become sexually active at an early age, and that many of them, males and females alike, have multiple sex partners. This early sexual initiation implies that adolescent reproductive health programmes should target youths aged 13 or younger. For school-based programmes this implies starting no later than Grade 6 or Standard 1, and preferably earlier. Young males appear to be a particularly vulnerable group that needs further attention. Adolescents perceive that teachers, peers and parents have the largest influence on their reproductive health attitudes. Schools appear to have the most potential for providing reproductive health information, because they reach youths both directly and indirectly by educating their peers. The results also show that male and female sexual behaviour is affected by different factors. Among males, having secondary education strongly increases the odds of being sexually active, presumably because such males make attractive partners. Among females, on the other hand, being in school significantly reduces the odds of being sexually active. This finding is consistent with the policy imposing a one-year school expulsion for pregnant schoolgirls, which was implemented as a deterrent to schoolgirl pregnancy.

Indian Men with Higher Socioeconomic Status are More Likely to be Knowledgeable about Reproductive Health

This paper presents the findings of the Uttar Pradesh Male Reproductive Health Survey conducted between November 1995 and April 1996. Knowledge about fertility maternal health and sexually transmitted diseases (STDs) was investigated among 6549 husbands. Overall univariate and multivariate analysis showed that married men who believe that it is possible to prevent pregnancy are more likely than men who hold fatalistic pregnancy attitudes to be knowledgeable about STDs and a womans fertile period. However they were less likely to have information about serious complications a woman may experience during pregnancy and childbirth. Generally men throughout the state had low levels of knowledge about sexual and reproductive health though those with higher socioeconomic status those who lived in urban areas and those who were more educated were more likely than others to be well informed. The lack of reproductive health knowledge among Indian men can have dangerous implications for women who often must defer to male family members in matters of health. Ensuring that men understand the basic facts about fertility and reproductive health as well as the importance of proper care is vital to the health and well-being of women.

History and current status of reproductive health surveys at CDC

Since the development of immunization surveys in the 1950s to evaluate poliomyelitis immunization programs, the Centers for Disease Control and Prevention (CDC) has traditionally used populationbased surveys to evaluate public health programs.1 The use of population-based surveys continued overseas in the smallpox eradication program during the late 1960s and 1970s.2,3 Family planning epidemiology was begun at CDC in the late 1960s, first as an activity, then as the Family Planning Evaluation Division, and later as part of the Division of Reproductive Health (DRH). At first, service statistics systems were developed for local and state health departments.4,5 It quickly became apparent that population-based household surveys would be needed to obtain data on family planning users in the private sector and nonusers.6–9 Jack Smith, chief of the statistics activity, spearheaded the early efforts to improve service statistics systems and to develop populationbased surveys for evaluating family planning programs. In 1979, Smith was the lead researcher for a joint household survey with the Mexican Ministry of Health that was carried out along the U.S.–Mexico border to obtain family planning data on non-Hispanics and Hispanics.10–13 Since that effort, with the development of the random-digit dialing method, statewide surveys on reproductive health have been carried out by telephone in Idaho, Arizona, New York, Hawaii, and Georgia.14,15 The switch to telephone as the survey mode has been due largely to cost considerations. Parallel to the development of family planning survey methodologies in the United States, the Family Planning Evaluation Division, in collaboration with the U.S. Agency for International Development, developed the Contraceptive Prevalence Survey (CPS) for use in developing countries.16 The first of these surveys was conducted in El Salvador in 1975.17 The CPS is a regional or national probability household-based sample survey designed primarily for managing and evaluating family planning programs. This survey collects information on knowledge and use of contraception in relation to desire for more children, choice of contraceptive methods, availability of family planning services, and other program-related factors. The survey provides rapid feedback to program administrators on the use of family planning services and on program success in serving women at risk of unintended pregnancy. To ensure representativeness, the CPS (and subsequent surveys described below) uses a three-stage sampling design. The first stage is a selection of census sectors with probability proportional to size. Within the selected census sectors, a random sample of households is then chosen. In the third stage of the sample design, one woman of reproductive age is selected from each household. In a standardized interview, each woman is asked about her knowledge, use, and attitudes concerning contraceptive methods and sources of contraceptive supplies and services. Results are weighted to compensate for geographic oversampling or undersampling, the selection of one woman per household, and nonresponse differentials. Contraceptive Prevalence Surveys do more than reveal the extent of contraceptive use. They also help administrators evaluate family planning programs, check service statistics, and identify groups of women in need of family planning services. Each CPS provides the rapid feedback necessary to evaluate and improve family planning information and service delivery programs. Because questionnaires are short and usually only several thousand women are interviewed, the surveys can be repeated every few years to gauge the impact of new or reoriented programs undertaken on the basis of earlier findings. The CPS data are especially useful in determining how many women are at risk of unintended pregnancy; that is, how many do not want to become pregnant but may do so because they are fecund, sexually active, and not using contraception. Included among these are women whom family planning services have not yet reached. Identifying these women is of prime importance to program administrators. Around 1980, the CPS evolved into the Family Planning and Maternal Child Health Survey (FP-MCH), which expanded the content of the CPS to include data From the Behavioral Epidemiology and Demographic Research Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Address correspondence and reprint requests to: L. Morris, MD, CDC-MS K-35, Behavioral Epidemiology and Demographic Research Branch, 1600 Clifton Road, Atlanta, GA 30333. E-mail: lmorris@ cdc.gov.

A reproductive health survey on unintended pregnancy in Yamagata, Japan: feasibility of the survey and test-retest reliability and validity of a questionnaire.

We have designed a survey to investigate factors related to unintended pregnancy using a newly devised questionnaire. This pilot study was conducted to examine the feasibility of the study and the test-retest reliability and the validity of the questionnaire. Samples were 107 cervical and breast cancer screening participants aged 35-49 year-old in 1999 in Yamagata, Japan. The same questionnaires were mailed twice to examine the test-retest reliability. Women's medical records for cancer screening were used to examine the validity of the questionnaire. Ninety-six women agreed to participate in the study and 89.6% of them responded to the first survey. The agreements between two surveys were substantial to perfect for the nominal and ordinal data, and for the continuous data, the standard deviations (SDs) were less than 1 and the correlation coefficients were over 0.6. The comparison between medical record and questionnaire derived data showed perfect agreements for reproductive items except age at last birth (SD: 0.71, correlation coefficient: 0.97), and fair agreements for drinking and smoking habits. Obtaining information on unintended pregnancy by questionnaire is feasible, and the test-retest reliability and the validity of the questionnaire are satisfactory. Currently we are conducting a survey with a larger sample.

Among Young Jamaicans, Sex and Childbearing Often Begin During Adolescence

This article presents a report on the sexual and childbearing behaviors of Jamaican youths. Using data on 1191 women and 2279 men aged 15-24 years interviewed in the 1997 Jamaica Reproductive Health Survey the report revealed that the mean age at first intercourse was 15.9 years for women and 13.4 years for young men. A significant proportion of the respondents were sexually experienced at the time of the survey. However respondents who attended church regularly were less likely than others to be sexually experienced. About 56% of the young women and 31% of the young men practiced contraception at first intercourse. The most commonly used method was the condom. Reasons for not using contraception at first intercourse were that they did not expect to have sex (47% women and 31% men) and that they were not aware of any contraceptive methods (13% women and 31% men). In the context of childbearing overall findings revealed that 43% of the women had ever been pregnant and 39% had live births while 10% of the men reported they had ever fathered a child. Results varied with educational and socioeconomic status of respondents.

Men in Uttar Pradesh, India, Know Little About Women's Reproductive Health Needs

The article presents findings from the 1995-96 Uttar Pradesh Male Reproductive Health Survey among 6727 married men of all ages in India. Findings reveal that 81% of the married men were 20-49 years old. Mens knowledge of womens reproductive health was limited. 78% were unable to correctly identify the fertile period in the menstrual cycle. Only 33% of men who had completed high school knew the correct fertile period. Younger men were less likely than older men to know the fertile period. Knowledge of the fertile period and knowledge of symptoms of pregnancy complications were highest among men with high socioeconomic status. 47% could not correctly identify a symptom of serious pregnancy or childbirth complications. 71% did not know that symptoms were not always apparent with a sexually transmitted disease (STD). 47% were not aware that STDs could be transmitted from a pregnant woman to a fetus or a newborn. 84% did not engage in extramarital relations. 12% reported premarital sexual relations. 2% reported extramarital sex. 87% had never used a condom in extramarital sex. 9% had symptoms of an STD. 64% believed that wives must follow a husbands instructions. 68% believed that wives must follow instructions of elders and in-laws. 37% reported that a wifes use of contraception would involve a difficult negotiation with her husband.

Puerto Rico: Contraceptive Use is High, Sterilization is the Most Popular Method

The 1995-96 Survey of Reproductive Health conducted in Puerto Rico sampled 5944 women aged 15-49 years. 45% of the subjects were legally married 13% were in consensual union 27% had never married and the remainder were either widowed separated or divorced. 42% of the sample had attended college and 40% were employed. Women in union in Puerto Rico bear an average of 2.2 children. Overall 70% of women in Puerto Rico had ever been pregnant and 67% had ever given birth. 78% of women in union use contraception with female sterilization accounting for 59% of contraceptive use. The second most popular method among women in union is the pill chosen by 10% followed by the condom and rhythm (6% each) withdrawal (4%) and vasectomy (3%). The level of use of most methods increases with educational level. 49% of 15-24 year olds have ever had sex; 35% of the age group began having sex before entering a union and 14% did so after entering a union. The proportion who began having sex before marriage increases with age from 17% among 15-17 year olds to 50% among 23-24 year olds. 99% of all women in the country receive prenatal care and 82% of those who recently gave birth began such care during the first trimester. 62% of women who had given birth since January 1990 breast-fed their most recent child. All of the women were aware of HIV and 26% of those who were sexually experienced yet never married felt that they were at risk of contracting HIV infection. 9% of sexually active women have been forced to have sexual intercourse at least once.

Use of family planning at first sexual intercourse among young adults in Ecuador.

The purpose of this study was to assess factors associated with the use of family planning at first sexual intercourse among young adults aged 15 to 24 in urban Ecuador. The study population consisted of 1443 young adults (494 females and 949 males) in the cities of Quito and Guayaquil, interviewed by the 1988 Ecuador Young Adult Reproductive Health Survey, who reported having experienced consensual sexual intercourse. Approximately 11% of females and 15% of males reported using contraception at first intercourse. Binary logistic regression was performed to assess jointly the effect of multiple factors on contraceptive use at first intercourse. The regression model was first run on the entire study population and then separately for males and females. In the overall population, the following variables were significantly related to using family planning at first sex: being male; being from Guayaquil; older age; father's completion of secondary school. Having lost one's virginity to a prostitute was significantly associated with non-use of family planning. Males were 3.6 times more likely than females to use family planning during their first sexual intercourse. For each year older a young adult was at first sex, his or her odds of using family planning was multiplied by a factor of 1.3. Twenty-eight per cent of males in this study experienced their first sexual intercourse with a prostitute, and these young men were highly unlikely to use family planning. A male who experienced first intercourse with his girlfriend was more than five times as likely to use contraception than a male who lost his virginity to a prostitute.

Abortion Rate Among Young Romanians Declines; Those not in Union Report Rise in Contraceptive Use

This report presents findings from 1996 Romania Young Adult Reproductive Health Survey data among 2047 men and 2025 women aged 15-24 years. 46% of women and 66% of men were sexually experienced (SE). 20% of teenaged women and 41% of teenaged men were SE. About 66% of sexually active unmarried respondents and 52% of married women used contraception at their last sexual intercourse (SI). About 39% of SE women and 20% of SE men had their first SI (FSI) at age 18 or 19. 11% of SE women and 36% of SE men had their FSI before age 16. Early FSI was associated with womens lower levels of education rural status and low socioeconomic status. The best educated men were the most likely to be SE. Men with the least schooling were the most likely to have had their FSI under age 16. 50% of SE women had had premarital sex. Men were more than twice as likely to have had premarital intercourse. 88% of women and 65% of men had only 1 partner in the 3 months before the interview. 81% of SE women and 13% of SE men had only 1 partner in their lifetime. Contraceptive and AIDS knowledge was widespread. Levels of correct knowledge were low. 32% had ever had a pregnancy of which 52% ended in a live birth and 38% ended in induced abortion. The abortion rate declined to 124/1000 women aged 20-24 years and 28/1000 women aged 15-19 years. The fertility rate also declined. 43% of pregnancies were unintended. Unintended pregnancies were 23% of current pregnancies 28% of miscarriages 96% of induced abortions and 11% of births.

Machismo/Marianismo Attitudes, Employment, Education, and Sexual Behavior Among Women in Ecuador and the Dominican Republic

This research presents an examination of determinants of gender role attitudes and behavior that promote inequalities underlying fertility behavior. Using data from Young Adult Reproductive Health Surveys of women aged 15–24 in Ecuador and the Dominican Republic, this work tests theories of Chafetz (1984, 1990) and Blumberg (1978, 1984), who state this access to employment is among the most important determinants of gender role attitudes (labeled here as machismo/marianismo attitudes). Analyses included examination of bivariate and multivariate associations using path analyses between structural variables including education, employment, religiosity, age, and place of residence; access variables including knowledge of STD, HIV, and contraception; and machismo/marianismo attitudes and sexual behavior. Results indicate that residence and formal education are stronger and more consistent determinants of the rejection of machismo/marianismo attitudes compared to access to employment. Determinants of sexual behavior are not possible to generalize given inadequate measurement of these variables. These findings are consistent across samples and show residence and formal education are determinants that supersede nation specific determinants of machismo/marianismo attitudes. Implications from these findings are that approaches including increasing access to formal education for women may be implemented to encourage changes in machismo/marianismo attitudes related to fertility behavior.

CONTRACEPTION AND CULTURE: THE USE OF YUYOS IN PARAGUAY

The use of herbs (yuyos) as contraception is common practice in Paraguay. This report analyzes data from the 1995-1996 Paraguayan Reproductive Health Survey. The analysis reveals that women are more familiar with yuyos (88%) than any other method of family planning. Modeling the determinants of ever having relied on yuyos as contraception demonstrates that older women (OR = 1.043) and women with more children (OR = 2.283) are significantly more likely to have used yuyos, but an interaction between older women with more children shows they are less likely to have used this method (OR = .982). Women living in rural areas (OR = .664) and those with more education (OR = .883) are less likely to have used the method. These findings show widespread acceptance and use of yuyos for contraception in Paraguay. More research into the chemical properties of yuyos is needed to determine their contraceptive efficacy and to prevent harmful effects from their misuse.

An alternative sampling strategy for obtaining child health data in a reproductive health survey

Retrospective demographic surveys typically collect substantial information about child health. This information is often collected for all children born during a specified period. For women with several young children, the interview can become quite long. To shorten the interview, some surveys have asked child health questions only for the last child born. However, data on the last birth may be biased because last children have a younger age distribution and have longer subsequent birth intervals than does the average child. In this paper, we propose an alternative approach to collecting child health data - that child health questions be asked only for a child chosen randomly from among the respondent's children younger than age five. This alternative has the advantage of keeping the interview shorter but does not lead to biased information.

Reproductive health survey, Romania 1993 Institute for Mother and Child Care (Romania) and Centers for Disease Control and Prevention (USA), 1995

Reproductive health survey, Romania 1993 Institute for Mother and Child Care (Romania) and Centers for Disease Control and Prevention (USA), 1995

1993 Czech Republic reproductive health survey: Final report Czech Statistical Office, WHO Collaborating Center for Perinatal Medicine/Institute for the Care of Mother and Child (Prague) and Centers for Disease Control and Prevention (USA), 1995

1993 Czech Republic reproductive health survey: Final report Czech Statistical Office, WHO Collaborating Center for Perinatal Medicine/Institute for the Care of Mother and Child (Prague) and Centers for Disease Control and Prevention (USA), 1995

Romanian Maternal Death Rate Fell by Two-Thirds After the 1989 Revolution

This article summarizes findings from the 1993 Romanian Reproductive Health Survey among 4861 women aged 15-44 years. Restrictive and pronatalist policies were repealed in December 1989. By 1993 fertility declined to 1.6 children per woman. Contraceptive prevalence increased by 20% from 1987-90 to 1990-93. Induced abortion rates doubled. Maternal mortality declined by almost 66%. About 75% of contraceptive use was based on traditional methods and about 70% of the increase in use was due to increases in traditional method use. 57% of women in a union were currently using a method. 66% of traditional method use was withdrawal. About 63% of traditional method users viewed their protection the same as use of the pill or IUD regardless of educational level. 80% of traditional method users did not want to switch methods. The failure rate from withdrawal or the calendar method was 30% within one year of initiating use. About 20% were uninformed about the pill or the IUD. 35% were not familiar with female sterilization. 88% did not know about vasectomy. Condom IUD pill and sterilization use was respectively 4% 4% 3% and 1%. Modern method use was highest among educated women and women living in Bucharest. 71% reported that nonuse of modern methods was due to potential side effects. Nonuse was also due to partners preference for a traditional method (67%) limited knowledge of other methods (61%) and difficulty in obtaining (38%) or paying for (34%) a modern method. The ideal number of children was 2.1. 96% of women about AIDS; 32-36% knew about transmission from sharing objects sharing public toilets and kissing. 27% thought AIDS could be transmitted by a mosquito. Perception of risk was unrelated to use of protected behavior such as condom use. Fertility declined the most among women aged 35-39 years. Fertility was lowest among the most educated women and urban women. Abortion increases were highest among teenagers aged 15-19 years. Abortion rates were also high among women aged 25-34 years women with only a primary education women of low socioeconomic status and women living in Bucharest. Abortion complications declined from 21% to 9% after legalization. 61% of women reported the most recent pregnancy as unintended.

Survey of Reproductive Health Among Female MR Workers

Epidemiologic data were obtained to evaluate potential risks from exposure to the static and time-varying magnetic fields used in magnetic resonance (MR) imaging. A questionnaire sent to women workers in more than 90% of clinical MR facilities in the United States addressed menstrual-reproductive experiences, work activities, and potential confounders (eg, age, smoking, alcohol use). In 1,915 completed questionnaires, 1,421 pregnancies were reported: 280 occurred in an MR worker (technologist or nurse), 894 in an employee in another job, 54 in a student, and 193 in homemakers. Comparing MR-worker pregnancies with those occurring in employees at other jobs, a relative risk ratio of 1.27 (95% confidence interval [CI], 0.92-1.77) was found for spontaneous abortions; for conception taking more than 12 months, 0.90 (CI, 0.54-1.51); for delivery before 39 weeks, 1.19 (CI, 0.76-1.88); for birth weight below 5.5 lb (2.5 kg), 1.01 (CI, 0.50-2.04); and for male gender of the offspring, 0.99 (CI, 0.80-1.22). Adjustment for maternal age, smoking, and alcohol use also failed to markedly change any of the associations. These results suggest that there is not a substantial increase in these common adverse reproductive outcomes.

Unprotected First Coitus Is Common Among Urban Youths in The Gambia

This paper presents findings of the 1986-87 Gambia Reproductive Health Survey of Young Adults (aged 14-24) about their reproductive and family planning knowledge attitudes and practice. A total of 834 unmarried young men and 1687 married and unmarried young women in Greater Banjul Gambia were surveyed. Overall results indicated that premarital sexual activity begins at an early age among urban young adults (24% of the ever-married women in the survey). Relatively few practiced contraception at first intercourse and fewer than half of the sexually active young adults ever used a modern contraceptive method. Leading reasons for never having used a contraceptive method included lack of knowledge and inaccessibility of supplies. However women who had their first intercourse after marriage cited the desire for pregnancy as the reason for not having practiced contraception. It is concluded that the survey results offer encouraging evidence that acceptance of modern contraceptive use may be beginning to take hold among Gambian young adults. Hence initiatives should focus on increasing contraceptive knowledge and use in this group. Several approaches are recommended.

Survey of reproductive health among female MR workers.

Epidemiologic data were obtained to evaluate potential risks from exposure to the static and time-varying magnetic fields used in magnetic resonance (MR) imaging. A questionnaire sent to women workers in more than 90% of clinical MR facilities in the United States addressed menstrual-reproductive experiences, work activities, and potential confounders (eg, age, smoking, alcohol use). In 1,915 completed questionnaires, 1,421 pregnancies were reported: 280 occurred in an MR worker (technologist or nurse), 894 in an employee in another job, 54 in a student, and 193 in homemakers. Comparing MR-worker pregnancies with those occurring in employees at other jobs, a relative risk ratio of 1.27 (95% confidence interval [CI], 0.92-1.77) was found for spontaneous abortions; for conception taking more than 12 months, 0.90 (CI, 0.54-1.51); for delivery before 39 weeks, 1.19 (CI, 0.76-1.88); for birth weight below 5.5 lb (2.5 kg), 1.01 (CI, 0.50-2.04); and for male gender of the offspring, 0.99 (CI, 0.80-1.22). Adjustment for maternal age, smoking, and alcohol use also failed to markedly change any of the associations. These results suggest that there is not a substantial increase in these common adverse reproductive outcomes.

High Levels of Premarital Sex and Low Method Use Increase Unintended Pregnancy Among Chile's Young

According to a study of young adults in Santiago Chile there are high rates of premaritally conceived first births and unintended pregnancies in the country. Such levels were noted to be the result of a high incidence of premarital sexual activity and inadequate contraceptive use among unmarried men and women aged 15-24. This paper reports the findings of a study which determined the levels of premarital sexual activity and contraceptive use and the social and demographic characteristics associated with these levels. Data were obtained from the Santiago Young Adult Reproductive Health Survey. Overall analysis showed that 35% of the women (n = 865) and 65% of the men (n = 800) had had premarital intercourse. The factors associated with premarital sexual activity included marital status religious values and age at first intercourse. In terms of contraceptive use method use at first premarital intercourse was predominantly related to age. It is noted that among those who were younger than 18 at first intercourse only 14% of women and 15% of men said they had used a method while among those aged 18-24 at first intercourse 26% of women and 30% of men had done so.

Premarital Sexual Activity and Contraceptive Use in Santiago, Chile

The Santiago Young Adult Reproductive Health Survey was conducted in 1988 to examine the sexual behavior of and contraceptive use among young adults in Chile. The survey was based on multistage household probability samples of 865 women and 800 men aged 15-24 who were living in Santiago in 1988. Findings show that 35 percent of females and 65 percent of males had had premarital intercourse. Among those who had done so, the median age at first experience was 18.4 years for women and 16.4 years for men. Only 20 percent of females and 19 percent of males used contraceptives at first premarital intercourse. Use of contraceptives increased with age at the time of that event. Fertility data reveal that 70 percent of first births were premaritally conceived, and more than one-third of these were born prior to union. The high rates of premarital and unintended pregnancy among young women and the low prevalence of effective contraceptive use indicate a need for greater emphasis on sex education and family planning services directed at adolescents and unmarried young adults in Santiago.