Reproductive Health Survey Research Articles

Factors associated with local herb use during pregnancy and labor among women in Kigoma region, Tanzania, 2014\u20132016

BackgroundDespite research suggesting an association between certain herb use during pregnancy and delivery and postnatal complications, herbs are still commonly used among pregnant women in sub-Sahara Africa (SSA). This study examines the factors and characteristics of women using local herbs during pregnancy and/or labor, and the associations between local herb use and postnatal complications in Kigoma, Tanzania.MethodsWe analyzed data from the 2016 Kigoma Tanzania Reproductive Health Survey (RHS), a regionally representative, population-based survey of reproductive age women (15–49 years). We included information on each woman’s most recent pregnancy resulting in a live birth during January 2014–September 2016. We calculated weighted prevalence estimates and used multivariable logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for factors associated with use of local herbs during pregnancy and/or labor, as well as factors associated with postnatal complications.ResultsOf 3530 women, 10.9% (CI: 9.0–13.1) used local herbs during their last pregnancy and/or labor resulting in live birth. The most common reasons for taking local herbs included stomach pain (42.9%) and for the health of the child (25.5%). Adjusted odds of local herb use was higher for women reporting a home versus facility-based delivery (aOR: 1.6, CI: 1.1–2.2), having one versus three or more prior live births (aOR: 1.8, CI: 1.4–2.4), and having a household income in the lowest versus the highest wealth tercile (aOR: 1.4, CI: 1.1–1.9). Adjusted odds of postnatal complications were higher among women who used local herbs versus those who did not (aOR: 1.5, CI: 1.2–1.9), had four or more antenatal care visits versus fewer (aOR: 1.4, CI: 1.2–1.2), and were aged 25–34 (aOR: 1.1, CI: 1.0–1.3) and 35–49 (aOR: 1.3, CI: 1.0–1.6) versus < 25 years.ConclusionsAbout one in ten women in Kigoma used local herbs during their most recent pregnancy and/or labor and had a high risk of postnatal complications. Health providers may consider screening pregnant women for herb use during antenatal and delivery care as well as provide information about any known risks of complications from herb use.

O caminho da saúde sexual e reprodutiva na América Latina: uma análise temporal de indicadores para cinco países da Região

Apresenta-se a evolução do padrão reprodutivo de diferentes países da América Latina com níveis de fecundidade distintos, procurando entender se a Região está tornando-se mais homogênea em termos de comportamento reprodutivo. Utilizam-se como indicadores desse padrão: proporção de mulheres sem filhos, idade mediana à primeira união e ao ter o primeiro filho e presença de filho ao usar contracepção pela primeira vez. Os dados provêm de pesquisas sobre saúde reprodutiva de Brasil, Colômbia, El Salvador, Peru, e República Dominicana em três pontos no tempo: décadas de 80 e 90 e início dos anos 2000 segundo idade e escolaridade. Os resultados mostram que as diferenças estão diminuindo entre os países com a proximidade dos níveis de fecundidade, mas ainda permanecem brechas por escolaridade que sugerem ampliar-se dentro dos países. Os resultados oferecem importantes insumos para entender os trajetos delineados por diferentes gerações nos países da Região no que se refere ao padrão reprodutivo.

Association between Knowledge of Sexually Transmitted Infections and Sources of the Previous Point of Care among Nigerians: Findings from Three National HIV and AIDS Reproductive Health Surveys.

Background. Adequate knowledge of sexually transmitted infections (STIs) is critical for effective control of disease. Health education/counselling at the point of care provides ample opportunities to improve knowledge of patient seeking treatment. There is no study from Nigeria that investigates association between sources of previous point of care of STI and quality of knowledge of people on STI. We hypothesised that previous treatment of STI will be associated with better knowledge of STI and HIV infection. Methods. Three consecutives nationally representative cross-sectional surveys on HIV and AIDS Reproductive Health in Nigeria, conducted in 2005, 2007, and 2012 were analysed. Outcome measures were knowledge of STI only, and a combined knowledge of STI and HIV transmission and prevention. We designed a knowledge scale of 14-item questions for STI and 41-item questions for STI and HIV. Logistic regression was used to identify risk factors at 5% significance level. Results. Knowledge of STI increased from 13.4% in 2005 to 15.0% in 2007 to 26.5% in 2012. Respondents that received treatment from pharmacy and patient medicine vendors had higher odds of good knowledge of STI than those who did not receive any treatment (aOR = 2.55) in 2005. In 2012, respondents treated at health facilities were over two times likely to have good knowledge of STI and HIV transmission and prevention (aOR = 2.35). STI positive individuals in the highest economic class were two times likely to have good knowledge of STI and HIV transmission and prevention than those in the lowest class. Conclusion. Participants that previously sought care from health facilities, pharmacy, and patient medicine vendors had better knowledge of STIs and HIV infection prevention and transmission than those who sought care from unorthodox sources. We recommend a national awareness creation on STI prevention including provision of information on safe point of care for STIs in Nigeria.

Resilience and Reproductive Health Diagnosis in Mexican Indigenous Women

Mental Health is a determinant of reproductive mortality and morbidity especially in the developing regions of the world with reproductive health problems. The right to sexual and reproductive health has been enunciated by the United Nations as a goal to be achieved by 2030. However, indigenous women are the most vulnerable population because of the conditions that surround them. A cross-sectional quantitative study was done in the indigenous communities of Mexico to know the resilience and reproductive health diagnosis. A Mexican Resilience Scale, gynaeco-obstetrical clinical history and a reproductive health survey were applied. A total of 180 women participated from which 34.6% and 61.4% of the women used a form of birth control method in their first and last sexual intercourse, respectively. There were statistically significant differences between the three attitudes among reproductive health and the highest levels of resilience (p&lt;0.05). Resilience was seen to have a positive influence on the attitude of indigenous women, reducing the vulnerability among reproductive health.

Young people's willingness to go for HIV/acquired immunodeficiency syndrome counseling and testing in oluku community in South Nigeria

Background: Young people are vulnerable to HIV/acquired immunodeficiency syndrome (AIDS) as they significantly contribute to new HIV infections in Nigeria and sub-Saharan Africa. HIV counseling and testing (HCT) provides an opportunity for increased awareness, prevention, treatment, care, and support for HIV/AIDS and contributes to the prevention and control of HIV/AIDS. Objective: This study aims to determine the HIV/AIDS awareness, knowledge of methods of prevention and transmission of HIV/AIDS, HIV status of sexual partner, and willingness to go for HIV/AIDS counseling and testing (HCT) among young people in Oluku Community, Ovia North East, local government, Edo State, South South, Nigeria. Materials and Methods: This was a descriptive cross-sectional study conducted between January and June, 2013, using multistage sampling method. Data were collected using interviewer-administered questionnaire adapted from the 2007 National HIV/AIDS and Reproductive Health Survey (NARHS) plus. Results: A total of 400 young people participated in this study; their mean age was 17.8 years (3.9 years). There were more females (211 [52.8%]) than males (189 [47.3%]). Majority (92.3%) of the young people were aware of HIV/AIDS; most heard of it via electronic media (81%), peers (63.5%), and parents (55.5%). Majority knew the methods of transmission of HIV/AIDS as having multiple sexual partners (80.0%), sharing sharps (78.3%), blood transmission (71.5%), and having unprotected sex (69.8%). Abstinence (50.1%) and condom use (37.8%) and faithfulness to partner (5.3%) were the methods practiced by most young people to prevent disease transmission and pregnancy. Most (61.9%) of the young people did not know the HIV/AIDS status of their partners before sexual intercourse. More than two-thirds (68.0%) had never gone for HCT, however majority (73.0%) of them were willing to go for HCT. Conclusion and Recommendations: Most young people were aware of HIV/AIDS and the methods of transmission, whereas more than two-thirds had never gone for HCT. However, majority of them were willing to go for HCT. Efforts should be geared toward improving access to HCT services by using stand-alone, mobile/outreach, and health facility-based HCT centers and community enlightenment on the importance of avoiding premarital sex and their roles in reducing HIV/AIDS and other sexually transmitted infection transmission.

HUBUNGAN PENGETAHUAN REMAJA TENTANG HIV/AIDS DENGAN PERILAKU SEKSUAL REMAJA DI SMK MUTIARA KOTA BANDUNG

Indonesian Youth Reproductive Health Survey (SKRRI) in 2002-2003, adolescents said they hadfriends who had had sexual relations at the age of 14-19 years, women 34.7%, men 30.9%.Whereas at the age of 20-24 years women are 48.6% and men are 46.5%. Adolescent knowledgeabout HIV / AIDS is one important component of predisposing factors although increasingknowledge will not always lead to behavior change but has a positive relationship. Thepopulation in this study were all students aged 15-16 years at SMK Mutiara Bandung in 2014,amounting to 142 people. The sample in this study were students of class X-XI aged 15-16 yearsat SMK Mutiara Bandung in 2014. The sampling technique that will be used in this study is thesample random sampling method. Based on the results of the study it can be seen that of the 39respondents, who lack knowledge with bad sexual behavior as many as 27 respondents (69.2%).Sexual behavior of respondents who are less influenced by factors influencing peers, and theirenvironment. Whereas respondents who lack knowledge with good behavior are 12 respondents(30.8%).Keywords: Knowledge, HIV / AIDS, Sexual Behavior

Fertility, Migration and Acculturation (FEMINA): a research protocol for studying intersectional sexual and reproductive health inequalities

BackgroundThe existing knowledge on the interplay between reproductive and sexual health, migration and acculturation is recent and inconsistent, particularly on the sociocultural motives and constraints regarding fertility. Therefore, sexual and reproductive health (SRH) surveys are needed to provide accurate and comparable indicators to identify and address SRH inequalities, with specific focus on under researched aspects, such as the interrelation between migration and gender. FEMINA (FErtility, MIgratioN and Acculturation) aims to investigate intersectional SRH inequalities among Cape Verdean immigrant and Portuguese native families and how they impact on fertility in Portugal. This study will use a comprehensive approach exploring simultaneously the components of SRH, namely regarding identities, perceptions and practices of both women and men among lay people and relevant experts and stakeholders. The project has three main goals: 1) to identify social determinants of SRH among Cape Verdean immigrant and Portuguese native men and women of reproductive age; 2) to gain understanding of the diversity of the sexual and reproductive experiences and expectations of Cape Verdean immigrant and Portuguese native men and women of reproductive age, considering the singularities of their migratory, social and family dynamics; and 3) to produce recommendations for policy makers, employers and service providers on how to better address the SRH needs of Portuguese-born and immigrant populations.MethodsThe study will address these goals using a mixed methods approach, including: a cross-sectional telephone survey with a probabilistic sample of 600 Cape Verdean immigrant and 600 Portuguese native women and men (women aged 18 to 49 and men aged 18 to 54), residents of the Greater Lisbon Area; a qualitative research through in-depth interviews with a subsample of 30 Cape Verdean immigrants and 30 Portuguese native men and women; and a Delphi technique for finding consensus on good practices in SRH for the entire population with a special emphasis on immigrants, namely extra-EU migrants.DiscussionData will be used to produce a comprehensive set of indicators to monitor SRH in Portugal, to foster a greater understanding of its specificities and challenges to policy and decision makers, and to provide targeted recommendations to promote inclusive and migrant sensitive SRH services.

Changes in Maternal Care During the Healthcare Reforms in the Republic of Georgia

Since 1991, the health system of the Republic of Georgia has passed through several phases of reform. Privatization and marketization of the healthcare system are among the major reforms. The aim of this study was to analyze the changes in the utilization of, and access to maternal care services during the period 1999–2010. Secondary analysis was done using data from three national reproductive health surveys (RHS). From three RHSs we selected 7,684 women who experienced childbirth/s during 5-years prior to each survey. We analyzed data on pregnancy outcome, type of childbirth, access and utilization of prenatal, natal and immediate postnatal care, and looked at associations with maternal age, ethnicity, educational level, employment status, residence, religion, and economic status. Binary and multinomial regressions were the main statistical models used along with descriptive statistics. We found that the overall utilization of prenatal care services was quite high; in the first wave, it was 92.1% then increased to 95.1% and 98.1% in the second wave and in the third wave respectively. However, utilization of postnatal services was quite low. According to RHS 1999–2000 only 10.7% of mothers utilized postnatal services, which increased to 23.3% in 2010. Women of age group 30–34 were more likely not to use prenatal care services than the other age groups. Rural dwellers, women with lower education level, and women with lower income were less likely to utilize prenatal check-ups. According to the findings from the survey, there were improvements in access to prenatal and natal care as well as utilization of maternal care services over the years. Overall, the use of maternal care has improved during the reforms.

Understanding IPV Perpetration Among Young Jamaican Men: The Role of Socialization and Attitudinal Factors.

This study examined the association among a number of demographic, socialization, and attitudinal factors, and intimate partner violence (IPV) perpetration in a sample of young Jamaican men. We conducted bivariate and logistic regression analyses using data from the 2008 Reproductive Health Survey (RHS) administered by the Statistical Institute of Jamaica (STATIN) for the National Family Planning Board. The RHS is a nationally representative sample of Jamaican women of childbearing age and men aged 15-24 years. Findings indicated that being in a co-residential union, residing in an urban area, and having fair or poor health were significant demographic characteristics associated with IPV perpetration. Similarly, witnessing violence between parents in childhood, being physically hit after age 15 years, and having a controlling nature were significant socialization and attitudinal predictors of perpetrating recent IPV. Implications for practice, policy, and areas for further research are discussed.

Description of Sexual Behavior Risk on Early Adolescent in Hope Island Villages of Thousand Island

Adolescent is a period of psychosexual development which at this stage are very prominent change is when the sexual function of maturity shown through behavior change. Indonesia Adolescent Reproductive Health Survey proves that nationally there is an increasing incidence of sexual intercourse than 3 million teens who claimed ever done premarital sexual behavior in 2007 to 3.7 milliion youth in 2012. This study is adescriptif study with 135 respondents as study sample are early adolescent in the Hope Island Villages 0f Thosand Island. The result of this study showed that most respondents are adolescent aged 11 years (40%), 52,6% were male and 47.4% female, 54.8% had sexual behavior risk and 21.5% of respondents ever do sexual intercourse. Advice to government, social agencies, and research institutions and community servicein college in order to perform adolescent reproductive health education to adolescent in Hope Island Villages of Thousand Island.

Factores de riesgo asociados con embarazos no deseados en mujeres estudiantes de medicina.

Most pregnancies in adolescents and young adults are unwanted and many are the consequence of inconsistent contraception use. To analyze the risk factors that may influence on female adolescents with unwanted pregnancies. Cross-sectional, descriptive study in Ecuadorian female medical students, where the 2013 National Sexual and Reproductive Health Survey, the family APGAR scale, and the Graffar-Méndez Castellanos socio-economic scale were used. There was statistically significant difference in the age of active sexual life initiation between those who became pregnant (18.11 ± 1.45) and those who did not (19.22 ± 2.28). Average age at pregnancy was 20.41 ± 2.18; 59.3 % of those who had a pregnancy and 32% of those without pregnancy did not use protection in their first intercourse. Pregnancy was more common in city residents (100%), Catholic females (85.2%), who belonged to middle-high (55.6%) and middle-high socioeconomic strata (29.6%) and to families with moderate dysfunction (40.7%). A significant percentage of adolescents in our study had an unwanted pregnancy at an early age despite being young undergraduate medical students, coming from moderately dysfunctional families and belonging to a middle-high socioeconomic status.

Inequalities in contraceptive use in Latin America and the Caribbean.

Inequalities in contraceptive use in Latin America and the Caribbean.

Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries.

SummaryBackgroundThe rise in contraceptive use has largely been driven by short-acting methods of contraception, despite the high effectiveness of long-acting reversible contraceptives. Several countries in Latin America and the Caribbean have made important progress increasing the use of modern contraceptives, but important inequalities remain. We assessed the prevalence and demand for modern contraceptive use in Latin America and the Caribbean with data from national health surveys.MethodsOur data sources included demographic and health surveys, multiple indicator cluster surveys, and reproductive health surveys carried out since 2004 in 23 countries of Latin America and the Caribbean. Analyses were based on sexually active women aged 15–49 years irrespective of marital status, except in Argentina and Brazil, where analyses were restricted to women who were married or in a union. We calculated contraceptive prevalence and demand for family planning satisfied. Contraceptive prevalence was defined as the percentage of sexually active women aged 15–49 years who (or whose partners) were using a contraceptive method at the time of the survey. Demand for family planning satisfied was defined as the proportion of women in need of contraception who were using a contraceptive method at the time of the survey. We separated survey data for modern contraceptive use by type of contraception used (long-acting, short-acting, or permanent). We also stratified survey data by wealth, area of residence, education, ethnicity, age, and a combination of wealth and area of residence. Wealth-related absolute and relative inequalities were estimated both for contraceptive prevalence and demand for family planning satisfied.FindingsWe report on surveys from 23 countries in Latin America and the Caribbean, analysing a sample of 212 573 women. The lowest modern contraceptive prevalence was observed in Haiti (31·3%) and Bolivia (34·6%); inequalities were wide in Bolivia, but almost non-existent in Haiti. Brazil, Colombia, Costa Rica, Cuba, and Paraguay had over 70% of modern contraceptive prevalence with low absolute inequalities. Use of long-acting reversible contraceptives was below 10% in 17 of the 23 countries. Only Cuba, Colombia, Mexico, Ecuador, Paraguay, and Trinidad and Tobago had more than 10% of women adopting long-acting contraceptive methods. Mexico was the only country in which long-acting contraceptive methods were more frequently used than short-acting methods. Young women aged 15–17 years, indigenous women, those in lower wealth quintiles, those living in rural areas, and those without education showed particularly low use of long-acting reversible contraceptives.InterpretationLong-acting reversible contraceptives are seldom used in Latin America and the Caribbean. Because of their high effectiveness, convenience, and ease of continuation, availability of long-acting reversible contraceptives should be expanded and their use promoted, including among young and nulliparous women. In addition to suitable family planning services, information and counselling should be provided to women on a personal basis.FundingWellcome Trust, Pan American Health Organization.

Kisspeptin Protein in Seminal Plasma Is Positively Associated with Semen Quality: Results from the MARHCS Study in Chongqing, China.

Objectives To study the associations between kisspeptin levels in seminal plasma and blood plasma and semen quality. Materials and Methods We conducted a male reproductive health survey in June 2014. A total of 666 volunteers were recruited from colleges in Chongqing, China. All volunteers completed a questionnaire including information on domestic characteristics and some potential confounders. We tested the kisspeptin levels in both blood and seminal plasma. Total seminal kisspeptin was calculated as the concentration of kisspeptin in seminal plasma multiplied by semen volume. Semen samples were tested according to the 2010 World Health Organization's (WHO) guidelines. Spearman correlation and multivariate linear regression were used to explore the association between kisspeptin concentrations in seminal plasma and blood plasma and semen quality. Potential confounders that were adjusted for included age, abstinence time, body mass index (BMI), grade, and smoking. Results The median of kisspeptin levels in seminal plasma was 60,000 times higher than kisspeptin in blood plasma (28.0 × 106 pg/ml versus 448.9 pg/ml). Each interquartile range (IQR) of kisspeptin in seminal plasma was associated with a 4.6% (95% confidence interval [CI]: 1.6%–7.6%) increase in sperm concentration. Each IQR of total kisspeptin was associated with a 7.7% (95% CI: 4.4%–11.0%) increase in total sperm number and a 7.8% (95% CI: 4.0%–11.7%) increase in total motile sperm count. Kisspeptin levels were further classified into quartiles and Q1 was set as the reference level. Subjects in the high total kisspeptin group had 57.5% (95% CI: 33.2%–86.2%) higher total sperm number than the reference group. Conclusion The positive association between kisspeptin levels in seminal plasma and semen quality supported an important role for the KISS1/GPR54 system in male reproductive health. Kisspeptin may be a potential marker of male reproductive health and an alternative strategy for treating infertility.

State policy and contraceptive choices: evidence from China 1979–2012

ABSTRACTThis study examines the relationship between China’s contraception policy and married women’s (20–49 years) choice between long-acting and short-acting contraceptive methods during two periods–1980–1994 and 1995–2012. The aim is to examine the link between strictness of the contraception policy and married women’s contraceptive choice. Using data from the 1988 and the 2006 National Family Planning and Reproductive Health Surveys, we estimated the effect of contraception policy in the tightened and the loosened policy periods using a permutation test. The results show that while contraception policy promoted long-acting contraceptive methods, many married women themselves preferred short-acting contraceptive methods. During the tightened policy period, we found married women on average were 2.7 times more likely to use long-acting methods. The effect was only 1.7 times during the loosened policy period. The effect was also parity dependent. The more stringent the contraception policy was, the more likely married women used a long-acting contraceptive method. This study provides the first ever proper estimation of China’s contraception policy effects during the two periods.

Prevalence of and Factors Influencing Parent–Child Communication About HIV/AIDS, and Sexual and Reproductive Health Issues in Nigeria

This study investigated the prevalence of and factors that determine parent–child communication about HIV/AIDS and sexual and reproductive health (SRH) issues in Nigeria. The study used data from the National HIV/AIDS and Reproductive Health Survey (NARHS). The data are nationally representative and offers sociodemographic information on women aged 15 to 49 years and men aged 15 to 64 years. Prevalence of parent–child communication about HIV/AIDS, family planning, and contraception was generally low at 37.4%, 32.5%, and 9.5%, respectively. Determinants of discussions with children on HIV/AIDS, family planning, and contraception were respondents’ zone, economic status, and educational attainment. Parents held more discussions with female children than with the males. Parents aged 50 to 64 years, compared with the younger parents, were double likely (odds ratio [OR] = 2.04; 1.52-2.73) to discuss HIV/AIDS with their wards older than 13 years. Male parents, parents living in urban areas, and parents with richer economic status had higher odds of discussing HIV/AIDS and SRH issues with their wards.

Who obtains abortion in Georgia and why?

PurposeWhile induced abortion practices are common in Georgia, the sociodemographic subgroups of women predominantly affected by abortion and their leading motives have not yet been explored. The study aims to understand differentials in women undergoing abortion according to background characteristics and get insight into their reasons for availing of abortion services.Materials and methodsWe analyzed the data on 2,054 abortions from the Georgian Reproductive Health Survey 2010. We computed an abortion index (AI) to identify the subgroups of women with the highest relative abortion rates. We performed descriptive analysis of the reasons for pregnancy termination and assessed the statistical significance of differences in proportions using the chi-squared test. We applied multivariate binary logistic regression analyses to study the sociodemographic predictors of the four leading reasons for abortion.ResultsIn Georgia, women seeking abortion were predominantly those with two or more children (AI 1.9–2.2), from an Azeri ethnic group (AI 2.0), in the age category 25–34 years (AI 1.5), married (AI 1.5), or practicing Islam (AI 1.5). Unwillingness to have more children was the most commonly cited reason for the abortion decision (49.4%), followed by socioeconomic concerns (22.0%) and desire to space out pregnancies (18.1%). Health-related reasons were cited by only 7.5% as a leading motive for abortion.ConclusionWomen with specific background characteristics are disproportionally affected by abortion and, thus, are in utmost need of support in successful birth planning. Desire to stop or space childbearing and socioeconomic challenges are the overriding motives for terminating unintended pregnancies. Planning and execution of effective family planning programs targeting those at greatest risk for abortion have the potential to reduce the burden of induced abortion in Georgia.

HIV treatment scale-up: a critical step to controlling HIV epidemic in a resource-limited country.

The study was conducted to determine the trend in HIV treatment coverage among people living with HIV and to evaluate effectiveness of the national antiretroviral treatment (ART) programme in reducing new infections in a mixed HIV epidemic nation, Nigeria. Ecological cross-sectional study. The study utilized national HIV programme service data and National HIV/AIDS and Reproductive Health Survey (NARHS) data for 36 states and Federal Capital Territory from 2012 to 2015 in Nigeria. Chi-squared test for trend was conducted to determine differences in ART coverage across the years. We correlated 2015 ART coverage with HIV prevalence Annual Rate of Reduction (ARR) between 2012 and 2015. A linear regression model was fitted to predict the HIV prevalence ARR in relation to ART coverage and adjusted for the effect of socio-behavioral interventions (coverage of condom-use among male). Nigeria has recorded steady progress with HIV treatment coverage with an annual rate of progress of 18.25%, P<0.001; however, huge gaps still exist. Females and adults had higher odds of receiving ART. HIV prevalence annual reduction rate was higher for states that had higher ART coverage (r=0.4; P=0.02). Our analysis indicated that a 10% increase in ART coverage was associated with a 4% increase in the annual rate of reduction for HIV prevalence (adjusted β=0.4; 95% confidence interval: 0.1-0.8; P=0.01). Regardless of the low ART coverage, our analysis supports the evidence base to inform accelerated access to HIV treatment for population Nigeria and other similar resource-limited settings to make ending HIV by 2030 a reality.

An empirical exploration of female child marriage determinants in Indonesia

BackgroundChild marriage, defined as marriage before age 18, is associated with adverse human capital outcomes. The child marriage burden remains high among female adolescents in Indonesia, despite increasing socioeconomic development. Research on child marriage in Southeast Asia is scarce. No nationally representative studies thus far have examined determinants of child marriage in Indonesia through multivariate regression modeling.MethodsWe used data from the nationally representative 2012 Indonesian Demographic and Health Survey and the Adolescent Reproductive Health Survey to estimate determinants of child marriage and marital preferences. We ran multivariate models to estimate the association between demographic and socioeconomic characteristics and the following early marriage outcomes: 1) ever been married or cohabited, 2) married or cohabited before 18 years, 3) married or cohabited before 16 years, 4) self-reported marital-age preferences and 5) attitudes approving female child marriage.ResultsAmong the child marriage research sample (n = 6578, females aged 20–24 at time of survey), approximately 17% and 6% report being married before 18 and 16 years old respectively. Among the marital preferences research sample (n = 8779, unmarried females 15–24), the average respondent preferred marriage at approximately 26 years and 5% had attitudes approving child marriage. Education, wealth and media exposure have protective effects across marriage outcomes, while rural residence is a risk factor for the same. There are significant variations by region, indicating roles of religious, ethnic and other geographically diverse factors.ConclusionThis research fills a gap in understanding of child marriage determinants in Indonesia. There appears to be little support for child marriage among girls and young women, indicating an entry point for structural interventions that would lead to lasting change. Future research efforts should prioritize rigorous testing of gender-transformative education and economic strengthening interventions, including cost-effectiveness considerations to better understand how interventions and policies can be leveraged to deliver on ending child marriage in Indonesia and globally.

Effects of gestational age and the mode of surgical abortion on postabortion hemorrhage and fever: evidence from population-based reproductive health survey in Georgia

BackgroundEvery year around 50 million unintended pregnancies worldwide are terminated by induced abortion. Even in countries, where it is legalized and performed in a safe environment, abortion carries some risk of complications for women. Findings of researchers on the factors that influence the sequelae of abortion are controversial and inconsistent. This study evaluates the effects of gestational age and the method of surgical abortion (i.e., dilatation and curettage and vacuum aspiration) on the most common abortion complications: postabortion hemorrhage and fever.MethodsWe performed a secondary analysis of the data from the population-based Georgian Reproductive Health Survey 2010. Information on 1974 surgical abortions performed >30 days prior to the survey interview were analyzed during the study. Logistic regression statistical analysis was applied to compare the abortion sequelae that followed vacuum aspiration and dilatation and curettage at different gestational ages (<10 weeks and ≥10 weeks). We examined two major early abortion-related complications: postabortion hemorrhage and febrile morbidity (fever ≥38 °C).ResultsPostabortion hemorrhage was reported in 43 cases (1.9%), and febrile morbidity occurred in 44 cases (2%) among all of the surgical abortions. The abortions performed by dilatation and curettage were associated with an estimated fourfold increased risk of developing hemorrhage (OR 4.4, 95% CI 2.2–8.6) and a twofold increased risk of developing fever (OR 2.37, 95% CI 1.17–4.79) compared with the abortions that were performed via vacuum aspiration. The risk of postabortion hemorrhage (OR 1.9, 95% CI 0.8–4.4) or fever (OR 0.9, 95% CI 0.4–2.1) did not significantly differ at gestational age < 10 weeks and ≥10 weeks.ConclusionVacuum aspiration was associated with reduced risks of postabortion hemorrhage and fever compared to dilatation and curettage. Gestational age ≥ 10 weeks was not found to be a predictive factor of immediate postabortion complications: hemorrhage and fever.