"Safe sex advice is good - but so difficult to follow". Views and experiences of the youth in a health centre in Kampala. From Kiswa Youth Clinic, Kampala, Uganda.
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BACKGROUND: Young people in Uganda are advised by the Ministry of Health and other authorities to abstain from sex in order to avoid the human immunodeficiency virus (HIV), other sexually transmitted diseases (STD) and early pregnancies. If they cannot abstain they should use condoms and they should stay faithful to their partner. OBJECTIVE: To find out how young people perceive this advice and if they find it possible and realistic to follow. METHOD: In May and June 2000 twenty informants were selected by purposeful sampling and were interviewed in English. Given items were discussed. The interviews were recorded on tape, transcribed, extracted and sorted into categories in a qualitative research method. RESULTS: Most of the interviewed youth claimed that the advice is good and helpful but there are many obstacles. The results showed that information given in schools about condom use and safer sex behaviour is not always adequate. However, despite lack of clear health education messages, the risk of being HIV positive is of major concern to many youth. In addition, the expected lack of support if the test is positive is a common reason for abstaining from HIV testing. CONCLUSIONS: More discussions in society are needed to create consensus on safe sex messages presented to young people. HIV infection is a major concern but many young people abstain from testing, as they expect to receive inadequate support. (+info)
Unintended pregnancy among the urban poor.
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This article seeks to determine the proportion of pregnancies that are unintended among poor women in New York City, compare the New York City rate to national data, and examine factors associated with unintended pregnancy in this population. Pregnancy testing data collected between June 1, 1998, and June 1, 2001, from field sites operated by the Office of Family Health, New York City Department of Health and Mental Hygiene were analyzed. Pregnancy planning (intended vs. unintended) was examined by age group, race/ethnicity, marital status, frequency of contraceptive use, number of previous pregnancies, drug and alcohol use, and smoking. Odds ratios were calculated to determine if pregnancies were more likely to be unintended among women with certain characteristics. Logistic regression was used to examine independent risk factors for unintended pregnancy. Of the 20,518 women who had a pregnancy test during the study period, 9,406 (45.8%) were pregnant. Of the pregnancies, 82% were unintended. Marital status was the strongest predictor of unintended pregnancy, increasing the risk 2.5-fold for unmarried women. Adolescents and those who drank alcohol were also at increased risk of unintended pregnancy. The extremely high percentage of pregnancies that were unintended among the study population suggests that national unintended pregnancy rates are not representative of what occurs among low-income women in an urban setting. Unintended pregnancy interventions should be tailored for the urban poor and target unmarried, young women. (+info)
Access to health care for induced abortions: analysis by means of a French national survey.
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BACKGROUND: With an incidence of 15 per thousand, abortion is a common reproductive event in France. This study describes conditions of access to health care for abortions based on women's reports, taking into account the woman's background and the influence of the first professional contacted. METHODS: A representative sample of 2,863 women, aged 18 to 44, was interviewed by telephone between September 2000 and January 2001. Of these women, 480 had an abortion in the last 10 years. MAIN RESULTS: The choice of first professional depended on women's background, as we found differences according to age, educational level or past induced abortion. This choice affected subsequent access conditions, in terms of time delay or complexity of patterns of care to access abortion services. Women who first contacted a private gynaecologist, which is the most frequent situation in France, had more direct and shorter patterns of care. Conversely, general practitioners were associated with longer and more indirect patterns of care, especially when women were less well educated. CONCLUSION: This study reveals the heterogeneous nature of patterns of access to an abortion in France. It also raises questions concerning the training of general practitioners, who seem to be less well prepared to take charge of a request for an abortion than other professionals. Efforts must be made to better inform women and these professionals about the process required for abortions. (+info)
Parental pregnancy intention and early childhood stunting: findings from Bolivia.
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BACKGROUND: This study examined the impact of maternally reported pregnancy intention, differentiating unwanted and mistimed pregnancies, on the prevalence of early childhood stunting. Additionally, it examined the influence of paternal pregnancy intention status. METHODS: Data were collected from a nationally representative sample of women and men interviewed in the 1998 Bolivia Demographic and Health Survey. The sample was restricted to lastborn, singleton children younger than 36 months who had complete anthropometric information. Multivariable logistic regression examined the association between pregnancy intention and stunting. RESULTS: Children from unwanted and mistimed pregnancies comprised 33% and 21% of the sample, respectively. Approximately 29% of the maternally unwanted children were stunted as compared to 19% among intended and 19% among mistimed children. Children 12-35 months (toddlers) from mistimed pregnancies (adjusted prevalence risk ratio [PR(adj)] 1.33, 95% confidence interval [CI]: 1.03-1.72) and unwanted pregnancies (PR(adj) 1.28, 95% CI: 1.04-1.56) were at about a 30% greater risk for stunting than children from intended pregnancies. Infants and toddlers with both parents reporting them as unwanted had an increased risk of being stunted as compared with children both of whose parents intended the pregnancy. No association was found for infants less than 12 months. CONCLUSIONS: Reducing unintended pregnancies in Bolivia may decrease the prevalence of childhood growth stunting. Children born to parents reporting mistimed or unwanted pregnancies should be monitored for growth stunting, and appropriate interventions should be developed. Measurement of paternal pregnancy intention status is valuable in pregnancy intention studies. (+info)
Studying time to pregnancy by use of a retrospective design.
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Biologic fertility can be measured using time to pregnancy (TTP). Retrospective designs, although lacking detailed timed information about behavior and exposure, are useful since they have a well-defined target population, often have good response rates, and are simpler and less expensive to conduct than prospective studies. This paper reviews retrospective TTP studies from a methodological viewpoint and shows how methodological problems can be avoided or minimized by appropriate study design, conduct, and analysis. Sensitivity analyses using data from four European retrospective TTP studies are presented to explore the issues. Although the identified biases tend to have small impacts, the effects are not systematic across studies, and sensitivity analyses are recommended routinely. Planning bias can be checked by comparing propensity to report contraceptive failures in different exposure groups. Medical intervention bias can be avoided by censoring and inclusion of unsuccessful pregnancy attempts. Truncation bias can be a serious problem if unrecognized, but it is avoidable with appropriate study design and/or analysis. Behavior change bias can be minimized by assessing the covariates at the beginning of unprotected intercourse. More complete inference is possible if the study design covers the whole population, not just those who achieve a pregnancy. (+info)
Female sterilisations with Filshie clips: what is the risk failure? A retrospective survey of 30,000 applications.
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OBJECTIVE: To assess the failure rate of Filshie clip sterilisations in Victoria, Australia. DESIGN: Retrospective study between 1994 and 1998. SETTING: All specialist gynaecologists practising in the state of Victoria, Australia. INTERVENTIONS: Questionnaires (up to three) followed by telephone calls if necessary. MAIN OUTCOME MEASURES: A response rate of 276/277 (99.6%) was obtained. All pregnancies were recorded. RESULTS: Seventy-three failures were notified from an estimated 30,000 Filshie clip sterilisations carried out in the study period. CONCLUSIONS: The estimated failure rate of Filshie clip sterilisations in the state of Victoria carried out by specialist gynaecologists was between 2 and 3 per 1000 sterilisation operations. (+info)
Revisiting a pilot survey involving contraception and teenage pregnancy in Ayrshire and Arran.
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CONTEXT: How to respond to the challenge of reducing unplanned pregnancy rates in Ayrshire and Arran. OBJECTIVES: (1) To improve understanding of the educational needs of 11-15-year-olds regarding contraception which could be used to inform planning of future sex education in schools in Ayrshire and Arran. (2) To put this in context by reviewing contraceptive usage amongst 14-16-year-old pregnant teenagers. DESIGN: (1) A questionnaire given to 11-15-year-olds during a sex education class. (2) A retrospective study of pregnant 14-16-year-olds. PARTICIPANTS: (1) School pupils aged 11-15 from an area of mixed social background (n = 80). (2) Pregnant 14-16-year-olds presenting at Ayrshire Central Maternity Hospital between September 1997 and March 1998 (n = 74). RESULTS: (1) Ninety-nine percent of the teenagers said they would use contraception. Seventy-three percent of girls, but only 52% of boys, were aware of the services available. Ninety percent of girls knew about emergency contraception, but only 59% of boys. Thirty-three percent thought they received too little sex education at school. Thirty-two percent received no sex education from home, and 10% 'too little'. More information about sexually-related diseases, safe sex and having a baby was requested. (2) The study of pregnant teenagers showed that 69% went ahead with their pregnancies, that 71% were not habitually using contraception and only 4% were using contraception at the time of conception. DISCUSSION: Teenagers said they would use contraception. However, boys were not aware of local services giving advice and help to young people, nor about emergency contraception. Teenagers felt they had no or 'too little' sex education at home. They felt too young to become a parent and be 'tied down'. CONCLUSIONS: (1) Teenagers at school want information about a wider range of sexual issues. (2) There is a gap between learning about contraception and its practical use, including emergency contraception. (3) Discussion and reinforcement of sex education at home may not exist for many teenagers. (4) Teenagers at school felt that they were not ready to be parents as this would restrict their social lives and disrupt their education. (5) It is recognised that young men are less well-informed than young women are, and this could impact on safe sex. (+info)
The evolution of the Marie Stopes electrocautery no-scalpel vasectomy procedure.
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OBJECTIVE: To review the evolution of the procedure, the reoperation rate and efficacy data for vasectomies performed in Marie Stopes centres during the periods 1990-1994 and 1995-1999. DESIGN: Retrospective review of re-operation rates and primary and secondary failures during the periods 1990-1994 and 1995-1999. SETTING: Marie Stopes vasectomy centres in the UK. PARTICIPANTS: A total of 41 123 men undergoing vasectomy. RESULTS: The re-operation rate for the period 1990-1994 was 0.7% and fell to 0.46% for 1995-1999. The reported pregnancy rate fell from 1 in 1429 procedures for the period 1990-1994 to 1 in 2804 for 1995-1999. CONCLUSION: The results show that vasectomy has had a low failure rate well below that of other methods of birth control. The outcome data continue to improve over time with the evolution of improved techniques and surgical expertise. (+info)