Elena Regushevskaya

Contraceptive use and abortion among women of reproductive age in st. Petersburg, Russia

CONTEXT: Although the characteristics associated with contraceptive use among Russian women have been studied no large-scale research has been conducted on womens use of different contraceptive methods and abortion. METHODS: A random sample of 1147 women aged 18-44 completed questionnaires at local womens clinics in St. Petersburg in 2003-2004. Chi-square tests were used to examine differences in selected characteristics among age-groups and logistic regression was used to assess associations between these characteristics and the use of contraceptive methods at last intercourse and abortion history. RESULTS: Among women at risk of unintended pregnancy six in 10 had used reliable contraceptives (the pill the IUD or condoms) at last intercourse; 42% had used condoms. Women in the middle income level were more likely than women with lower income to have used the pill (odds ratio 2.1); cohabiting women and those who had had children had lowered odds of using condoms (0.6 and 0.3-0.5 respectively). More than half of those surveyed reported having had an abortion. Characteristics associated with increased odds of having had an abortion included being 25 or older (2.2-3.5) cohabiting (2.9) having high income (1.7) having experienced first intercourse before turning 18 (2.2) and having used no contraceptive method at first sex (1.5). The factor that was most strongly associated with abortion was a womans number of births (4.9-5.7). CONCLUSIONS: Educational programs that promote the consistent use of condoms especially among young women and family planning programs that reduce financial barriers to contraceptive use are critically needed in Russia.

Risk factors for induced abortions in St Petersburg, Estonia and Finland. Results from surveys among women of reproductive age

Objectives To compare the risk factors of self-reported abortion in St Petersburg, Estonia and Finland, which are neighbouring areas having different abortion rates. Methods Data from four population-based questionnaire surveys (Finland 1992 and 1999; St Petersburg 2003; Estonia 2004) were used. With the exception of the 1992 Finnish survey (based on interviews) all were postal surveys. There were 1070 respondents in Finland (78% and 52% response rates), 1147 (68%) in St Petersburg, and 5190 (54%) in Estonia. Results The prevalence of self-reported abortions was highest among women in St Petersburg and among the two oldest age groups of Russian-speaking Estonians. In all areas women with a history of abortion were more likely to have low education, children, a history of multiple partners and to have had their first intercourse when younger than 18 years. Insufficient use of reliable contraception, both at first and last intercourse, was the only risk factor that was more common in St Petersburg and in Estonia than in Finland. In Estonia, more Estonian than Russian-speaking women used reliable contraceptives. Conclusion The comparison of three areas suggests that high abortion rates are related to low contraceptive use and not to other risky sexual behaviour.

The socioeconomic characteristics of risky sexual behaviour among reproductive-age women in St Petersburg

Aims: To examine the sexual behaviour of reproductive age women in St Petersburg and its variation according to socio-demographic characteristics. Methods: A cross-sectional survey with a self-administered questionnaire. A random sample of women aged 18—44 in two districts in St Petersburg in 2004 were invited to a womans clinic to complete a questionnaire. Of those women who were contacted (n=1719), 67% completed the anonymous questionnaire either in a clinic or at home. Results were analyzed according to three age-groups (18—24, 25—34, 35—44 years). Predictive characteristics were studied by use of multivariate models. Results: Younger respondents had on average started sexual life much earlier than the oldest (mean age 17.6 and 19.7 years respectively). The use of contraception at first coitus had become more common for each consecutive generation, though 25% of women aged 18—25 used no contraception, and only 45% used reliable contraception at first intercourse. Around 16% of the women had had two or more sex partners during the previous year, 55% of the youngest and 43% of the oldest had used reliable contraceptive methods. Older women were less likely to use contraceptives in last intercourse. High personal income, having children and low education were related to early age at first intercourse. Being single (women over 24 years) or having high income (women in all ages) was correlated with having had multiple sexual partners. Conclusions: In addition to youth, sexual education should be targeted to older women, many of whom practice risky sexual behaviour.

Socioeconomic differences in self-rated health among women: a comparison of St. Petersburg to Estonia and Finland

IntroductionSocial determinants of health have not been intensively studied in Russia, even though the health divide has been clearly demonstrated by an increased mortality rate among those with low education. A comparative analysis of social health determinants in countries with different historical and economic backgrounds may provide useful evidence for addressing health inequalities. We aimed to assess socioeconomic determinants of self-rated health in St. Petersburg as compared to Estonia and Finland.MethodsData for women aged 18–44 were extracted from existing population-based surveys and analysed. In St. Petersburg the data were originally collected in 2003 (response rate 68%), in Estonia in 2004–2005 (54%), and in Finland in 2000–2001 (86%). The study samples comprised 865 women in St. Petersburg, 2141 in Estonia and 1897 in Finland.ResultsSelf-rated health was much poorer in St. Petersburg than in Estonia or Finland. High education was negatively associated with poor self-rated health in all the studied populations; it was (partially) mediated via health behaviour and limiting long-term illness only in Estonia and Finland, but not in St. Petersburg. High personal income and employment did not associate with poor self-rated health among St. Petersburg women, as it did in Estonia and Finland. In St. Petersburg housewives rather than employed women had better self-rated health, unlike the two other areas.ConclusionWomen’s self-rated health in St. Petersburg varied similarly by education but differently by income and employment as compared to Estonia and Finland. Education is likely the most meaningful dimension of women’s socioeconomic position in St. Petersburg. More research is needed to further clarify the pathways between socioeconomic position and health in Russia.

Unauthorised pregnancies and use of maternity care in rural China

ABSTRACT Objectives To describe the use of maternity care in rural China by the legal status of the pregnancy. Methods Cross-sectional survey wherein information was obtained about 2576 women who gave birth in 2006. Logistic regression was used to compare women having an unauthorised pregnancy with those having an authorised second birth, adjusting for confounding factors. Results Almost all respondents had antenatal care and most deliveries occurred in hospitals. Women with unauthorised pregnancies were significantly less likely to have had maternity care, particularly prenatal care, postnatal care, to have been hospitalised during pregnancy, and to have been reimbursed for hospital delivery costs than women with an authorised second birth. They were also more likely to have been hospitalised for seven or more days after delivery. Primiparous women used maternity care services and received financial support more often than women with an authorised second birth. Among the women with an unauthorised pregnancy an important reason for not using hospital care during pregnancy or delivery was financial constraint. Conclusions Women with unauthorised pregnancies use less maternity care, although pregnancy in such circumstances may adversely impact their health. Primiparous women benefit from more financial support than multiparous women.

A pragmatic randomised controlled trial on routine iron prophylaxis during pregnancy in Maputo, Mozambique (PROFEG): rationale, design, and success

The effects of prophylactic iron during pregnancy on maternal and child health in developing settings with endemic malaria and high prevalence of HIV remain unclear. This paper describes the rationale, implementation and success of a pragmatic randomised controlled trial comparing routine iron supplementation vs. screening and treatment for anaemia during pregnancy. The setting was two health centres in Maputo, Mozambique. Pregnant women (≥ 12-week gestation; ≥ 18 years old; and not with a high-risk pregnancy, n=4326) were recruited. The main outcomes are preterm delivery and low birthweight. The women were randomly assigned to one of two iron administration policies: a routine iron group (n=2184) received 60 mg of ferrous sulphate plus 400 μg of folic acid daily while a selective iron group (n=2142) had screening and treatment for anaemia and a daily intake of 1 mg of folic acid. The recruitment, follow-up, and collection of follow-up data were successful; both groups were similar to each other in all the trial stages. Collection of delivery data was challenging and data on about 40% of births is missing. These are currently being traced through different hospitals and health centres. The compliance of the study personnel and the women with regard to regular measurement of haemoglobin and intake of the iron and folic acid tablets was high and similar in both trial arms. Taking into account the various constraints encountered, the stages of the present trial prior to delivery were carried out well.

Clinical research in Finland in 2002 and 2007: quantity and type

BackgroundRegardless of worries over clinical research and various initiatives to overcome problems, few quantitative data on the numbers and type of clinical research exist. This article aims to describe the volume and type of clinical research in 2002 and 2007 in Finland.MethodsThe research law in Finland requires all medical research to be submitted to regional ethics committees (RECs). Data from all new projects in 2002 and 2007 were collected from REC files and the characteristics of clinical projects (76% of all submissions) were analyzed.ResultsThe number of clinical projects was large, but declining: 794 in 2002 and 762 in 2007. Drug research (mainly trials) represented 29% and 34% of the clinical projects; their total number had not declined, but those without a commercial sponsor had. The number of different principal investigators was large (630 and 581). Most projects were observational, while an experimental design was used in 43% of projects. Multi-center studies were common. In half of the projects, the main funder was health care or was done as unpaid work; 31% had industry funding as the main source. There was a clear difference in the type of research by sponsorship. Industry-funded research was largely drug research, international multi-center studies, with randomized controlled or other experimental design. The findings for the two years were similar, but a university hospital as the main research site became less common between 2002 and 2007.ConclusionsClinical research projects were common, but numbers are declining; research was largely funded by health care, with many physicians involved. Drug trials were a minority, even though most research promotion efforts and regulation concerns them.

Comparison of routine prenatal iron prophylaxis and screening and treatment for anaemia: pregnancy results and preliminary birth results from a pragmatic randomised controlled trial (PROFEG) in Maputo, Mozambique

Objective To present the pregnancy results and interim birth results of a pragmatic randomised controlled trial comparing routine iron prophylaxis with screening and treatment for anaemia during pregnancy in a setting of endemic malaria and HIV. Design A pragmatic randomised controlled trial. Setting Two health centres (1° de Maio and Machava) in Maputo, Mozambique, a setting of endemic malaria and high prevalence of HIV. Participants Pregnant women (≥18-year-olds; non-high-risk pregnancy, n=4326) attending prenatal care consultation at the two health centres were recruited to the trial. Interventions The women were randomly allocated to either Routine iron (n=2184; 60 mg ferrous sulfate plus 400 μg of folic acid daily throughout pregnancy) or Selective iron (n=2142; screening and treatment for anaemia and daily intake of 1 mg of folic acid). Outcome measures The primary outcomes were preterm delivery (delivery <37 weeks of gestation) and low birth weight (<2500 g). The secondary outcomes were symptoms suggestive of malaria and self-reported malaria during pregnancy; birth length; caesarean section; maternal and child health status after delivery. Results The number of follow-up visits was similar in the two groups. Between the first and fifth visits, the two groups were similar regarding the occurrence of fever, headache, cold/chills, nausea/vomiting and body aches. There was a suggestion of increased incidence of self-reported malaria during pregnancy (OR 1.37, 95% CI 0.98 to1.92) in the Routine iron group. Birth data were available for 1109 (51%) in the Routine iron group and for 1149 (54%) in the Selective iron group. The birth outcomes were relatively similar in the two groups. However, there was a suggestion (statistically non-significant) of poorer outcomes in the Routine iron group with regard to long hospital stay after birth (relative risk (RR) 1.43, 95% CI 0.97 to 1.26; risk difference (RD) 0.02, 95% CI −0.00 to 0.03) and unavailability of delivery data (RR 1.06, 95% CI 1.00 to 1.13; RD 0.03, 95% CI −0.01 to 0.07). Conclusions These interim results suggest that routine iron prophylaxis during pregnancy did not confer advantage over screening and treatment for anaemia regarding maternal and child health. Complete data on birth outcomes are being collected for firmer conclusions. Trial registration The trial is registered at ClinicalTrials.gov, number NCT00488579 (June 2007). The first women were randomised to the trial proper April 2007–March 2008. The pilot was November 2006–March 2008. The 3-month lag was due to technical difficulties in completing trial registration.

The determinants of sexually transmitted infections among reproductive age women in St. Petersburg, Estonia and Finland

ObjectivesSexually transmitted infections’ (STIs) rate vary in St. Petersburg, Estonia and Finland; the aim was to compare the determinants of self-reported sexually transmitted infections in these areas.MethodsData from four population-based questionnaire surveys were used (Finland in 1992 and 1999; St. Petersburg in 2003; Estonia in 2004). With the exception of the 1992 Finnish survey (interview) all were postal surveys, with 1,070 respondents in Finland (78 and 52% response rates), 1,147 (68%) in St. Petersburg, and 5,190 (54%) in Estonia.ResultsRisky sexual behaviours were equally common in the three areas and the determinants were the same. Women with an STIs history more often had had their first sexual intercourse when aged under 18, had not used condom during first intercourse, had a high number of lifetime or previous year sexual partners. However, marital status and education were not similar determinants. Cohabiting and well-educated women in Finland were more likely to have STIs while in other areas the associations found were not statistically significant.ConclusionsRisky behaviour predicts STIs, but does not explain the varying rates of STIs between areas.

Is selective prenatal iron prophylaxis better than routine prophylaxis: final results of a trial (PROFEG) in Maputo, Mozambique

Objective To compare routine versus selective (ie, screening and treatment for anaemia) prenatal iron prophylaxis in a malaria-endemic and HIV-prevalent setting, an extended analysis including previously missing data. Design A pragmatic randomised controlled clinical trial. Setting 2 health centres in Maputo, Mozambique. Participants Pregnant women (≥18 years old; non-high-risk pregnancy) were randomly allocated to routine iron (n=2184) and selective iron (n=2142) groups. Interventions In the routine group, women received 60 mg ferrous sulfate plus 400 μg folic acid daily. In the selective group, women received 1 mg of folic acid daily and haemoglobin (Hb) screening at each visit; with low Hb (cut-off 9 g/dL) treatment (120 mg+800 μg of folic acid daily) for a month. Outcome measures Primary outcomes: preterm birth, low birth weight; secondary outcomes: self-reported malaria, labour complications, caesarean section, perinatal death, womans death. Nurses collected pregnancy data. Birth data were abstracted from hospital records for 52% of women and traced using various methods and linked with probabilistic matching for 24%. Womens deaths were collected from death registers. Results Birth data were available for 3301 (76%) of the women. Outcomes were similar in the two groups: preterm births (27.1% in the selective vs 25.3% in the routine group), low birthweight infants (11.0% vs 11.7%), perinatal deaths (2.4% vs 2.4%) and caesarean sections (4.0% vs 4.5%). Womens deaths during pregnancy or <42 days postpartum were more common in the selective group (0.8% among the two best matched women) than in the routine group (0.4%). Extra deaths could not be explained by the cause of death, Hb level or HIV status at recruitment. Conclusions Birth outcomes were similar in the two iron groups. There might have been more womens deaths in the selective iron group, but it is unclear whether this was due to the intervention, other factors or chance finding. Trial registration number NCT00488579.