Kai Part

Intimate partner violence and sexual health outcomes: a population-based study among 16–44-year-old women in Estonia

BACKGROUND Violence against women as a public issue and health burden has only recently been acknowledged in Estonia. The aim of this study was to outline the prevalence and to explore the associations of intimate partner violence (IPV) and selected sexual health outcomes. METHODS Data from the population based cross-sectional survey among representative sample of 16-44-year-old non-pregnant women (n = 1966) were analysed using multivariate logistic regression. RESULTS Of 1966 respondents, 362 (18.4%) reported IPV during 12 months preceding the survey. Physical IPV was reported by 339 (17.2%), sexual by 80 (4.1%) and both physical and sexual by 35 (1.8%) of respondents. After controlling for significant confounding socio-demographic factors, exposure to IPV was found to be associated with contraception non-use [adjusted odds ratio (AOR) = 2.02, 95% confidence interval (CI) 1.44-2.82] or the use of unreliable contraceptive methods (AOR = 1.54, CI 1.16-2.04) during the most recent sexual intercourse, having never used a condom (AOR = 1.53, CI 1.12-2.10), repeat induced abortion (AOR = 1.72, CI 1.24-2.37), lifetime sexually transmitted infections (AOR = 2.05, CI 1.56-2.68) and dyspareunia (AOR = 2.14, CI 1.65-2.77). CONCLUSION The exposure of IPV was an important contributor to sexual risk behaviour and adverse sexual health outcomes among women of reproductive age in Estonia. Any strategy to promote sexual health should include prevention of IPV and other forms of violence against women with the strengthening of womens sexual and reproductive rights.

Youth sexual health improvement in Estonia 1990-2009: the role of sexuality education and youth-friendly services.

ABSTRACT Objectives A new school curriculum was introduced in Estonia in 1996 comprising for the first time sexuality education (SE) topics. The first youth counselling centres (YCCs) addressing sexual health matters were set up in 1991–1992. This study describes the development of school-based SE and YCCs in 1992 − 2009, and explores the concurrent changes in sexuality-related knowledge, behaviour, and sexual health indicators. Methods The analyses are based on 12 population-based surveys. Data on births, abortions and sexually transmitted infections, including HIV, are taken from national registers. Results By the middle of the past decade SE was well established. There has been a trend towards younger age at first sexual intercourse, and increased usage of condoms and reliable contraceptive methods. The abortion rate among 15–19-year-olds declined by 61% and their fertility rate by 59%. The annual number of registered new HIV cases among 15–19-year-olds dropped from 560 in 2001 to 25 in 2009, new syphilis cases from 116 in 1998 to two in 2009, and gonorrhoea cases from 263 in 1998 to 20 in 2009. Conclusions This study documents considerable improvements in sexual health indicators of youths, and indicates that these run parallel to the development of school-based SE and YCCs.

Teenage pregnancies in the European Union in the context of legislation and youth sexual and reproductive health services

To study cross‐country and regional variations and trends in reported teenage pregnancies in the context of legislation and youth sexual and reproductive health (SRH) services in Europe.

Gender differences in factors associated with sexual intercourse among Estonian adolescents

Aims: To examine factors associated with early sexual intercourse among 15 to 16-year-old adolescents by gender. Methods: The data were collected from a random sample of Estonian basic schools’ ninth grade pupils in 1999 using self-completed questionnaires. A multivariate logistic regression analysis for boys and girls was used to test for associations between sexual intercourse, and personal gender role-related attitudes, attitudes towards sexual intercourse, pubertal timing, smoking status and experience of drunkenness. Results: Of the respondents, 14.6% of boys and 13.1% of girls had experienced sexual intercourse. Traditional gender role-related attitudes were associated with sexual intercourse among girls, but not among boys. Smoking and experience of drunkenness was strongly associated with sexual intercourse for both genders. Conclusions: Gender differences in the association between gender role-related attitudes and early sexual intercourse were observed among 15 to 16-year-olds in Estonia. Smoking and experience of drunkenness were strongly related to sexual intercourse for both genders.

Ethnic differences in factors associated with the use of contraception among 20- to 44-year-old women in Estonia and St. Petersburg, Russia

BACKGROUND The aim of this study was to explore factors associated with contraception among 20- to 44-year-old women in different ethnic groups in two Eastern European countries. STUDY DESIGN Data on sexually experienced women in need of contraception taken from population-based cross-sectional surveys, conducted in Estonia (n=1680) and in St. Petersburg (n=798), were analyzed. Factors associated with contraception nonuse or the use of unreliable contraceptive methods were explored using multivariate logistic regression analysis. RESULTS The age-standardized prevalence rate of contraception nonuse or the use of unreliable contraceptive methods was high (27.3% among Estonian-speaking women in Estonia, 39.9% and 42.5% among Russian-speaking women in Estonia and in St. Petersburg, respectively). Age, economic subsistence, high-risk sexual behavior and smoking did not correlate with contraception nonuse or the use of unreliable contraceptive methods among Russian-speaking women in Estonia and in St. Petersburg; this was in contrast to Estonian-speaking women in Estonia. Previous childbirth and abortion reduced the risk of contraception nonuse or the use of unreliable contraceptive methods among Estonian-speaking women in Estonia (adjusted odds ratio, 0.50; 95% confidence interval [CI], 0.31-0.81) but elevated the risk among Russian-speaking women in St. Petersburg (1.99; 1.17-3.40). Abortion, not previous childbirth, was associated with an increased risk among Russian-speaking women in Estonia (2.94; 1.25-6.95). CONCLUSIONS The importance of different risk factors associated with contraceptive use varies between different ethnic groups. Cross-national comparisons are essential for the design of public health policies that decrease the burden of sexual ill health.

Impact and cost-effectiveness analysis of the national school-based sexuality education programme in Estonia

Policy-makers making decisions on the implementation of school-based sexuality education (SE) programmes face two important questions: (1) what are the costs of implementing and scaling up SE programmes, and (2) what are the impacts? This paper responds to these questions by retrospectively assessing costs, impact and cost-effectiveness of the national school-based SE programme in Estonia 1997–2009. The three-year curriculum had been taught to 190,000 students at the end of 2009. The cost of reaching one student was USD 32.90 and the total costs were USD 5.6 million. There has been a remarkable improvement in sexual health indicators in the age groups 15–19 and 20–24 years in Estonia between 2001 and 2009. During this period, annual abortions, STIs and diagnosed HIV infections in the age groups were reduced by 37%, 55% and 89%, respectively. It is difficult to assess to what extent the improvements in these sexual health indicators are attributable to the SE programme. Nevertheless, our conservative threshold analysis indicates that the Estonian SE programme could be considered cost-saving if only 4% of the observed reductions in HIV infections are attributable to the programme. There is strong evidence, therefore, to support that the Estonian school-based sexuality programme has been cost-effective.

Polyvictimization and the Associations Between Poor Self-Perceived Health, Dissatisfaction With Life, and Sexual Dysfunction Among Women in Estonia:

The severe impact of different forms of violence on health has been demonstrated in a substantial number of studies. At the same time, it has been acknowledged that different forms of violence tend to co-occur, such that many survivors of violence have been exposed to more than one violent event and/or more than one form of violence. Despite mounting evidence concerning the associations between polyvictimization and health, there are still important gaps in this knowledge concerning adult female populations sexual health, including both physical and mental aspects associated with it. The aim of this study was to evaluate the exposure to emotional, physical, and sexual violence among women and associations with poor self-perceived health, dissatisfaction with life, stress, and worry due to sex life and sexual dysfunction. The term polyvictimization is used in this article to express the exposure to more than one form of violence. We used data from a cross-sectional study carried out in Estonia in 2014 among women aged 16 to 44 years. Responses of 2,333 women were analyzed for this article. Of all the respondents, 27.9% were polyvictimized. Women who had been exposed to all three forms of violence had, after adjusting for confounding factors, the highest risk of reporting poor self-perceived health, limited daily activities due to chronic health problems, feelings of depression, dissatisfaction with life, stress, and worry due to sex life and sexual dysfunction. The results of this study demonstrate that exposure to violence is associated with poorer health outcomes and that the association is stronger among those who have been polyvictimized.