Paul W. Stupp

Reproductive patterns and child mortality in guatemala

In this paper, we investigate the association of child mortality with maternal age, parity, birth spacing, and socioeconomic status, in a sample of Guatemalan children who were included in a public health intervention program. Our results indicate that maternal age, birth order, and the length of the previous and following birth intervals all have a significant impact on the risk of child mortality and that these associations cannot be accounted for by differences in breastfeeding, socioeconomic status, or the survival status of the previous child.

The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania.

A national household survey of 4,861 women aged 15-44 on reproductive health issues was conducted in Romania in 1993. The survey provided the opportunity to study the impact of policy changes by comparing selected aspects of fertility, abortion, and contraceptive use before and after the December 1989 revolution, when the laws restricting abortion and contraceptive use were abolished. After abortion became legal, the total fertility rate dropped to below replacement level, while the induced abortion rate doubled. Contraceptive prevalence increased 20 percent, but augmentation of the use of traditional methods, rather than the change in legislation, accounted for 70 percent of the increase. Limited sex education and contraceptive information, mistrust and misinformation about modern methods, a lack of adequately trained providers, and a shortage or uneven distribution of contraceptive supplies are major reasons for the continued high rates of unintended pregnancy.

Ethnic inequality in Guatemalan women's use of modern reproductive health care.

CONTEXT Guatemala has some of the poorest reproductive health indices and largest disparities in health in Latin America, particularly between indigenous and ladina women. To reduce these disparities, it is necessary to understand how indigenous womens disadvantages in linguistic, socioeconomic or residential characteristics relate to their underutilization of reproductive health services. METHODS Logistic regression analyses of a nationally representative sample of women aged 15-49 from the 2008-2009 National Survey of Maternal and Infant Health were used to estimate ethnic disparities in womens use of institutional prenatal care and delivery, and in met demand for modern contraceptives. Using predicted probabilities, we estimated the extent to which these disparities were attributable to a language barrier among indigenous women and to their disadvantage in selected socioeconomic and residential characteristics. RESULTS The ethnic difference in use of institutional prenatal care was small; however, institutional delivery was far less common among indigenous women than among ladina women (36% vs. 73%), as was met need for modern contraceptives (49% vs. 72%). Not speaking Spanish accounted for the largest portion of these ethnic differentials. Indigenous womens poor education and rural residence made up smaller portions of the ethnic differential in modern contraceptive use than did their economic disadvantage. CONCLUSION The large proportion of indigenous women who use institutional prenatal care suggests that further integrating the three services may increase their use of institutional delivery and modern contraceptives. Adding speakers of local Mayan languages to the staff of health facilities could also help increase use.

Prevalence and correlates of sexual risk behaviors among Jamaican adolescents.

CONTEXT Despite high levels of sexual activity and risk behaviors among Jamaican youth, few population-based studies have examined their prevalence or correlates. METHODS The prevalence of three sexual risk behaviors was assessed using data from the 2008-2009 Jamaican ?Reproductive Health Survey on a subsample of adolescents aged 15-19 who neither were in a union nor had a child. Factors associated with the risk behaviors were examined separately for females and males, using bivariate analysis and multivariate logistic regression. RESULTS In the year prior to the survey, 32% of females and 54% of males had had sexual intercourse; of those, 12% and 52%, respectively, had had more than one sexual partner, and 49% and 46% had used condoms ?inconsistently or not at all. School enrollment was protective against females being sexually active and males having multiple partners. Females who were enrolled in an age-appropriate or higher grade had decreased odds of using condoms inconsistently or not at all, and males who were enrolled in a lower than age-appropriate grade had a decreased risk of being sexually active. Males in the lowest wealth tercile were less likely than those in the highest tercile to have been sexually active or to have had multiple partners. Weekly attendance at religious services was protective against all three risk behaviors for both genders, with the exception of inconsistent or no condom use among males. CONCLUSIONS Future reproductive health programs should continue to target adolescents in venues other than schools and churches, and should also address the varying needs of females and males.

Contraception matters: two approaches to analyzing evidence of the abortion decline in Georgia.

CONTEXT The abortion rate in the republic of Georgia is the highest documented in the world. Analyses using reliable data are needed to inform programs for preventing unintended pregnancy and abortion. METHODS Data from two large national household surveys conducted in 1999 and 2005 were used to assess the relationship between contraceptive use and abortion. Two analytic approaches were used. First, abortion rates were estimated for three subgroups: users of modern contraceptives, users of traditional contraceptives and nonusers of contraceptives. A decomposition method was then used to estimate the proportions of change in abortion rates that were due to changes in contraceptive use and to changes in use- and nonuse-specific abortion rates. Second, a methodology developed by Westoff was used to examine abortion rates among contraceptive users and among nonusers with differing risks of unintended pregnancy. RESULTS According to data from the 60 months before each survey, contraceptive prevalence among married women increased by 23% (from 39% to 48%) and the marital abortion rate declined by 15% (from 203 to 172 abortions per 1,000 woman-years) between 1999 and 2005. Both approaches showed that nonuse of any method was the principal determinant of the high unintended pregnancy rate and that the increase in use of modern contraceptives was a significant contributor to the recent drop in abortion (explaining 54% of the decline, according to the decomposition analysis). CONCLUSIONS Efforts to increase availability and use of modern family planning methods in Georgia should lead to a direct and measurable decline in the abortion rate.

Using parity-progression ratios to estimate the effect of female sterilization on fertility.

In this article, a new methodology that employs parity-progression ratios to estimate the effect of female sterilization on fertility is described, and results using data from Ecuador are compared to those obtained using a previously existing approach that classifies women by marital duration. The methods differ in how they disaggregate marital fertility and in the assumption they make about what the subsequent fertility of sterilized women would have been if they had not been sterilized. The analysis of the Ecuadoran data shows that the estimate of births averted by sterilization has diminished over time, even as sterilization prevalence has been increasing. This situation is attributed to a decline in the fertility of nonsterilized women resulting from increased use of reversible methods of contraception.