Robert J. Magnani

The effectiveness of adolescent reproductive health interventions in developing countries: a review of the evidence

Youth in many developing countries are at acute risk of sexually transmitted infections (STI) and human immunodeficiency virus (HIV) infection and unintended pregnancies. Approximately one-half of people currently infected with HIV are females developing countries aged < 25 years. In addition more than 13 million adolescent girls have unintended births each year in the developing world. In response adolescent reproductive health (ARH) interventions seeking to influence sexual risk-taking behaviors among youth have become increasingly common in developing country settings. These interventions have taken a variety of shapes and forms from conventional sex education in schools multicomponent community-based programs. Until recently however few rigorous impact assessments had been undertaken and their effectiveness has been largely undocumented. Fortunately the number of interventions that have undergone rigorous evaluations has increased significantly during the last decade and in this article we review and synthesize this emerging body of evidence with an eye toward advancing our understanding of “what works” in ARH programming in developing countries. (excerpt)

Reproductive health risk and protective factors among unmarried youth in Ghana.

CONTEXT In Ghana, as in many other Sub-Saharan African countries, the behaviors of the current cohort of adolescents will strongly influence the course of the HIV/AIDS epidemic. This study sought to identify factors associated with elevated risks of pregnancy and sexually transmitted infection among unmarried Ghanaian youth. METHODS A nationally representative sample of 3,739 unmarried 12-24-year-olds were surveyed. Various regression techniques were used to assess the effects of individual and contextual factors on sexual behavior and condom use. RESULTS Forty-one percent of female and 36% of male youth reported being sexually experienced. On average, sexually experienced youth had had fewer than two partners; only 4% of these females and 11% of males had had more than one sexual partner in the three months before the survey. Although Ghanaian youth are knowledgeable about condoms, only 24% of sexually experienced males and 20% of females reported consistent condom use with their current or most recent partner. A sizable number of contextual factors and attributes of youth themselves were associated with sexual behaviors, while individual characteristics were stronger predictors of condom use. CONCLUSIONS The findings provide further justification for interventions targeting key contextual factors that influence youth behaviors in addition to providing youth with necessary communication, negotiation and other life skills.

Uso de contracepção por adolescentes de escolas públicas na Bahia

OBJETIVO: O interesse sobre o comportamento contraceptivo de adolescentes vem crescendo, especialmente pela relevância social conferida a gravidez nessa faixa etaria. Assim, realizou-se estudo para investigar fatores associados ao uso de metodos anticoncepcionais entre adolescentes escolares. METODOS: Estudo transversal que utilizou um questionario auto-aplicado em 4.774 alunos de ambos os sexos, entre 11 e 19 anos. Calcularam-se as prevalencias de uso de contraceptivos na primeira e na ultima relacao sexual e em ambas as situacoes (uso consistente). A regressao logistica foi utilizada para a analise simultânea dos fatores e calculo de medidas ajustadas. RESULTADOS: Entre 1.664 estudantes com iniciacao sexual, os fatores associados positivamente ao uso consistente de contraceptivos pelos rapazes incluiram a iniciacao sexual mais tardia, com parceria estavel, contar com a familia como fonte potencial de contraceptivos e acesso a servicos de saude; entre as mocas, ter iniciado a vida sexual ha pouco tempo e ter o pai como fonte de informacao sobre sexualidade, contracepcao e prevencao DST/Aids. A gravidez foi relatada por 6,4% dos rapazes e 18,1% das mocas, sendo sua ausencia associada ao uso consistente de contraceptivos por elas (OR=3,83; 2,06-7,15). CONCLUSOES: Os resultados confirmam a complexidade da determinacao do comportamento contraceptivo entre adolescentes e a necessidade de que os programas educativos incorporem as multiplas dimensoes da questao para que tenham efetividade.

Do Service Providers in Tanzania Unnecessarily Restrict Clients' Access to Contraceptive Methods?

Data from the 1996 Tanzania Service Availability Survey are used to analyze the prevalence of medical barriers by type of provider by type of facility and by urban-rural location. Relatively high proportions of providers restrict eligibility by age particularly for oral contraceptives the most widely used method among Tanzanian women. Between 79% and 81% of medical aides trained midwives maternal and child health aides and auxiliary staff (the most common types of family planning service providers in rural Tanzania) impose age restrictions for the pill. Among all providers 10-13% report that there is at least one modern method they would never recommend and 13% report having sent a client home until her next menses an inappropriate process hurdle for the provision of most hormonal methods. In the aggregate these restrictions severely limit access to contraceptives for certain groups of women. For example young unmarried women who are not menstruating at the time of their visit would encounter one or more barriers or process hurdles at more than 70% of urban facilities and at 80% of rural facilities. If pre-service and in-service training and supervisory visits placed greater emphasis on compliance with the Tanzanian National Family Planning Programs service guidelines and standards providers unnecessary restrictions on contraceptive use might be reduced and ultimately eliminated. (authors)

The reliability of reporting of contraceptive behavior in DHS calendar data: evidence from Morocco.

This report addresses the consistency of reporting in the contraceptive calendar in the 1992 and 1995 Morocco Demographic and Health Surveys. Because a panel design was used in these surveys, the same women were interviewed in both years, providing a unique opportunity to examine the reliability of responses. Measures of reliability for various aspects of contraceptive-use dynamics are computed, and the impact of reporting errors on contraceptive failure, discontinuation, and switching rates is estimated. Results suggest that reporting of contraceptive behavior in Moroccan DHS calendar data appears to be relatively reliable at the aggregate level. Individual respondents, particularly those whose contraceptive patterns have been complex, have a lower level of reliability. The observed inconsistencies do not appear to affect aggregate-level estimates of contraceptive prevalence; however, measures of contraceptive-use dynamics are less stable.

THE EFFECTS OF MATERNAL–CHILD HEALTH SERVICE UTILIZATION ON SUBSEQUENT CONTRACEPTIVE USE IN MOROCCO

There are a number of reasons for anticipating that contact by women in developing country settings with modern maternal-child health (MCH) services will lead to increased use of family planning services. Indeed, the expectation of such a relationship underlies the integrated service delivery strategy that has been adopted on a more or less global basis. However, the available empirical evidence in support of this proposition is inconclusive. This study re-examines this issue in Morocco. Household survey data and data on the supply environment for health and family planning services gathered in 1992 are analysed in the study. A full-information maximum likelihood estimator is used to control for the possible endogeneity of health care and contraceptive choices. The findings indicate a substantial and apparently causal relationship between the intensity of MCH service use and subsequent contraceptive use. Policy simulations indicate that sizeable increases in contraceptive prevalence might be realized by increasing the coverage and intensity of use of MCH services.

Breast-feeding, water and sanitation, and childhood malnutrition in the Philippines

This study examines effects and interactions of socioeconomic status, access to water supply and sanitation, and breast-feeding practices in relation to child growth in two provincial cities in the Philippines. Multivariate analysis identified food expenditure per head, education of the household head and gender of the child as significant predictors of nutritional status. The duration of partial and full breast-feeding was negatively (though non-significantly) associated with growth. Sanitation facilities and breast-feeding are, however, important determinants during the first year of life. Among children over 1 year of age, socioeconomic variables and gender are the most important predictors. Breast-feeding is shown to provide more important health benefits for children in lower income households. The need for further studies on the causes of gender differences in nutritional status was apparent.

The relationship between maternal and child nutritional status in rural Guinea

It has become common public practice to consider the nutritional status of children under five years (as measured by anthropometry) as a barometer for the population as a whole, even though no published literature confirms the relationship between the nutritional status of different demographic segments of the population. This study investigates the relationship between maternal and child anthropometry using data from a regional cross‐sectional survey recently undertaken in the Republic of Guinea. The degree of correlation between maternal and child anthropometry is assessed and the performance of child anthropometric status as a screening tool for maternal anthropometric status is evaluated using various epidemiologic techniques. The major finding of this study is that although maternal and child anthropometric indices including receiver operator characteristic (ROC) analysis are significantly correlated, the magnitude of correlation is modest. More importantly, maternal malnutrition exists in many house...

The effects of monetized food aid on reproductive behavior in rural Honduras

This article presents research findings on the question of whether the monetization of non-emergency food aid has adversely influenced national family planning program efforts in Honduras. Women receiving food aid in the form of cash coupons are compared in the study with women receiving food rations and a third group of women with similar characteristics who were not food aid recipients on three types of outcomes: recent fertility, fertility preferences, and contraceptive use. The health facilities where study subjects received health/family planning services and food aid benefits were also compared to assess possible adverse cross-program effects on family planning service delivery. A ‘sample selection’ model was used in the analysis to control for unobserved differences between comparison groups. No compelling evidence for adverse demand- or supply-side effects of monetized food aid on family planning efforts was observed. The most striking study finding was the extremely high level of unmet need for family planning.

Prevalence and Differentials of Low Birth Weight in Niamey, Niger

This study provides population representative data on live births occurring in Niamey, Niger during the period 1980 to 1985. A total of 5097 live births were systematically sampled from maternity registers over the study period. Due to legislation and incentives to register all live births, between 90 and 95 per cent of all live births are represented in this study. The data here suggest that low birth weight (LBW) prevalence may be lower in this urban area than it is in the region as a whole; and that the demographic risk factors are similar to those found in other developing countries. Finally, in many developing countries, maternity coverage of attended births may be quite high, suggesting that record or prospective studies examining trends in LBW and risk factors for perinatal outcomes might be convenient and implemented at very low cost.