Shelley Clark

Son preference and sex composition of children: Evidence from india

Although the effect of son preference on sex composition of children ever born is undetectable in national-level estimates that aggregate across all families, this article provides empirical evidence from India that son preference has two pronounced and predictable family-level effects on the sex composition of children ever born. First, data from India show that smaller families have a significantly higher proportion of sons than larger families. Second, socially and economically disadvantaged couples and couples from the northern region of India not only want but also attain a higher proportion of sons, if the effects of family size are controlled.

Misoprostol for women's health: a review.

OBJECTIVE To review published literature on misoprostol for womens health indications to provide a synthesis of available information and highlight areas in need of additional research. DATA SOURCES: Studies were identified through searches of medical literature databases including MEDLINE, Cochrane Database, and Popline, in addition to a review of references from identified articles. STUDY SELECTION: We included all studies reported in English and published before March 31, 2001, which evaluated the efficacy of misoprostol alone for labor and delivery, evacuation of the uterus after pregnancy failure and induced abortion. Studies were not excluded based on quality or sample size. TABULATION, INTEGRATION, AND RESULTS: Misoprostol shows promise for all of the womens health indications addressed. Currently available data, though, are often hard to interpret because of variations in regimen, dose, and outcome measures. The low cost, ease of administration and storage, and widespread availability of misoprostol make it particularly appealing for developing countries. Because many of the womens health problems for which misoprostol could be prescribed currently cause significant mortality and morbidity, increased access to and information on use of misoprostol could help improve womens health especially where these problems are most severe. CONCLUSION Further research is needed to identify optimal regimens for misoprostol for obstetric and gynecologic health indications. Registering misoprostol with national drug regulatory authorities for any of several womens health indications could help increase access to and safe use of this drug. Provider training would be a logical subsequent step.

Emergency Contraception in Nairobi, Kenya: Knowledge, Attitudes and Practices Among Policymakers, Family Planning Providers and Clients, and University Students

To gauge knowledge, attitudes, and practices about emergency contraception in Nairobi, Kenya, we conducted a five-part study. We searched government and professional association policy documents, and clinic guidelines and service records for references to emergency contraception. We conducted in-depth interviews with five key policymakers, and with 93 family planning providers randomly selected to represent both the public and private sectors. We also surveyed 282 family planning clients attending 10 clinics, again representing both sectors. Finally, we conducted four focus groups with university students. Although one specially packaged emergency contraceptive (Postinor levonorgestrel tablets) is registered in Kenya, the method is scarcely known or used. No extant policy or service guidelines address the method specifically, although revisions to several documents were planned. Yet policymakers felt that expanding access to emergency contraception would require few overt policy changes, as much of the guidance for oral contraception is already broad enough to cover this alternative use of those same commodities. Participants in all parts of the study generally supported expanded access to emergency contraception in Kenya. They did, however, want additional, detailed information, particularly about health effects. They also differed over exactly who should have access to emergency contraception and how it should be provided.

Sexual and marital trajectories and HIV infection among ever-married women in rural Malawi

Objective: To explore how sexual and marital trajectories are associated with HIV infection among ever-married women in rural Malawi. Methods: Retrospective survey data and HIV biomarker data for 926 ever-married women interviewed in the Malawi Diffusion and Ideational Change Project were used. The associations between HIV infection and four key life course transitions considered individually (age at sexual debut, premarital sexual activity, entry into marriage and marital disruption by divorce or death) were examined. These transitions were then sequenced to construct trajectories that represent the variety of patterns in the data. The association between different trajectories and HIV prevalence was examined, controlling for potentially confounding factors such as age and region. Results: Although each life course transition taken in isolation may be associated with HIV infection, their combined effect appeared to be conditional on the sequence in which they occurred. Although early sexual debut, not marrying one’s first sexual partner and having a disrupted marriage each increased the likelihood of HIV infection, their risk was not additive. Women who both delayed sexual debut and did not marry their first partner are, once married, more likely to experience marital disruption and to be HIV-positive. Women who marry their first partner but who have sex at a young age, however, are also at considerable risk. Conclusions: These findings identify the potential of a life course perspective for understanding why some women become infected with HIV and others do not, as well as the differentials in HIV prevalence that originate from the sequence of sexual and marital transitions in one’s life. The analysis suggests, however, the need for further data collection to permit a better examination of the mechanisms that account for variations in life course trajectories and thus in lifetime probabilities of HIV infection.

The Relationship History Calendar: Improving the Scope and Quality of Data on Youth Sexual Behavior

Most survey data on sexual activities are obtained via face-to-face interviews, which are prone to misreporting of socially unacceptable behaviors. Demographers have developed various private response methods to minimize social desirability bias and improve the quality of reporting; however, these methods often limit the complexity of information collected. We designed a life history calendar—the Relationship History Calendar (RHC)—to increase the scope of data collected on sexual relationships and behavior while enhancing their quality. The RHC records detailed, 10-year retrospective information on sexual relationship histories. The structure and interview procedure draw on qualitative techniques, which could reduce social desirability bias. We compare the quality of data collected with the RHC with a standard face-to-face survey instrument through a field experiment conducted among 1,275 youth in Kisumu, Kenya. The results suggest that the RHC reduces social desirability bias and improves reporting on multiple measures, including higher rates of abstinence among males and multiple recent sexual partnerships among females. The RHC fosters higher levels of rapport and respondent enjoyment, which appear to be the mechanisms through which social desirability bias is minimized. The RHC is an excellent alternative to private response methods and could potentially be adapted for large-scale surveys.

Safety, Efficacy and Acceptability of Mifepristone-Misoprostol Medical Abortion in Vietnam

Results: Success rates for both methods were extremely high (96% for medical abortion and 99% for surgical abortion). Medical abortion patients reported many more side effects than women obtaining surgical procedures (most commonly, cramping, prolonged bleeding and nausea), but none of these side effects represented a serious medical risk. Nearly all women, regardless of the method they chose, were satisfied with their abortion experience. Additionally, among women who had previously undergone surgical abortion, those who selected medical abortion were more likely than those who chose surgery to say that their study abortion was more satisfactory than their earlier one (32% vs. 4%).

Single motherhood and child mortality in sub-Saharan Africa: a life course perspective.

Single motherhood in sub-Saharan Africa has received surprisingly little attention, although it is widespread and has critical implications for children’s well-being. Using survival analysis techniques, we estimate the probability of becoming a single mother over women’s life course and investigate the relationship between single motherhood and child mortality in 11 countries in sub-Saharan Africa. Although a mere 5 % of women in Ethiopia have a premarital birth, one in three women in Liberia will become mothers before first marriage. Compared with children whose parents were married, children born to never-married single mothers were significantly more likely to die before age 5 in six countries (odds ratios range from 1.36 in Nigeria to 2.61 in Zimbabwe). In addition, up to 50 % of women will become single mothers as a consequence of divorce or widowhood. In nine countries, having a formerly married mother was associated with a significantly higher risk of dying (odds ratios range from 1.29 in Zambia to 1.75 in Kenya) relative to having married parents. Children of divorced women typically had the poorest outcomes. These results highlight the vulnerability of children with single mothers and suggest that policies aimed at supporting single mothers could help to further reduce child mortality in sub-Saharan Africa.

Misoprostol use in obstetrics and gynecology in Brazil, Jamaica, and the United States

Objectives: To investigate current clinical use of misoprostol for the treatment of a range of reproductive health indications by providers in Brazil, Jamaica, and the United States. Methods: Using a ‘snowball’ sampling technique, we surveyed 228 gynecologists and obstetricians in Brazil (n=123), Jamaica (n=52), and the United States (n=53). Results: Providers use misoprostol for labor induction (46%), postpartum hemorrhage (8%), intra‐uterine fetal death (61%), cervical priming (21%), missed abortion (57%), and incomplete abortion (16%) as well as first and second trimester abortion induction (27% and 13%, respectively). Conclusions: There is considerable variation in the regimens used; moreover, the regimens commonly used in clinical practice often differ from those recommended in the medical literature. While misoprostol is an appealing alternative for many reproductive health indications in developing countries, the varied regimens and lack of registration raise critical medical and policy questions.

HIV Risk Among Currently Married Couples in Rural Malawi: What Do Spouses Know About Each Other?

In countries with generalized HIV/AIDS epidemics, married couples have a shared risk of acquiring HIV/AIDS. Yet very little research has adopted a couple-level perspective to investigate perceived risk of HIV infection. In this paper, we used population-based data from 768 married monogamous couples in the 2004 Malawi Diffusion and Ideational Change Project (MDICP) to compare respondents’ perceptions about their spouses’ HIV status to their spouses’ actual HIV status. Using chi-squared and Kappa coefficient statistics, we evaluated how accurately respondents assess their spouse’s HIV status, and compared the assessment of their spouse’s HIV status with their assessment of their own serostatus. We found that individuals tend to overestimate their spouse’s as well as their own risk of having HIV. Husbands were generally more accurate in assessing their own risk of HIV infection than that of their wives, but wives were more accurate in assessing the HIV status of their spouses. In our multivariate logistic regression results, we found that marital infidelity is the most important correlate of overestimating individual and spousal HIV risk.

Emergency contraception: knowledge attitudes and practices among Brazilian obstetrician-gynecologists.

A nationally representative randomly selected sample of 579 Brazilian obstetrician-gynecologists responded to a 1997 mail-in survey that assessed their knowledge attitudes and practices on emergency contraception. Awareness of the concept of emergency contraception was virtually universal (98%); only 2% of the respondents have never heard of it. The vast majority of the respondents (66%) correctly indicated that emergency contraception prevents pregnancy. However 15% incorrectly thought that it induces abortion. Despite providers largely favorable attitudes toward emergency contraception they seldom informed their clients about the method or prescribed it. Of all physicians who responded to the survey only 11% reported informing all their female clients. About 43% provided information on emergency contraception only if their clients requested it and 41% did not usually inform their clients. Most surprisingly while 61% of the respondents reported having provided emergency contraception only 15% of these physicians could correctly list the brand name of a pill they prescribed the dosage and regimen and the timing of the first dose. Therefore educational efforts focusing on the specific prescription information and the introduction of a dedicated product would greatly improve womens access to emergency contraception in Brazil.