Stan Becker

Husband-Wife Communication About Family Planning and Contraceptive Use in Kenya

one or both partners know of at least one modern method, and among 85% of couples both partners approve of family planning. Discussion with the partner about family planning was reported in 82% of couples. However, only 67% of wives and 75% of husbands correctly predicted their spouse’s approval of family planning. Knowledge and approval of family planning, husband-wife communication, desire for more children and ideal family size are all significantly associated with current use. Multiple logistic regression analyses show that husband-wife communication, particularly the wife’s perception of her husband’s approval of family planning, is highly associated with current contraceptive use (odds ratio of 4.2). Dialogue appears to increase the effectiveness of communication: Specifically, one spouse’s perception of the other spouse’s approval is more likely to be correct if they have discussed family planning than if they have not, and this relationship significantly affects contraceptive use.

Contamination of weaning foods and transmission of enterotoxigenic Escherichia coli diarrhoea in children in rural Bangladesh

In longitudinal studies of infectious diseases and nutrition in Bangladesh, we determined the degree of bacterial contamination of traditional weaning foods and evaluated the role of these foods in the transmission of diarrhoeal diseases. 41% of samples of food items fed to weaning aged children contained Escherichia coli; these organisms were used as indicators of faecal contamination. Milk and foods prepared particularly for infants were more frequently and heavily contaminated with E. coli than was boiled rice, and E. coli levels were found to be related to the storage of cooked foods at high environmental temperatures. 50% of drinking water specimens also contained E. coli, but colony counts were approximately 10-fold lower than in food specimens. The proportion of a childs food samples that contained E. coli was significantly related to the childs annual incidence of diarrhoea associated with enterotoxigenic E. coli. This observation underscores the importance of seeking locally available foods that are hygienic as well as nutritious to supplement the diets of breastfeeding children in developing countries.

Socioeconomic factors differentiating maternal and child health-seeking behavior in rural Bangladesh: A cross-sectional analysis

BackgroundThere has been an increasing availability and accessibility of modern health services in rural Bangladesh over the past decades. However, previous studies on the socioeconomic differentials in the utilization of these services were based on a limited number of factors, focusing either on preventive or on curative modern health services. These studies failed to collect data from remote rural areas of the different regions to examine the socioeconomic differentials in health-seeking behavior.MethodsData from 3,498 randomly selected currently married women from three strata of households within 128 purposively chosen remote villages in three divisions of Bangladesh were collected in 2006. This study used bivariate and multivariate logistic analyses to examine both curative and preventive health-seeking behaviors in seven areas of maternal and child health care: antenatal care, postnatal care, child delivery care, mothers receipt of Vitamin A postpartum, newborn baby care, care during recent child fever/cough episodes, and maternal coverageby tetanus toxoid (TT).ResultsA principal finding was that a households relative poverty status, as reflected by wealth quintiles, was a major determinant in health-seeking behavior. Mothers in the highest wealth quintile were significantly more likely to use modern trained providers for antenatal care, birth attendance, post natal care and child health care than those in the poorest quintile (χ2, p < 0.01). The differentials were less pronounced for other factors examined, such as education, age, and the relative decision-making power of a woman, in both bivariate and multivariate analyses.ConclusionWithin rural areas of Bangladesh, where overall poverty is greater and access to health care more difficult, wealth differentials in utilization remain pronounced. Those programs with high international visibility and dedicated funding (e.g., Immunization and Vitamin A delivery) have higher overall prevalence and a more equitable distribution of beneficiaries than the use of modern trained providers for basic essential health care services. Implications of these findings and recommendations are provided.

Comparing couples' and individual voluntary counseling and testing for HIV at antenatal clinics in Tanzania: A randomized trial

Voluntary counseling and testing (VCT) for couples (CVCT) is an important HIV-prevention effort in sub-Saharan Africa where a substantial proportion of HIV transmission occurs within stable partnerships. This study aimed to determine the acceptance and effectiveness of CVCT as compared to individual VCT (IVCT). 1,521 women attending three antenatal clinics in Dar es Salaam were randomized to receive IVCT during that visit or CVCT with their husbands at a subsequent visit. The proportion of women receiving test results in the CVCT arm was significantly lower than in the IVCT arm (39 vs. 71%). HIV prevalence overall was 10%. In a subgroup analysis of HIV-positive women, those who received CVCT were more likely to use preventive measures against transmission (90 vs. 60%) and to receive nevirapine for themselves (55 vs. 24%) and their infants (55 vs. 22%) as compared to women randomized to IVCT. Uptake of CVCT is low in the antenatal clinic setting. Community mobilization and couple-friendly clinics are needed to promote CVCT.

Impact of community-based interventions on maternal and neonatal health indicators: Results from a community randomized trial in rural Balochistan, Pakistan

BackgroundPakistan has high maternal mortality, particularly in the rural areas. The delay in decision making to seek medical care during obstetric emergencies remains a significant factor in maternal mortality.MethodsWe present results from an experimental study in rural Pakistan. Village clusters were randomly assigned to intervention and control arms (16 clusters each). In the intervention clusters, women were provided information on safe motherhood through pictorial booklets and audiocassettes; traditional birth attendants were trained in clean delivery and recognition of obstetric and newborn complications; and emergency transportation systems were set up. In eight of the 16 intervention clusters, husbands also received specially designed education materials on safe motherhood and family planning. Pre- and post-intervention surveys on selected maternal and neonatal health indicators were conducted in all 32 clusters. A district-wide survey was conducted two years after project completion to measure any residual impact of the interventions.ResultsPregnant women in intervention clusters received prenatal care and prophylactic iron therapy more frequently than pregnant women in control clusters. Providing safe motherhood education to husbands resulted in further improvement of some indicators. There was a small but significant increase in percent of hospital deliveries but no impact on the use of skilled birth attendants. Perinatal mortality reduced significantly in clusters where only wives received information and education in safe motherhood. The survey to assess residual impact showed similar results.ConclusionsWe conclude that providing safe motherhood education increased the probability of pregnant women having prenatal care and utilization of health services for obstetric complications.

A meta-analysis of 61 sperm count studies revisited

OBJECTIVE To re-examine data on sperm counts over time from 61 studies from around the world. DESIGN Parametric analyses and flexible nonlinear models of the relation between sperm counts and time. MAIN OUTCOME MEASURE(S) Mean sperm concentrations per milliliter and regression coefficients for possible trends of concentrations over time. RESULT(S) A significant decline was found only in U.S. studies. CONCLUSION(S) Studies from specific sites have found declines in sperm counts, but a world-wide decline has not been demonstrated. Rigorous assessment of statistical models should be done before conclusions are drawn. Flexible smoothing models are a useful addition to currently available analytic methods.

Measuring Unmet Need: Wives, Husbands or Couples?

Data from the three Demographic and Health Surveys (DHS) in Bangladesh the Dominican Republic and Zambia were utilized to examine a new definition of unmet need--one that considers only responses regarding prospective fertility desires and intentions to use contraceptives. An unmet need is determined for wives for husbands and for couples. Results demonstrate that differences between spouses in contraceptive and fertility intentions are substantial in the three countries. There is a greater difference between husbands and wives concerning intentions to practice contraception than there is regarding childbearing intentions. In Zambia 55% of wives not practicing contraception report their intention to use contraceptives within 12 months compared with 36% of husbands. In Bangladesh the corresponding figures are 46% for wives and 42% for husbands while in the Dominican Republic the proportions are 49% and 41% respectively. When the unmet need calculated using wives reports is compared with the results using the minimum estimate couples unmet need is overestimated by 106% in Bangladesh by 96% in the Dominican Republic and by 246% in Zambia. On the other hand estimates based on wives reports were closer to the maximum estimate for couples. Based on these results the big discrepancies are an indication of spousal disagreement or lack of communication on reproductive goals or contraceptive use.

Contextual determinants of maternal mortality in rural Pakistan

Maternal mortality is high in Pakistan, particularly in the rural areas which have poor access to health services. We investigated the risk factors associated with maternal mortality in sixteen rural districts of Balochistan and the North-West Frontier (NWFP) provinces of Pakistan. We designed a nested case-control study comprising 261 cases (maternal deaths reported during last five years) and 9135 controls (women who survived a pregnancy during last five years). Using contextual analysis, we estimated the interactions between the biological risk factors of maternal mortality and the district-level indicators of health services. Women under 19 or over 39 yr of age, those having their first birth, and those having a previous history of fetal loss were at greater risk of maternal death. Staffing patterns of peripheral health facilities in the district and accessibility of essential obstetric care (EOC) were significantly associated with maternal mortality. These indicators also modified the effects of the biological risk factors of maternal mortality. For example, nulliparous women living in the under-served districts were at greater risk than those living in the better-served districts. Our results are consistent with several studies which have pointed out the role of health services in the causation of maternal mortality. Many such studies have implicated distance to hospital (an indicator of access to EOC) and lack of prenatal care as major determinants of maternal mortality. We conclude that better staffing of peripheral health facilities and improved access to EOC could reduce the risk of maternal mortality among women in rural Balochistan and the NWFP.

Reproductive health care: services oriented to couples

Historically, the combination of womens rights to care, population concerns and the development of female‐oriented contraceptive methods resulted in family planning programs focusing on womens contraceptive needs and little else. The 1994 United Nations Population Conference in Cairo called for an expansion of programs to cover reproductive health in its broadest interpretation. As this concept has developed and been put into practice it has become evident that a key element in reproductive health services should be the inclusion of the sexually active couple.

Contraceptive use in Matlab, Bangladesh: the role of gender preference

Research in several Asian societies has suggested that sons are generally preferred over daughters. The implications of gender preferences for actual fertility behavior have not been adequately investigated, however. This analysis examines the effect of the sex composition of surviving children on the acceptance and discontinuation of contraception in a sample of 3,145 women in Matlab, Bangladesh, who were observed for 60 months. Hazards regression analyses are employed in the analysis. Strong and highly significant effects of gender preference on contraceptive use are observed. The preference is not monotonically son-biased but is moderated toward a balanced composition, because parents desire to have several sons and at least one daughter. These findings suggest that gender preferences, particularly a preference for sons, represent a significant barrier to fertility regulation in rural Bangladesh.