Personality and mode of delivery

BACKGROUND

Women's rights to request an elective cesarean section without a specific medical indication has been intensively debated during the last decade among healthcare professionals. The aim of this study was to investigate if women requesting a cesarean section differ in their personality from those who plan a vaginal delivery. The aim was also to study differences between the groups in age, perceived health, and place of birth, IVF treatment, and family size planning.

METHOD

Three hundred and twenty-eight pregnant women from two different groups, "cesarean section on maternal request" (n=84), and "vaginal delivery group" (n=242) completed the self-report inventory Karolinska Scales of Personality at 37-39 gestational weeks in pregnancy.

RESULTS

A significant difference in age was found between the cesarean and the vaginal group (mean age 33.9 years versus 30.8, p<0.001). Analysis of covariance of personality traits showed that the subscales Monotony avoidance (p<0.003) and Socialization (p<0.002) differed significantly between women requesting cesarean section and women planning a vaginal delivery. There were no differences between the groups in variables concerning the anxiety proneness scale.

CONCLUSION

Personality traits such as Socialization and Monotony avoidance differ significantly before birth between mothers who request a cesarean section and those who do not.

Family planning: the unfinished agenda

Promotion of family planning in countries with high birth rates has the potential to reduce poverty and hunger and avert 32% of all maternal deaths and nearly 10% of childhood deaths. It would also contribute substantially to women's empowerment, achievement of universal primary schooling, and long-term environmental sustainability. In the past 40 years, family-planning programmes have played a major part in raising the prevalence of contraceptive practice from less than 10% to 60% and reducing fertility in developing countries from six to about three births per woman. However, in half the 75 larger low-income and lower-middle income countries (mainly in Africa), contraceptive practice remains low and fertility, population growth, and unmet need for family planning are high. The cross-cutting contribution to the achievement of the Millennium Development Goals makes greater investment in family planning in these countries compelling. Despite the size of this unfinished agenda, international funding and promotion of family planning has waned in the past decade. A revitalisation of the agenda is urgently needed. Historically, the USA has taken the lead but other governments or agencies are now needed as champions. Based on the sizeable experience of past decades, the key features of effective programmes are clearly established. Most governments of poor countries already have appropriate population and family-planning policies but are receiving too little international encouragement and funding to implement them with vigour. What is currently missing is political willingness to incorporate family planning into the development arena.

The effect of husbands' fertility preferences on couples' reproductive behaviour in rural Bangladesh

Bangladesh society is profoundly gender stratified, and yet male roles in reproductive health processes have not been rigorously investigated. This study examines the association between men's reproductive health knowledge, attitude and behaviour and their wives' subsequent reproductive behaviour using longitudinal data from the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). A total of 4969 matched husband-and-wife data from a 1998 survey and women's contraceptive use history data following this survey are used. Results show a significant association between husbands' fertility preferences and current use of any family planning method. When wives' background characteristics, and husbands' background and socioeconomic characteristics are controlled for, the predicted probability of using a method of contraception among non-educated wives whose husbands want more children is 0.49 compared with 0.64 for those whose husbands do not want more children. However, the net effect of husbands' preference for additional children diminishes as wives' level of education increases. Among wives who had completed high school, the predicted probability of using a method of contraception is 0.70 for those whose husbands want more children compared with 0.69 for those whose husbands do not want more children.

Circumstances of pregnancy: low income women in Georgia describe the difference between planned and unplanned pregnancies

INTRODUCTION AND BACKGROUND

The United States has a higher rate of unintended pregnancies than many other developed countries despite the availability of effective contraception. Using Azjen's Theory of Planned Behavior and Luker's Theory of Contraceptive Risk Taking this qualitative study explores the reasons for the high rate of unintended pregnancy among low income women in Georgia.

METHODS

Six focus groups (N=39) were conducted at county health department clinics. Women were recruited at the clinics to participate in a discussion of Pregnancy and Motherhood. All English or Spanish speaking women between the ages of 18 and 49 were eligible for participation.

RESULTS

Three dimensions of pregnancy planning emerged-the decision to have a child, taking specific behaviors to increase the likelihood of conception, and making plans to care for a child. Planned pregnancies may occur when a couple or a woman decides that they are ready to have a child, but also occur in less stable situations that pose risks for the family and the child. Unplanned pregnancies may be welcomed or be unwanted depending on the circumstances. Women perceive advantages and disadvantages to planned and unplanned pregnancies.

DISCUSSION

There are major differences between the definition and values of planned and unplanned pregnancies promoted by public health practitioners and those of the women in our study. This suggests the need for research on the circumstances in which pregnancies occur, as well as targeted interventions and policies that help women and men define and achieve the circumstances in which they would like to bear and rear children.

[Regression models for variables expressed as a continuous proportion]

OBJECTIVE

To describe some of the statistical alternatives available for studying continuous proportions and to compare them in order to show their advantages and disadvantages by means of their application in a practical example of the Public Health field.

MATERIALS AND METHODS

From the National Reproductive Health Survey performed in 2003, the proportion of individual coverage in the family planning program--proposed in one study carried out in the National Institute of Public Health in Cuernavaca, Morelos, Mexico (2005)--was modeled using the Normal, Gamma, Beta and quasi-likelihood regression models. The Akaike Information Criterion (AIC) proposed by McQuarrie and Tsai was used to define the best model.Then, using a simulation (Monte Carlo/Markov Chains approach) a variable with a Beta distribution was generated to evaluate the behavior of the 4 models while varying the sample size from 100 to 18,000 observations.

RESULTS

Results showed that the best statistical option for the analysis of continuous proportions was the Beta regression model, since its assumptions are easily accomplished and because it had the lowest AIC value. Simulation evidenced that while the sample size increases the Gamma, and even more so the quasi-likelihood, models come significantly close to the Beta regression model.

CONCLUSIONS

The use of parametric Beta regression is highly recommended to model continuous proportions and the normal model should be avoided. If the sample size is large enough,the use of quasi-likelihood model represents a good alternative.

Provision of contraceptive and related services by publicly funded family planning clinics, 2003

CONTEXT

In addition to contraceptive services, publicly funded family planning clinics provide low-income women with a range of reproductive diagnostic, treatment and educational services. Nationally representative information about the scope of services available from clinics is needed to formulate policy and programmatic recommendations.

METHODS

In 2003, more than 1,000 U.S. clinics responded to an eight-page survey on service availability and clinic policies. Differences in the proportions of clinics reporting each service or policy were examined by clinic type and receipt of Title X funding.

RESULTS

Nearly all clinics offer pills, injectables and condoms; 75% offer the patch; and 80% offer emergency contraception. Most clinics (73%) typically use a conventional Pap smear for initial cervical cancer screenings; 27% use liquid-based Pap tests. For follow-up, 68% of clinics use liquid-based or other advanced testing. Virtually all clinics screen at least some clients for chlamydia; Planned Parenthood and Title X-funded clinics, more than others, tend to focus screening efforts on sexually active women aged 25 and younger. Single-dose treatments are provided by 58% of clinics. Nine in 10 clinics offer HIV testing on-site, most of them to any client who requests it. Services targeted to specific populations include counseling about abstinence for minors (91%); non-reproductive health services for men (36%); and availability of staff such as translators (81%) and bilingual administrative (59%) or clinical personnel (57%) for non-English-speaking clients.

CONCLUSIONS

More public funding is imperative for clinics to keep up with the demands of new technologies and a diverse client base.

Public finance policy strategies to increase access to preconception care

Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15-44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states' experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs.

Advanced Methods for Evaluating the Impact of Family Planning Communication Programs: Evidence from Tanzania and Nepal

Evaluations of national family planning communication campaigns are often complicated by nonrandomized research designs and self-reported measures of exposure to media messages, both of which can bias estimates of campaign effectiveness if suitable analytical methods are not employed. This study uses three methods to address these problems: (1) single-equation multiple regression analysis; (2) propensity score matching (PSM); and (3) maximum-likelihood simultaneous equation models (SEM), namely bivariate probit. We use these methods to evaluate the impact of family planning health-communication campaigns on the use of modern family planning methods, focusing primarily on the radio drama Zinduka! in Tanzania and Ghanti Heri Haad Nilaun in Nepal. We find that these methods led to substantially different estimates of the magnitude of the impact of these communication campaigns. Specifically, we found that self-reported exposure to each radio program was exogenously related to family planning use and that PSM and multiple regression analysis gave similar estimates in those situations. An indicator of exposure to any type of family planning message was found to be endogenous, in which case bivariate probit and PSM gave different estimates of program impact. Researchers should, therefore, pay close attention to the results of tests for endogeneity and identification that guide the appropriate use of the different methods.

Family planning services: an essential component of preconception care

Family planning services are necessary for the widespread adoption of preconception care for two reasons. First, preconception care is more likely if pregnancies are planned, and family planning services encourage pregnancy planning. Second, family planning services usually include counseling, and counseling provides an opportunity to discuss the advantages of preconception care. However, the potential of family planning services to promote preconception care is limited by underutilization of these services and inadequate attention to preconception care during family planning visits. This article suggests ways to reduce these problems.

Estimates of pregnancies averted through California's family planning waiver program in 2002

CONTEXT

During its first year of operation (1997-1998), California's family planning program, Family PACT, helped more than 750,000 clients to avert an estimated 108,000 pregnancies. Given subsequent increases in the numbers of clients served and contraceptive methods offered by the program, updated estimates of its impact on fertility are needed.

METHODS

Claims data on contraceptives dispensed were used to estimate the number of pregnancies experienced by women in the program in 2002. Medical record data on methods used prior to enrollment were used to predict client fertility in the absence of the program. Further analyses examined the sensitivity of these estimates to alternative assumptions about contraceptive failure rates, contraceptive continuation and contraceptive use in the absence of program services.

RESULTS

Almost 6.4 million woman-months of contraception, provided primarily by oral contraceptives (57%), barrier methods (19%) and the injectable (18%), were dispensed through Family PACT during 2002. As a result, an estimated 205,000 pregnancies-which would have resulted in 79,000 abortions and 94,000 births, including 21,400 births to adolescents-were averted. Changing the base assumptions regarding contraceptive failure rates or method use had relatively small effects on the estimates, whereas assuming that clients would use no contraceptives in the absence of Family PACT nearly tripled the estimate of pregnancies averted.

CONCLUSION

Because all contraceptive methods substantially reduce the risk of pregnancy, Family PACT's impact on preventing pregnancy lies primarily in providing contraceptives to women who would otherwise not use any method.

The causes of stalling fertility transitions

An examination of fertility trends in countries with multiple DHS surveys found that in the 1990s fertility stalled in midtransition in seven countries: Bangladesh, Colombia, Dominican Republic, Ghana, Kenya, Peru, and Turkey. In each of these countries fertility was high (more than six births per woman) in the 1950s and declined to fewer than five births per woman in the early or mid-1990s, before stalling. The level of stalling varied from 4.7 births per woman in Kenya to 2.5 births per woman in Turkey. An analysis of trends in the determinants of fertility revealed a systematic pattern of leveling off or near leveling in a number of determinants, including contraceptive use, the demand for contraception, and number of wanted births. The stalling countries did not experience significant increases in unwanted births or in the unmet need for contraception during the late 1990s, and program effort scores improved slightly, except in the Dominican Republic. These findings suggest no major deterioration in contraceptive access during the stall, but levels of unmet need and unwanted births are relatively high, and improvements in access to family planning methods would, therefore, be desirable. No significant link was found between the presence of a stall and trends in socioeconomic development, but at the onset of the stall the level of fertility was low relative to the level of development in all but one of the stalling countries.

Male Hispanic immigrants talk about family planning

In order to improve delivery of family planning services by better understanding the views of people affected, researchers conducted four focus groups among Hispanic men who recently migrated to a Midwestern community. Participants expressed opinions about, attitudes towards, and knowledge of such matters as family planning, birth control information and access, the influence of religion on family planning and birth control decisions, general familial relations, the prevalence of infidelity, use of and access to the health care system, and cultural differences between the U.S. and their countries of origin. The men voiced opinions and attitudes supportive of family planning and appeared knowledgeable about various methods of birth control. Understanding the attitudes held by immigrant men is important for health care providers in designing successful service interventions for this rapidly growing segment of the population.

Social marketing: planning before conceiving preconception care

Social marketing approaches can help to shape the formation of and to create demand for preconception care services. This article describes four components of social marketing, often referred to as the 4 P’s, that should be carefully researched and set in place before a national effort to launch and sustain preconception care services is pursued. First, the product or package of services must be defined and adapted using the latest in scientific and health care standards and must be based on consumer needs and desires. Second, the pricing of the services in financial or opportunity costs must be acceptable to the consumer, insurers, and health care service providers. Third, the promotion of benefits must be carefully crafted to reach and appeal to both consumers and providers. Fourth, the placement and availability of services in the marketplace must be researched and planned. With the application of market research practices that incorporate health behavior theories in their exploration of each component, consumer demand for preconception care can be generated, and providers can take preconception care to the market with confidence.

Dutch community midwives’ views on preconception care

OBJECTIVE

to explore the opinions of midwives on the desirability of preconception care for all couples contemplating pregnancy, their willingness to introduce preconception care to midwifery practice and, if it were to be implemented, the necessary conditions, including knowledge, postgraduate education and referral possibilities for successful implementation in the community.

PARTICIPANTS

all community midwives (n = 129) working in 49 midwifery practices that refer their high-risk clients to the Erasmus University Medical Centre, Rotterdam (the Netherlands).

SETTING

Rotterdam and its immediate surrounding communities.

DESIGN

midwives working at the midwifery practices were recruited by telephone. All agreed to participate, and subsequently received a questionnaire by post.

FINDINGS

102 (79%) questionnaires were returned. Ninety-five (93%) of the 102 midwives were familiar with the concept of preconception care, and 71 (70%) of them already provided it to some extent. Of the 102 respondents, 84 (83%) seemed to be willing to provide such care in the future, and 56 (55%) felt that preconception care should be part of their professional domain. Midwives, however, lack time and knowledge to do so.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

community midwives already provide counselling, although not on a structural basis, and usually not earlier than in the first trimester of pregnancy. Midwives seem willing to play an active role in the provision of preconception care in the future. There is, however, great need for postgraduate training.

The influence of method-related partner violence on covert pill use and pill discontinuation among women living in La Paz, El Alto and Santa Cruz, Bolivia

Intimate partner violence is widespread worldwide. While assumed to impact women's ability to use contraceptive methods, few data are available to support this claim. In this study, eight focus group discussions were conducted to guide questionnaire development and to provide contextual information. Participants were women who were currently using the pill and women who had used the pill previously. In addition, 300 women were interviewed who initiated oral contraceptive pill use between December 1995 and April 1996. Participants were interviewed 3-6 months later to investigate the role intimate partner violence played in covert pill use and pill discontinuation. Special study procedures for asking women questions about violence were employed. Nineteen per cent of the women interviewed were using the pill covertly. The odds of covert pill use were four times higher in El Alto and La Paz than in Santa Cruz. Women who used the pill covertly were more likely to have experienced method-related partner violence (OR = 21.27) than women whose partners knew of their pill use. One-third of the women had discontinued pill use at the time of the interview. In the final multivariate analysis, having experienced side-effects (OR = 2.37) was a significant predictor of pill discontinuation and method-related partner violence was marginally predictive (OR = 1.91; 95% CI 1.0-3.66). While efforts are ongoing to incorporate men into family planning programmes, some male partners oppose, and in some situations violently oppose, contraceptive use. The needs of women with these types of partners must not be overlooked.

Improving birth control service utilization by offering services prerelease vs postincarceration

OBJECTIVES

We examined whether incarcerated women would substantially increase birth control initiation if contraceptive services were available within the prison compared with after their release back into the community.

METHODS

During phase 1 of the study, a nurse educator met with women at the Rhode Island Adult Correctional Institute and offered them referrals for contraceptive services at a community health clinic after their release. During phase 2, contraceptive services were offered to women during their incarceration.

RESULTS

The majority of the participants (77.5%) reported a desire to initiate use of birth control methods. Within 4 weeks of their release, 4.4% of phase 1 participants initiated use of a contraceptive method, compared with 39.1% of phase 2 participants (odds ratio [OR]=14.6; 95% confidence interval [CI]=5.5, 38.8).

CONCLUSIONS

Provision of contraceptive services to women during their incarceration is feasible and greatly increases birth control initiation compared to providing services only in the community.

African American women and family planning services: perceptions of discrimination

OBJECTIVES

The purpose of this study was to examine perceived race-based discrimination in obtaining family planning or contraceptive services among African American women in the U.S.

METHODS

We conducted a 30-minute telephone survey with a random sample of 500 African Americans (aged 15-44), which included questions about race-based discrimination when obtaining family planning services. The present analyses were limited to the 326 women who completed interviews.

RESULTS

The majority (79%) of women reported having seen a health care provider for family planning or birth control services. Of those, 67% reported race-based discrimination when obtaining such services. Half of the women reported more general experiences of discrimination when obtaining family planning services (e.g., poorer service), and 52% reported experiences that reflect stereotypes of African American women (e.g., doctor or nurse assumed they had multiple sexual partners). Most indicated that experiences of discrimination occurred infrequently. Generally, background characteristics were not significantly associated with perceived discrimination. However, in multivariate models, stronger Black identity, younger age, and lower income were associated with reports of discrimination.

CONCLUSION

African American women may be vulnerable to prejudice within reproductive health care contexts, including family planning.

Comparative study of the characteristics of family planning service users and non-users in northwest Ethiopia

Three hundred and forty-four (49.6%) family planning users and 350 (50.4%) non-family planning users were included in a study to assess the factors that are associated with utilisation of family planning services at different levels of health institutions in northwest Ethiopia. Desire for (more) children was the most common reason (51.4%) for not using family planning services, followed by inadequate knowledge about family planning services (14.6%). A higher proportion of the non-users were illiterate, of lower parity, and had their last child under one year of age (P<0.05). In logistics regression analysis family planning was significantly lower in the illiterate. Positive husband's attitude had the strongest association (OR 9.3, 95% CI 4.6, 18.7) with family planning. In addition to programs that create demand for smaller well-spaced children, IEC and family planning services should target men and strong emphasis should be given to use of family planning methods in as early period after birth as possible.

Prevalence and determinants of unmet need for family planning in a district of eastern region of Nepal

OBJECTIVES

The unmet need for family planning is defined as the discrepancy between individual's contraceptive behaviors and their stated fertility preferences--The extent of which is very high in developing countries like Nepal. This study explores the unmet need and its determinants.

METHODS

Among the teaching district of B.P. Koirala institute of Health Sciences, in the Eastern Region of Nepal, a district was selected randomly to conduct a cross-sectional study. A total of 1079 women were selected using systematic random sampling. We compared different demographic variables and sex-ration to unmet need by using means, percentage and applied chi-squared test where applicable.

RESULT

The extent of unmet need is 25 percent with 9.5 percent for spacing and 15.5 percent for limiting. The mean age at marriage is 16(+/-3.2) years. A strong association of gender preferences towards male child and unmet need exist, which is highly significant.

CONCLUSION

Unmet need is high despite extensive family planning program in Nepal. Mean age at marriage below legal age, low female education and gender discrimination are the factors responsible for unmet need.

"Fewer Children, Better Life" or "As Many as God Wants"?

In the West it is often assumed that religion (esp. Islam) and contraception are mutually exclusive. Yet, the Islamic Republic of Iran has one of the most successful family-planning programs in the developing world, and is often looked to as a potential model for other Muslim countries. Although Iran's family-planning program has been extremely successful among Iranians, it has been far less successful among Afghan refugees and other ethnic groups. Afghans and Iranians both seek services in Iran's public health sector for family health care, treatment of infectious disease, and childhood vaccinations. On these occasions, all adult married patients are strongly encouraged to use family planning to reduce the number of offspring. In this article, we explore how Iran's family-planning program is differentially perceived and utilized among low-income Iranian and Afghan refugee families in rural and urban locations. Particular attention is given to how different interpretations of Islam may or may not influence reproductive health-related behaviors and how cultural factors influence reproductive strategies.

Preventing and Terminating Unwanted Pregnancies in Turkey

PURPOSE

To determine the methods used to prevent pregnancy by women seeking abortion of unwanted pregnancy, their knowledge and use of emergency contraception, and reasons for wanting the abortion.

DESIGN

The sample was 144 randomly selected women, who requested abortion for termination of their pregnancies at two hospitals in Izmir, Turkey, during the study period.

METHODS

A questionnaire was completed by the researcher in face-to-face interviews.

FINDINGS

In this sample 43.8% had had previous abortions; 77.1% used some method of family planning; 7.0% used emergency contraceptives. The methods selected after unprotected sexual intercourse by these women included vaginal douche (37.5%), waiting to see whether the menstrual cycle would begin (27.0%), going to a hospital or maternal-child health center (24.3%), and two other alternatives (4.2%). One-fifth of the women said that, if they get pregnant again, they will have another abortion.

CONCLUSIONS

The number of unwanted pregnancies is high and many women seek abortions as a birth control method. Women in this sample needed information about effective methods for preventing pregnancy.

The provision and funding of contraceptive services at publicly funded family planning agencies: 1995-2003

CONTEXT

Publicly funded family planning agencies face significant challenges in delivering quality services to low-income women because of the higher costs of newer contraceptive methods, changes in health care financing and a growing uninsured population.

METHODS

In 2003, 627 of a nationally representative sample of 956 U.S. agencies receiving public funding for family planning services responded to an eight-page survey. Responses were compared with results from similar surveys in 1995 and 1999 to describe changes in the availability of contraceptive methods, policies on method provision and funding issues. Variation was examined by agency type and Title X funding status.

RESULTS

Between 1995 and 2003, the number of contraceptive methods available to women increased and agencies reduced barriers to oral and emergency contraceptives by liberalizing policies for their provision. By 2003, many agencies offered the newest contraceptive methods available-the progestin-only IUD (58%), the patch (76%) and the vaginal ring (39%). However, more than half of agencies did not stock certain methods because of their cost, and some key funding sources had declined. Between 1995 and 2003, the proportion of agencies receiving Medicaid funding fell from 91% to 80%, and the proportion of clients paying full fee for their contraceptive services fell from 19% to 14%. The share of agencies waiving fees for adolescents fell from 66% in 1999 to 44% in 2003.

CONCLUSIONS

Continued funding challenges limit the ability of publicly funded providers to offer all available methods to all women.

Prevalence of sexual activity and family-planning use among undergraduates in Southwest Nigeria

OBJECTIVE

To assess the prevalence of sexual activity and family-planning use among undergraduates in a private tertiary institution in Nigeria.

METHODS

A cross-sectional survey of 283 undergraduate students.

RESULTS

Out of 283 students, 245 (86.6%) are sexually active in the last month. Out of these 245, 219 (89%) are currently using a family-planning method. In the study population, the percentages of awareness, ever use, and current users are 89%, 77%, and 75%, respectively. The most commonly known, ever used, and currently used contraceptive is condom followed in descending order by calendar method, oral pills, coitus interruptus, injectable contraception, emergency contraception, intrauterine contraceptive device, and diaphragm. Unmarried students and male gender show statistical significance with condom use. The reasons for preferring the current contraceptive method, among 219 current users, include safety, cost, ready availability, and partner's preference, among others. Most of the nonusers gave no reason for a failure to use a contraceptive, but others felt that contraceptives are dangerous, while a minority were ignorant of any method. Though many use a condom, this use is inconsistent.

CONCLUSION

There is a high level of sexual activity among these undergraduates. Many are aware of family planning, and the condom is the most commonly known and used method, though not consistently. Reproductive-health education should be promoted among youths in Nigeria.

Women on top: the relative influence of wives and husbands on contraceptive use in KwaZulu-Natal

OBJECTIVES

The purpose of this paper is to examine the relative influence of husband and wife on contraceptive practice.

METHODS

A cross-sectional survey was conducted among adult men and women in KwaZulu-Natal, South Africa. A matched file for 238 married or cohabiting couples was created.

RESULTS

Knowledge of methods of contraception was virtually universal and attitudes to contraception were favorable both in men and women. A substantial proportion of men and women reported using a method of contraception. The wife's desire to stop childbearing was the most powerful predictor of contraceptive use among couples, after adjustment for possible confounders. The husband's approval (or not) of family planning and his preference for future childbearing were not significantly related to contraceptive use.

CONCLUSION

Contraceptive use within marital and cohabiting unions is high and the wife's fertility preference was found to be a key determinant of use. This conclusion challenges conventional wisdom that men are the dominant decision-makers in fertility and family planning decisions.

Chlamydia trachomatis infection in the family planning clinical setting across New South Wales

Background: Following a small pilot study in 2003, a study was set up to determine the prevalence of genital Chlamydia trachomatis infection in young women presenting to Family Planning NSW centres across New South Wales and to evaluate the characteristics of those infected. Methods: A cross-sectional survey of 621 consecutive women aged from 16 to 24 years was carried out over a 3-month period in 2004 at five Family Planning NSW centres. Urine samples were tested for C. trachomatis using the polymerase chain reaction (PCR) method. Women with a positive result were reviewed and treated. Results: Of 925 eligible clients, 621 (67%) were recruited to the study. Chlamydia trachomatis was detected in 35 of the 621 recruits (5.6%, 95% CI 3.8–7.4). The prevalence at the Hunter centre was significantly higher than the combined prevalence at the other four participating centres (9.7% compared with 3.9%; P = 0.008). Two characteristics were identified as independent predictors of infection in this study: ‘reporting a recent change of partner in the past three months’ (crude odds ratio (OR) 3.33, 95% CI 1.67–6.64) and ‘reporting three or more partners in the past year’ (crude OR 3.69, 95% CI 1.83–7.46). Reported condom use, a history of one or more sexually transmissible infections and current combined oral contraceptive pill use were not associated with infection in this study. Conclusions: The prevalence of C. trachomatis infection is sufficiently high to support targeted testing of 16–24-year-old women in the Family Planning NSW setting and informs the development of a national screening strategy.