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Aventin Á, Robinson M, Hanratty J, Keenan C, Hamilton J, McAteer ER, Tomlinson M, Clarke M, Okonofua F, Bonell C, Lohan M. Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1296. [PMID: 36911859 PMCID: PMC9837728 DOI: 10.1002/cl2.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Indexed: 06/18/2023]
Abstract
Background Involving men and boys as both users and supporters of Family Planning (FP) is now considered essential for optimising maternal and child health outcomes. Evidence on how to engage men and boys to meet FP needs is therefore important. Objectives The main objective of this review was to assess the strength of evidence in the area and uncover the effective components and critical process- and system-level characteristics of successful interventions. Search Methods We searched nine electronic databases, seven grey literature databases, organisational websites, and the reference lists of systematic reviews relating to FP. To identify process evaluations and qualitative papers associated with the included experimental studies, we used Connected Papers and hand searches of reference lists. Selection Criteria Experimental and quasi-experimental studies of behavioural and service-level interventions involving males aged 10 years or over in low- and middle-income countries to increase uptake of FP methods were included in this review. Data Collection and Analysis Methodology was a causal chain analysis involving the development and testing of a logic model of intervention components based on stakeholder consultation and prior research. Qualitative and quantitative data relating to the evaluation studies and interventions were extracted based on the principles of 'effectiveness-plus' reviews. Quantitative analysis was undertaken using r with robust variance estimation (RVE), meta-analysis and meta-regression. Qualitative analysis involved 'best fit' framework synthesis. Results We identified 8885 potentially relevant records and included 127 in the review. Fifty-nine (46%) of these were randomised trials, the remainder were quasi-experimental studies with a comparison group. Fifty-four percent of the included studies were assessed as having a high risk of bias. A meta-analysis of 72 studies (k = 265) showed that the included group of interventions had statistically significantly higher odds of improving contraceptive use when compared to comparison groups (odds ratio = 1.38, confidence interval = 1.21 to 1.57, prediction interval = 0.36 to 5.31, p < 0.0001), but there were substantial variations in the effect sizes of the studies (Q = 40,647, df = 264, p < 0.0001; I 2 = 98%) and 73% was within cluster/study. Multi-variate meta-regression revealed several significant intervention delivery characteristics that moderate contraceptive use. These included community-based educational FP interventions, interventions delivered to women as well as men and interventions delivered by trained facilitators, professionals, or peers in community, home and community, or school settings. None of the eight identified intervention components or 33 combinations of components were significant moderators of effects on contraceptive use. Qualitative analysis highlighted some of the barriers and facilitators of effective models of FP that should be considered in future practice and research. Authors' Conclusions FP interventions that involve men and boys alongside women and girls are effective in improving uptake and use of contraceptives. The evidence suggests that policy should continue to promote the involvement of men and boys in FP in ways that also promote gender equality. Recommendations for research include the need for evaluations during conflict and disease outbreaks, and evaluation of gender transformative interventions which engage men and boys as contraceptive users and supporters in helping to achieve desired family size, fertility promotion, safe conception, as well as promoting equitable family planning decision-making for women and girls.
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Affiliation(s)
- Áine Aventin
- Queen's University BelfastBelfastNorthern Ireland
| | | | | | - Ciara Keenan
- Queen's University BelfastBelfastNorthern Ireland
| | | | | | - Mark Tomlinson
- Queen's University BelfastBelfastNorthern Ireland
- Stellenbosch UniversityStellenboschSouth Africa
| | - Mike Clarke
- Queen's University BelfastBelfastNorthern Ireland
| | | | - Chris Bonell
- London School of Hygiene and Tropical MedicineLondonUK
| | - Maria Lohan
- Queen's University BelfastBelfastNorthern Ireland
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Karra M, Zhang K. User-Centered Counseling and Male Involvement in Contraceptive Decision Making: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e24884. [PMID: 33818398 PMCID: PMC8056297 DOI: 10.2196/24884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/04/2021] [Accepted: 02/16/2021] [Indexed: 02/05/2023] Open
Abstract
Background To achieve informed choice within the framework of reproductive autonomy, family planning programs have begun to adopt user-centered approaches to service provision, which highlight the individual client as the focal point of interaction and key decision maker. However, little is known about how user-centered approaches to family planning, particularly family planning counseling, shape contraceptive preferences and choices. Objective We conducted a multiarmed randomized controlled trial to identify the causal impact of user-centered approaches to family planning counseling on women’s contraceptive decision making in urban Malawi. This study aims to determine how a tailored, preference-driven approach to family planning counseling and the involvement of male partners during the counseling process may contribute to shaping women’s contraceptive preferences and choices. Methods Married women aged 18-35 years were recruited and randomly assigned to 1 of the 3 intervention arms or a control arm characterized by the following two interventions: an intervention arm in which women were encouraged to invite their husbands to family planning counseling (husband invitation arm) and an intervention arm in which women received targeted, tailored counseling on up to five contraceptive methods (as opposed to up to 13 contraceptive methods) that reflected women’s stated preferences for contraceptive methods. Women were randomized into a control arm, T0 (no husband invitation, standard counseling); T1 (husband invitation, standard counseling); T2 (no husband invitation, targeted counseling); and T3 (husband invitation, targeted counseling). Following counseling, all women received a package of family planning services, which included free transportation to a local family planning clinic and financial reimbursement for family planning services. Follow-up surveys were conducted with women 1 month after counseling. Results A total of 785 women completed the baseline survey, and 782 eligible respondents were randomized to 1 of the 3 intervention groups or the control group (T1, n=223; T2, n=225; T3, n=228; T0, n=108). Furthermore, 98.1% (767/782) of women were contacted for follow-up. Among the 767 women who were contacted, 95.3% (731/767) completed the follow-up survey. The analysis of the primary outcomes is ongoing and is expected to be completed by the end of 2021. Conclusions The results from this trial will fill knowledge gaps on the effectiveness of tailored family planning counseling and male involvement in family planning on women’s stated and realized contraceptive preferences. More generally, the study will provide evidence on how user-centered counseling may affect women’s willingness to use and continue contraception to realize their contraceptive preferences. Trial Registration American Economics Association’s Registry for Randomized Controlled Trials AEARCTR-0004194; https://www.socialscienceregistry.org/trials/4194/history/46808. Registry for International Development Impact Evaluations RIDIE-STUDY-ID-5ce4f42bbc2bf; https://ridie.3ieimpact.org/index.php?r=search/detailView&id=823. International Registered Report Identifier (IRRID) DERR1-10.2196/24884
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Affiliation(s)
- Mahesh Karra
- Frederick S Pardee School of Global Studies, Boston University, Boston, MA, United States
| | - Kexin Zhang
- Department of Economics, Boston University, Boston, MA, United States
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Chanthakoumane K, Maguet C, Essink D. Married couples' dynamics, gender attitudes and contraception use in Savannakhet Province, Lao PDR. Glob Health Action 2021; 13:1777713. [PMID: 32741343 PMCID: PMC7480449 DOI: 10.1080/16549716.2020.1777713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The use of contraception in Lao PDR remains inadequate. In 2017, unmet contraception needs among married women aged 15–49 were 14.3% in Lao PDR overall and 18.6% in the province of Savannakhet. Although the government has a goal to reduce gender inequalities, they still persist in many areas. Objective The aim of this research was to understand the extent to which couples’ dynamics and gender attitudes affect contraception use in Savannakhet, Lao PDR. Methods To conduct this research, mixed methods were used. Quantitative methods took the form of a survey filled out by 200 married couples in the province of Savannakhet. Afterwards, focus group discussions were carried out to give meaning to the quantitative data and to obtain a deeper understanding of gender roles and contraceptive use. Results Findings showed that most couples rely on female-dependent contraceptives and that while women hold most of the family planning responsibility, men’s opinions have more weight on the final decision. Additionally, women’s financial autonomy and spousal communication regarding birth control were associated with contraceptive use within the couple. However, this communication usually began after the birth of the third child. Lastly, the hypothesis that egalitarian gender attitudes were associated with contraceptive use could not be confirmed. Conclusion This study clearly demonstrates that contraception use is influenced by couples’ dynamics, more specifically spousal communication, in Lao PDR. The findings have highlighted the need to involve men in all stages of family planning, and to foster both spousal communication and financial autonomy for women. If the findings are implemented, this may foster shared decision making within couples.
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Affiliation(s)
| | | | - Dirk Essink
- Athena Institute, Vrije Universiteit Amsterdam , Amsterdam, Netherlands
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Comfort AB, Harper CC, Tsai AC, Perkins JM, Moody J, Rasolofomana JR, Alperin C, Schultz M, Ranjalahy AN, Heriniaina R, Krezanoski PJ. The association between men's family planning networks and contraceptive use among their female partners: an egocentric network study in Madagascar. BMC Public Health 2021; 21:209. [PMID: 33494746 PMCID: PMC7831255 DOI: 10.1186/s12889-021-10180-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/06/2021] [Indexed: 01/07/2023] Open
Abstract
Background Ensuring women have information, support and access to family planning (FP) services will allow women to exercise their reproductive autonomy and reduce maternal mortality, which remains high in countries such as Madagascar. Research shows that women’s social networks - their ties with partners, family members, friends, and providers - affect their contraceptive use. Few studies have considered the role of men’s social networks on women’s contraceptive use. Insofar as women’s contraceptive use may be influenced by their male partners, women’s contraceptive use may also be affected by their partner’s social networks. Men may differ by the types of ties they rely on for information and advice about FP. It is unknown whether differences in the composition of men’s FP networks matter for couples’ contraceptive use. This study assessed the association between men’s FP networks and couples’ contraceptive use. Methods This egocentric network study was conducted among married/partnered men (n = 178) in rural Madagascar. Study participants listed who they relied on for FP information and advice, including health providers and social ties. They provided ties’ gender, age, relationship, and perceived support of contraceptive use. The primary outcome was couples’ contraceptive use, and explanatory variables included FP networks and their composition (no FP network, social-only network, provider-only network, and mixed network of social and provider ties). Analyses used generalized linear models specifying a Poisson distribution, with covariate adjustment and cluster robust standard errors. Results Men who had FP networks were 1.9 times more likely to use modern contraception as a couple compared to men with no FP network (95% confidence interval [CI] 1.64–2.52; p ≤ 0.001). Compared to men with no FP network, men were more likely to use modern contraception if they had a social-only network, relative risk (RR) = 2.10 (95% CI, 1.65–2.68; p ≤ 0.001); a provider-only network, RR = 1.80 (95% CI, 1.54–2.11; p ≤ 0.001); or a mixed network, RR = 2.35 (95% CI, 1.97–2.80; p ≤ 0.001). Conclusions Whether men have a FP network, be it provider or social ties, distinguishes if couples are using contraception. Interventions should focus on reaching men not only through providers but also through their social ties to foster communication and support for contraceptive use.
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Affiliation(s)
- Alison B Comfort
- University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. .,Opportunity Solutions International, San Francisco, CA, USA.
| | - Cynthia C Harper
- University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Alexander C Tsai
- Massachusetts General Hospital, Harvard Medical School, 125 Nashua Street, Suite 722, Boston, MA, 02114, USA
| | - Jessica M Perkins
- Peabody College of Education and Human Development, Vanderbilt University, PMB 90, 230 Appleton Place, Nashville, TN, 37203-5721, USA
| | - James Moody
- Duke University, 268 Soc/Psych Building, Durham, NC, 27708-0088, USA
| | - Justin Ranjalahy Rasolofomana
- Institut National de Santé Publique et Communautaire, Ex-Ecole de Médecine de Befelatanana, BP 176, Antananarivo, Madagascar
| | - Cora Alperin
- University of Chicago, 5438 S Woodlawn Avenue, Chicago, IL, 60615, USA
| | - Margaret Schultz
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, Third Floor, San Francisco, CA, 94158, USA
| | | | - Ravo Heriniaina
- Opportunity Solutions International, Lot III G17, Ambalavao, Madagascar
| | - Paul J Krezanoski
- Opportunity Solutions International, San Francisco, CA, USA.,University of California San Francisco, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA, 94110, USA
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Teshome A, Wondafrash M, Gashawbeza B, Nigatu B, Asrat M, Compton SD. Post-abortion contraceptive adoption in Ethiopia. Int J Gynaecol Obstet 2021; 154:157-161. [PMID: 33341952 DOI: 10.1002/ijgo.13555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/27/2020] [Accepted: 12/17/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the effect of couple counseling on modern contraception adoption among women receiving abortions. METHODS A cross-sectional study was conducted between October 2019 and May 2020 at the abortion clinic of Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Women receiving abortion care were interviewed using Open Data Kit. Logistic regression was used to assess predictors of modern contraception adoption. RESULTS During the study period, a total of 326 women receiving abortion care were interviewed and 112 (34.4%) received couple counseling. Of the 112, 89 (79.5%) adopted modern contraception. The odds of using a modern contraceptive method were 2.34 times higher among women whose partner approved (adjusted odds ratio [aOR] 2.34; 95% confidence interval [CI] 1.05-5.22) compared with those without partner approval. The odds of using a modern contraceptive method was 1.78 times higher among women who believed they had partner support (aOR 1.78; 95% CI 1.03-3.10) compared with women without support. CONCLUSION Few women received couple counseling for contraception. Partner approval and a woman's belief that her partner supports her contraception decision were associated with contraception adoption.
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Affiliation(s)
- Abel Teshome
- Center of Excellence in Reproductive Health, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mekitie Wondafrash
- Center of Excellence in Reproductive Health, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Biruck Gashawbeza
- Center of Excellence in Reproductive Health, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Balkachew Nigatu
- Center of Excellence in Reproductive Health, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Matiyas Asrat
- Center of Excellence in Reproductive Health, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sarah D Compton
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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Hamm M, Evans M, Miller E, Browne M, Bell D, Borrero S. "It's her body": low-income men's perceptions of limited reproductive agency. Contraception 2019; 99:111-117. [PMID: 30336131 PMCID: PMC6744607 DOI: 10.1016/j.contraception.2018.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/17/2018] [Accepted: 10/08/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVES While some attention has been paid to men's contraceptive use and attitudes in international contexts, relatively little is known about the attitudes towards contraception and pregnancy of low-income, urban men in the U.S. STUDY DESIGN We conducted semi-structured interviews with 58 low-income men in Pittsburgh, PA, to explore their perspectives on contraception, pregnancy, fatherhood, and relationships. We analyzed the interviews using a combination of content analysis, the constant comparison method, and thematic analysis. RESULTS Men who we interviewed frequently described feeling that they lacked agency regarding when pregnancies occurred and whether or not they became fathers. Several factors contributed to their sense of low agency, including the belief that women should control contraception and reproduction, a reluctance to have conversations about contraception in some contexts, a lack of acceptable male-controlled contraceptive methods, experiences with pregnancy-promoting behaviors by women, and fatalistic attitudes towards pregnancy occurrence. CONCLUSIONS Many men in our study described perceptions of limited reproductive agency. In describing their lack of agency, men reinforced contemporary gender norms in which the "work" of pregnancy prevention is a woman's responsibility. Responses to men's perceived limited reproductive agency should work towards deconstructing gendered norms in the work of pregnancy prevention and promote shared and mutual gender responsibility over reproduction while also supporting women's reproductive autonomy. IMPLICATIONS This study identifies several factors that contribute to low-income men's sense of low reproductive agency and highlights the complexity of acknowledging men's feelings and perceptions about reproductive control in the broader context of gender and power.
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Affiliation(s)
- Megan Hamm
- Center for Research on Healthcare, University of Pittsburgh, 200 McKee Place, Suite 600, Pittsburgh, PA 15213, USA.
| | - Mark Evans
- University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Elizabeth Miller
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, USA; Division of Adolescent and Young Adult Medicine, Pediatrics, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA15224, USA; Center for Women's Health Research and Innovation, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA
| | - Mario Browne
- University of Pittsburgh Schools of the Health Sciences, 3550 Terrace St, Pittsburgh, PA 15213, USA
| | - David Bell
- Columbia University Medical Center, 1790 Broadway, New York, NY 10019, USA
| | - Sonya Borrero
- Center for Research on Healthcare, University of Pittsburgh, 200 McKee Place, Suite 600, Pittsburgh, PA 15213, USA; Center for Women's Health Research and Innovation, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15240, USA
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Abstract
The negative relationship between birth interval length and neonatal mortality risks is well documented, but heterogeneity in this relationship has been largely ignored. Using the Bangladesh Maternal Mortality and Health Care Survey 2010, this study investigates how the effect of birth interval length on neonatal mortality risks varies by maternal age at birth and maternal education. There is significant variation in the effect of interval length on neonatal mortality along these dimensions. Young mothers and those with little education, both of which make up a large share of the Bangladeshi population, can disproportionately benefit from longer intervals. Because these results were obtained from within-family models, they are not due to unobservable heterogeneity between mothers. Targeting women with these characteristics may lead to significant improvements in neonatal mortality rates, but there are significant challenges in reaching them.
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El-Khoury M, Thornton R, Chatterji M, Kamhawi S, Sloane P, Halassa M. Counseling Women and Couples on Family Planning: A Randomized Study in Jordan. Stud Fam Plann 2018; 47:222-38. [PMID: 27611319 DOI: 10.1111/sifp.69] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article evaluates the effects of involving men in family planning counseling in Jordan using a randomized experiment. We randomly assigned a sample of 1,247 married women to receive women-only counseling, couples counseling, or no counseling. We measured the effects of each type of counseling on family planning use, knowledge, attitudes, and spousal communication about family planning. Compared to no counseling, couples counseling led to a 54 percent increase in uptake of modern methods. This effect is not significantly different from the 46 percent increase in modern method uptake as a result of women-only counseling. This outcome may be due, in part, to lower rates of compliance with the intervention among those assigned to couples counseling compared to women-only counseling. To realize the possible added benefits of involving men, more tailored approaches may be needed to increase men's participation.
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Affiliation(s)
| | | | - Minki Chatterji
- Abt Associates, 4550 Montgomery Ave. #800N, Bethesda, MD 20814
| | - Sarah Kamhawi
- Monitoring, Evaluation and ResearchOfficer,Abt Associates-led SHOPS project, Amman, Jordan
| | - Phoebe Sloane
- Abt Associates, 4550 Montgomery Ave. #800N, Bethesda, MD 20814
| | - Mays Halassa
- Technical Specialist, Abt Associates, Amman, Jordan
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Ha BTT, Jayasuriya R, Owen N. Predictors of Men’s Acceptance of Modern Contraceptive Practice: Study in Rural Vietnam. HEALTH EDUCATION & BEHAVIOR 2016; 32:738-50. [PMID: 16267145 DOI: 10.1177/1090198105277332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Studies have shown family planning adoption is likely to be more effective for women when men are actively involved. The transtheoretical model of behavior change was used to examine men’s involvement in general contraception and intrauterine device (IUD) use by their wives. The study was carried out in rural Vietnam with 651 eligible participants. Cons of IUD use for men in precontemplation and contemplation/preparation were significantly higher than those in the action/maintenance stages, whereas the reverse was true for pros of IUD. The self-efficacy for convincing wife to have IUD in precontemplation was significantly lower than for those in higher stages. Women’s education and ages, spontaneous recall of modern contraceptive method, cons for IUD, and self-efficacy for contraception and for convincing wives to get IUD inserted (or continue use) were significant predictors of men’s readiness to accept IUD. Interventions are targeted to reduce cons and increase self-efficacy for IUD use.
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Zhang WH, Che Y, Chen Q, Cheng L, Temmerman M. Contraception interventions for women seeking abortion. Hippokratia 2014. [DOI: 10.1002/14651858.cd011067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Wei-Hong Zhang
- Université Libre de Bruxelles; School of Public Health; 808, Route de Lennik, CP 592 Brussels Belgium 1070
| | - Yan Che
- Shanghai Institute of Planned Parenthood Research (SIPPR); Centre for Clinical Research and Training; 2140 Xie Tu Road Shanghai China 200032
| | - Qiuju Chen
- Ghent University; Center for Reproductive Health; Gent Belgium
| | - Linan Cheng
- Shanghai Institute of Planned Parenthood Research (SIPPR); Centre for Clinical Research and Training; 2140 Xie Tu Road Shanghai China 200032
| | - Marleen Temmerman
- World Health Organization; Department of Reproductive Health and Research; 20 Via Appia Geneva Switzerland 1211
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Najafi-Sharjabad F, Rahman HA, Hanafiah M, Syed Yahya SZ. Spousal communication on family planning and perceived social support for contraceptive practices in a sample of Malaysian women. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2014; 19:S19-27. [PMID: 25949248 PMCID: PMC4402996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 12/03/2014] [Indexed: 12/05/2022]
Abstract
BACKGROUND In Malaysia, contraceptive prevalence rate (CPR) during past three decades has been steady, with only 34% of women practicing modern contraception. The aim of this study was to determine the factors associated with modern contraceptive practices with a focus on spousal communication and perceived social support among married women working in the university. MATERIALS AND METHODS A cross-sectional study was carried out using self-administered structured questionnaire. The association between variables were assessed using Chi-square test, independent sample t-test, and logistic regression. RESULTS Overall, 36.8% of women used modern contraceptive methods. Significant association was found between contraceptive practice and ethnicity (P = 0.003), number of pregnancies (P < 0.001), having child (P = 0.003), number of children (P < 0.001), positive history of mistimed pregnancy (P = 0.006), and experience of unwanted pregnancy (P = 0.003). The final model showed Malay women were 92% less likely to use modern contraception as compared to non-Malay women. Women who discussed about family planning with their spouses were more likely to practice modern contraception than the women who did not [odds ratio (OR): 2.2, Confidence Interval (CI): 1.3-3.7]. Those women with moderate (OR: 4.9, CI: 1.6-10.8) and strong (OR: 14, CI: 4.5-26.4) perception of social support for contraceptive usage were more likely to use modern contraception than the women with poor perception of social support. CONCLUSION Spousal communication regarding family planning would be an effective way to motivate men for supporting and using contraceptives. Family planning education initiatives should target both men and women, particularly high-risk cases, for promoting healthy timing and spacing of pregnancies. Ethnic disparities need to be considered in planning reproductive health programs.
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Affiliation(s)
- Fatemeh Najafi-Sharjabad
- Department of Public Health, School of Health, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Hejar Abdul Rahman
- Department of Community Health, Faculty of Medicine and Health Science, University Putra Malaysia, Malaysia
| | - Muhamad Hanafiah
- Department of Community Health, Faculty of Medicine and Health Science, University Putra Malaysia, Malaysia
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Unintended pregnancy and its correlates among female attendees of sexually transmitted disease clinics in Eastern China. BIOMED RESEARCH INTERNATIONAL 2013; 2013:349174. [PMID: 23841063 PMCID: PMC3697277 DOI: 10.1155/2013/349174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 05/29/2013] [Accepted: 06/01/2013] [Indexed: 11/25/2022]
Abstract
This study is to determine the prevalence of unintended pregnancy and its risk factors among the female attendees of sexually transmitted disease (STD) clinics in Zhejiang Province, China.
A self-administered questionnaire survey of a cross-sectional design was administered to attendees at four STD clinics in 2007. Of the 313 female STD clinic attendees, 42.5% reported that they had at least
one unintended pregnancy; the induced abortion rate was 39.0%. Over their lifetime, 12.1% responded “use condoms always/often” and 5.4% “always/often used oral contraceptives.”
The risk factors for the
unintended pregnancy identified by the multivariate analysis were as follows: being married, experience of nonconsensual sex, and a history of STD, having two and over two sexual partners. Unintended
pregnancies and induced abortion by female STD clinic attendees have reached an alarming prevalence. Doctors at STD clinics should attach importance not only to the STD problem of the female attendees,
but also to the unintended pregnancy and the associated factors. Targeted contraceptive counseling and intervention should be promoted at STD clinics as a strategy to improve the efficiency and effectiveness
of the reproductive health services in China.
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Yang X, Li S, Feldman MW. Development and validation of a gender ideology scale for family planning services in rural China. PLoS One 2013; 8:e59919. [PMID: 23573222 PMCID: PMC3613413 DOI: 10.1371/journal.pone.0059919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 02/19/2013] [Indexed: 11/23/2022] Open
Abstract
The objectives of this study are to develop a scale of gender role ideology appropriate for assessing Quality of Care in family planning services for rural China. Literature review, focus-group discussions and in-depth interviews with service providers and clients from two counties in eastern and western China, as well as experts’ assessments, were used to develop a scale for family planning services. Psychometric methodologies were applied to samples of 601 service clients and 541 service providers from a survey in a district in central China to validate its internal consistency, reliability, and construct validity with realistic and strategic dimensions. This scale is found to be reliable and valid, and has prospects for application both academically and practically in the field.
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Affiliation(s)
- Xueyan Yang
- School of Public Policy and Administration and Shaanxi Laboratory for Population and Development Research, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China.
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Singh A, Becker S. Concordance between partners in desired waiting time to birth for newlyweds in India. J Biosoc Sci 2012; 44:57-71. [PMID: 21933466 PMCID: PMC4164230 DOI: 10.1017/s0021932011000459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Examining waiting time to birth among newlywed couples is likely to provide insights into the desire for spacing births among newlywed husbands and wives. Data from the Indian National Family Health Survey of 2005-06 are used to examine the desired waiting time (DWT) to birth among newlywed couples. The dependent variable is spousal concordance on desired waiting times. Overall 65% of couples have concordant desired waiting times. Among discordant couples, wives were more likely to want to wait longer than their husbands. Couples from richer wealth quintiles were more likely than couples from the poorest quintile to have concordant desired waiting times. Muslims were less likely than Hindus to have concordant desires. There is a need for spacing contraceptive methods among newlyweds in India. This may have implications for the Indian Family Planning Programme, which to date has largely focused on sterilization. Programmes need to include newlywed husbands to promote use of spacing methods.
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Affiliation(s)
- Abhishek Singh
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai – 400 088, India
| | - Stan Becker
- Johns Hopkins School of Public Health, Baltimore, USA
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“Male Involvement” in Women and Children's HIV Prevention: Challenges in Definition and Interpretation. J Acquir Immune Defic Syndr 2011; 57:e114-6; author reply e116-7. [DOI: 10.1097/qai.0b013e31821d33d6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Montgomery ET, van der Straten A, Chidanyika A, Chipato T, Jaffar S, Padian N. The importance of male partner involvement for women's acceptability and adherence to female-initiated HIV prevention methods in Zimbabwe. AIDS Behav 2011; 15:959-69. [PMID: 20844946 PMCID: PMC3111667 DOI: 10.1007/s10461-010-9806-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Enlisting male partner involvement is perceived as an important component of women's successful uptake of female-initiated HIV prevention methods. We conducted a longitudinal study among a cohort of 955 Zimbabwean women participating in a clinical trial of the effectiveness of a female-initiated HIV prevention method (the diaphragm and lubricant gel) to: (a) describe the extent to which women involved their male partners in the decision to use the study products, and (b) measure the effect perceived male partner support had on their acceptability and consistent use of these methods. Reported levels of male partner involvement in discussions and decisions regarding: joining the study, study activities, the outcome of HIV/STI test results, and product use were very high. In multivariate analyses, regular disclosure of study product use and partner approval for the diaphragm and gel were significantly associated with women's acceptability and consistent use of the products; an essential component for determining efficacy of investigational prevention methods. These results support the need for more sophisticated measurement of how couples interact to make decisions that impact study participation and investigational product use as well as more rigorous adaptations and evaluations of existing strategies to involve male partners in female-initiated HIV prevention trials.
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Affiliation(s)
- Elizabeth T Montgomery
- Women's Global Health Imperative, RTI International, San Francisco Project Office, San Francisco, CA, USA.
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Danforth E, Kruk M, Rockers P, Mbaruku G, Galea S. Household decision-making about delivery in health facilities: evidence from Tanzania. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2009; 27:696-703. [PMID: 19902806 PMCID: PMC2928090 DOI: 10.3329/jhpn.v27i5.3781] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This study investigated how partners' perceptions of the healthcare system influence decisions about delivery-location in low-resource settings. A multistage population-representative sample was used in Kasulu district, Tanzania, to identify women who had given birth in the last five years and their partners. Of 826 couples in analysis, 506 (61.3%) of the women delivered in the home. In multivariate analysis, factors associated with delivery in a health facility were agreement of partners on the importance of delivering in a health facility and agreement that skills of doctors are better than those of traditional birth attendants. When partners disagreed, the opinion of the woman was more influential in determining delivery-location. Agreement of partners regarding perceptions about the healthcare system appeared to be an important driver of decisions about delivery-location. These findings suggest that both partners should be included in the decision-making process regarding delivery to raise rates of delivery at facility.
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Affiliation(s)
- E.J. Danforth
- Department of Anthropology, University of South Florida, 4202 E. Fowler Avenue, Tampa, Florida, 33620, USA
| | - M.E. Kruk
- Department of Health Management and Policy, University of Michigan School of Public Health, 109 Observatory Road, SPH II M3166, Ann Arbor, MI, 48109, USA and Averting Maternal Death and Disability Programme Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, Room B-320, New York, NY 10032, USA
| | - P.C. Rockers
- Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory Road, SPH II M3166, Ann Arbor, MI, 48109, USA
| | - G Mbaruku
- Ifakara Health Institute and Averting Maternal Death and Disability, Mikocheni, PO Box 78373, Dar-es-salaam, Tanzania
| | - S Galea
- Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory Road, SPH II M3166, Ann Arbor, MI, 48109, USA
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DeRose LF, Ezeh AC. Decision-Making Patterns and Contraceptive Use: Evidence from Uganda. POPULATION RESEARCH AND POLICY REVIEW 2009. [DOI: 10.1007/s11113-009-9151-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Becker S, Bazant ES, Meyers C. Couples counseling at an abortion clinic: a pilot study. Contraception 2008; 78:424-31. [DOI: 10.1016/j.contraception.2008.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2008] [Revised: 06/26/2008] [Accepted: 06/26/2008] [Indexed: 12/22/2022]
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20
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Nobili MP, Piergrossi S, Brusati V, Moja EA. The effect of patient-centered contraceptive counseling in women who undergo a voluntary termination of pregnancy. PATIENT EDUCATION AND COUNSELING 2007; 65:361-8. [PMID: 17125957 DOI: 10.1016/j.pec.2006.09.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 09/12/2006] [Accepted: 09/20/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate, by means of a randomized controlled trial, whether a patient-centered contraceptive counseling intervention increased the use of contraception, and the knowledge and positive attitudes towards contraception, in women who undergo a termination of pregnancy (TOP). METHODS The study was carried out at the San Paolo Hospital of Milan between the 1st of February and the 31st of May 2004. Participants (41 women; ages 20-44 years) were randomly divided into two groups: an experimental group (n = 20), who received patient-centered contraceptive counseling, and a control group (n = 21), who received the routine treatment in use at the San Paolo Hospital and were referred to the community health centers after the TOP. Both groups were administered a questionnaire at two points in time (before the counseling and 1 month later) which evaluated participants' knowledge, attitudes and use of contraception (the latter was also followed up 3 months later). The counseling intervention lasted 30 min and was carried out by a psychologist and a gynaecologist. RESULTS It was found that knowledge, favorable attitudes and use of effective contraception increased significantly for the experimental group, whereas there was no significant change for the control group. CONCLUSION The counseling intervention was therefore found to be efficacious in improving understanding and use of contraception in women who have undergone a TOP. The hope is that this will contribute to increased use of effective contraception in the future. PRACTICE IMPLICATIONS Following the principles of patient-centered medicine, this study provides evidence for the importance of exploring woman's feelings, beliefs, wishes and expectations regarding contraception within a contraceptive counseling intervention.
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Affiliation(s)
- Maria Patrizia Nobili
- Institute of Medical Psychology, Faculty of Medicine, University of Milan, San Paolo Hospital, Via di Rudinì 8, 20142 Milan, Italy.
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21
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Rasch V, Lyaruu MA. Unsafe Abortion in Tanzania and the Need for Involving Men in Postabortion Contraceptive Counseling. Stud Fam Plann 2005; 36:301-10. [PMID: 16395947 DOI: 10.1111/j.1728-4465.2005.00072.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Targeting male partners involved in unsafe abortions for contraceptive counseling could be an important strategy for decreasing the incidence of unwanted pregnancies, yet few postabortion-care programs have attempted to involve these men. To assess the need for and determine the content of postabortion contraceptive counseling for men, this study examined the contraceptive knowledge, attitudes, and practices of male partners of women who have had an unsafe abortion. A survey was administered to 213 men accompanying female partners receiving hospital care after having undergone an unsafe abortion in Dar es Salaam, Tanzania, and 20 of these men participated in in-depth interviews. Sixteen percent of the men surveyed accompanied an extramarital partner, and of those, only 44 percent reported having practiced contraception in the last six months, compared with 81 percent of the men accompanying their wives and 83 percent accompanying their girlfriends. In general, the men wished to support their partners in practicing contraception, and the majority were willing to participate in contraceptive counseling. These findings suggest that male partners should be included in postabortion contraceptive counseling, which should be sensitive to the nature of the partners' relationship, the risk of HIV transmission, and the importance of promoting gender
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Affiliation(s)
- Vibeke Rasch
- Department of International Health, Post Office Box 2099, Copenhagen University, Denmark DK-1014, Copenhagen K.
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Ha BTT, Jayasuriya R, Owen N. Increasing male involvement in family planning decision making: trial of a social-cognitive intervention in rural Vietnam. HEALTH EDUCATION RESEARCH 2005; 20:548-56. [PMID: 15687102 DOI: 10.1093/her/cyh013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
We tested a social-cognitive intervention to influence contraceptive practices among men living in rural communes in Vietnam. It was predicted that participants who received a stage-targeted program based on the Transtheoretical Model (TTM) would report positive movement in their stage of motivational readiness for their wife to use an intrauterine device (IUD) compared to those in a control condition. A quasi-experimental design was used, where the primary unit for allocation was villages. Villages were allocated randomly to a control condition or to two rounds of intervention with stage-targeted letters and interpersonal counseling. There were 651 eligible married men in the 12 villages chosen. A significant positive movement in men's stage of readiness for IUD use by their wife occurred in the intervention group, with a decrease in the proportions in the precontemplation stage from 28.6 to 20.2% and an increase in action/maintenance from 59.8 to 74.4% (P < 0.05). There were no significant changes in the control group. Compared to the control group, the intervention group showed higher pros, lower cons and higher self-efficacy for IUD use by their wife as a contraceptive method (P < 0.05). Interventions based on social-cognitive theory can increase men's involvement in IUD use in rural Vietnam and should assist in reducing future rates of unwanted pregnancy.
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Beenhakker B, Becker S, Hires S, Molano Di Targiana N, Blumenthal P, Huggins G. Are partners available for post-abortion contraceptive counseling? A pilot study in a Baltimore City clinic. Contraception 2004; 69:419-23. [PMID: 15105066 DOI: 10.1016/j.contraception.2003.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2003] [Revised: 12/06/2003] [Accepted: 12/28/2003] [Indexed: 12/01/2022]
Abstract
About half of the 1.2 million abortions each year in the United States are repeat abortions. While most abortion providers counsel women about contraception, one reason for the high repeat rate could be failure to take into account the social context of the women--in particular, the male partner. To assess whether there might be a window of opportunity for a contraceptive intervention that includes the male partner at the time of the abortion, we undertook a pilot study at an urban abortion clinic to examine the role of the male partner among women receiving abortions. Between May 2001 and August 2002, two questionnaires were administered to 109 women receiving abortions in a Baltimore City clinic. On the procedure day, women were more likely to be accompanied by a male partner upon arrival (30%) or when leaving (34%) than by any other individual. The majority of women receiving abortions reported that their partners played positive decision-making and support roles throughout the abortion process. A significant proportion of couples could be available for contraceptive counseling following an abortion, providing rationale for couples' post-abortion contraceptive counseling for women whose partners are already actively and positively involved in the abortion process. Such an intervention may help to reduce repeat abortions.
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Affiliation(s)
- Britta Beenhakker
- Department of Population and Family Health Sciences, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA
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24
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Latka M. Drug‐Using Women Need Comprehensive Sexual Risk Reduction Interventions. Clin Infect Dis 2003; 37 Suppl 5:S445-50. [PMID: 14648462 DOI: 10.1086/377566] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In the United States, drug users have dramatically reduced drug-related risk behaviors but continue sexual behaviors that place them at risk for human immunodeficiency virus (HIV) infection. Successful interventions are likely to be those that intervene at multiple levels, yet, historically, sexual interventions for drug users have primarily addressed only personal factors, such as condom use. Sexual risk arises from personal factors (e.g., perceived vulnerability and protective behaviors); interpersonal factors (e.g., relationship type and a partner's risk profile); social factors (e.g., gender roles and sexual mixing patterns among and between networks); and, finally, community-level factors (e.g., access to preventive methods and the prevalence of a sexually transmitted pathogen within a network). For female drug users, multiple sources of risk plus concurrent drug use during sex pose additional prevention challenges that disproportionately elevate their risk of sexually acquired HIV infection. New, multimodal interventions need to be developed and tested to more effectively address the many sources of sexual risk facing female drug users.
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Affiliation(s)
- Mary Latka
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, New York 10029, USA.
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25
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Blanc AK. The effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence. Stud Fam Plann 2001; 32:189-213. [PMID: 11677692 DOI: 10.1111/j.1728-4465.2001.00189.x] [Citation(s) in RCA: 315] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article reviews what has been learned to date about the role of gender-based power in sexual relationships in determining sexual and reproductive health outcomes. A framework for assessing the relationship between power relations and reproductive health is outlined and measurement issues are critically discussed. A summary is included of the main types of intervention approaches that have been implemented, as are a discussion of the programmatic, methodological, and ethical implications of the findings and recommendations for further experimentation and research. Although many challenges remain, results to date suggest that when the role of gender-based power is made an integral feature of sexual and reproductive health programs, there is a considerable payoff for both women and men.
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Affiliation(s)
- A K Blanc
- Blancroft Research International, 11718 Lightfall Court, Columbia, MD 21044, USA.
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Sanderson M, Shu XO, Jin F, Dai Q, Wen W, Hua Y, Gao YT, Zheng W. Abortion history and breast cancer risk: results from the Shanghai Breast Cancer Study. Int J Cancer 2001; 92:899-905. [PMID: 11351314 DOI: 10.1002/ijc.1263] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Studies of the association between induced abortion and breast cancer risk have been inconsistent, perhaps due to underreporting of abortions. Induced abortion is a well-accepted family planning procedure in China, and women who have several induced abortions do not feel stigmatized. The authors used data from a population-based case-control study of breast cancer among women age 25-64 conducted between 1996 and 1998 in urban Shanghai to assess whether a history of and the number of induced abortions were related to breast cancer risk. In-person interviews were completed with 1,459 incident breast cancer cases ascertained through a population-based cancer registry, and 1,556 controls randomly selected from the general population in Shanghai (with respective response rates of 91% and 90%). After adjusting for confounding, there was no relation between ever having had an induced abortion and breast cancer (odds ratio [OR] = 0.9, 95% confidence interval [CI] 0.7-1.2). Women who had 3 or more induced abortions were not at increased risk of premenopausal breast cancer (OR = 0.9, 95% CI 0.6-1.4) or postmenopausal breast cancer (OR = 1.3, 95% CI 0.8-2.3). These results suggest that a history of several induced abortions has little influence on breast cancer risk in Chinese women.
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Affiliation(s)
- M Sanderson
- Department of Epidemiology and Biostatistics, University of South Carolina and South Carolina Cancer Center, Columbia, SC, USA.
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