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Azadi B, Tantet C, Sylla F, Andro A. Women who have undergone female genital mutilation/cutting's perceptions and experiences with healthcare providers in Paris. Cult Health Sex 2022; 24:583-596. [PMID: 34751634 DOI: 10.1080/13691058.2021.1982010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
Female genital mutilation/cutting (FGM/C) is a health and human rights issue and a dangerous form of gender-based violence. Given migratory flows from the countries in which it is practised, FGM/C concerns a substantial number of women living in Western countries. In this study, we looked at women who had undergone FGM/C experiences with French medical practitioners. We also discussed with them the desirability of screening for, and prevention of, FGM/C in international travel medicine centres. A qualitative approach was used to collect and analyse the data. Focus groups and semi-structured interviews were held with 26 women (24 participants in focus groups and 2 individual interviews). Transcriptions were coded and analysed thematically. All the participants came from sub-Saharan Africa. Their median age was 32.9 years. Persistent silence about FGM/C in the host society following immigration resulted in dissatisfaction with healthcare providers. Participants expected professionals to address the subject of FGM/C, feeling professionals should bring up the subject first so as to put women at ease. International travel medicine centres were discussed by some as a possible means of prevention.
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Affiliation(s)
- Bahar Azadi
- INSERM, CRIDUP, University of Paris 1- Panthéon-Sorbonne, Paris, France
| | | | - Fatoumata Sylla
- INSERM, CRIDUP, University of Paris 1- Panthéon-Sorbonne, Paris, France
| | - Armelle Andro
- INSERM, CRIDUP, University of Paris 1- Panthéon-Sorbonne, Paris, France
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Poncet L, Panjo H, Ringa V, Andro A. Do vulnerable groups access prevention services? Cervical cancer screening and HIV testing among homeless migrant women in the Paris metropolitan area. PLoS One 2021; 16:e0255900. [PMID: 34388200 PMCID: PMC8363022 DOI: 10.1371/journal.pone.0255900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Homeless migrant women, facing adverse living conditions and barriers to legal status, are at risk of cervical cancer, HIV infection and may encounter barriers to screening services. We investigate factors associated with each screening in a population of migrant women in France and aim to determine the mean time since last HIV testing according to duration of residence in France. Methods We use data from the DSAFHIR study (Rights and Health of Migrant Women in Emergency Housing) investigating health and migration experience of homeless migrant women housed in emergency housing hotels in the Paris Metropolitan area in 2017. We computed multivariate logistic regression models to investigate no lifetime cervical cancer screening (CCS) and no lifetime HIV test. We used linear regression models to analyze time since last HIV test. Results We included 469 women. 46% of respondents had no lifetime CCS, 31% had no lifetime HIV test. Both screenings were associated with educational attainment and French proficiency. Compared with duration of residence < 1 year, duration ≥ 7 years was associated with a lower likelihood of no lifetime CCS (adjusted Odd Ratio = 0.17; 95% CI = 0.07–0.39). Compared to women born in North Africa, women born in West (aOR = 0.15; 95% CI = 0.07–0.33) and East Africa (aOR = 0.06; 95% CI = 0.02–0.20) were less likely to have no lifetime HIV test. Time since last HIV test increased for each additional year spent in France (coef = 0.21; 95% CI = 0.09, 0.33). Conclusion While access to CCS remains poor for recent migrants, HIV testing is more likely to occur shortly after migration.
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Affiliation(s)
- Lorraine Poncet
- UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP, Université Paris-Saclay, Villejuif, France
- French Collaborative Institute on Migration, Paris, France
- * E-mail:
| | - Henri Panjo
- UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP, Université Paris-Saclay, Villejuif, France
| | - Virginie Ringa
- UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP, Université Paris-Saclay, Villejuif, France
| | - Armelle Andro
- French Collaborative Institute on Migration, Paris, France
- Institute of Demography, Université Paris I Pantheon-Sorbonne, Paris, France
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Poncet L, Panjo H, Schmitz T, Luton D, Mandelbrot L, Estellat C, Andro A, Ringa V, Azria E. Gestational weight gain in a migration context: are migrant women more at risk of inadequate or excessive weight gain during pregnancy? J Epidemiol Community Health 2021; 76:230-238. [PMID: 34389663 DOI: 10.1136/jech-2021-216619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/20/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Inadequate or excessive gestational weight gain (GWG) is associated with adverse maternal and neonatal outcomes. Little is known on adequacy of GWG in migrant women. This study investigates whether migrant women in France are at higher risk of inadequate or excessive GWG, and what characteristics are associated with GWG in migrant and non-migrant groups. METHODS We used data from the PreCARE multicentric prospective cohort (N=10 419). The study includes 5403 women with singleton deliveries, with non-migrant (n=2656) and migrant (n=2747) status. We used multinomial logistic regression, adjusting for maternal age and parity, to investigate the association of migrant status, socioeconomic status-related variables and GWG. In stratified analyses, we identified factors associated with GWG in both groups. RESULTS Compared with non-migrant women, migrant women had increased risk of inadequate GWG (adjusted odds ratio (aOR) 1.18; 95% CI 1.03 to 1.34). Non-migrant women with foreign origins had increased risk of excessive GWG (aOR 1.58; 95% CI 1.30 to 1.92). Women born in Sub-Saharan Africa had increased risk of both inadequate and excessive GWG. Regardless of migration status, women with lower education and women who did not start pregnancy with a normal weight were less likely to gain adequately. Inadequate prenatal care was associated with inadequate GWG only among non-migrant women. CONCLUSION Migrant women are at higher risk of inadequate GWG.
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Affiliation(s)
- Lorraine Poncet
- CESP Primary Care and Prevention Team, Université Paris-Saclay, UVSQ, Université Paris-Sud, INSERM, Villejuif, France .,French Collaborative Institute on Migrations, France, Paris, France
| | - Henri Panjo
- CESP Primary Care and Prevention Team, Université Paris-Saclay, UVSQ, Université Paris-Sud, INSERM, Villejuif, France
| | - Thomas Schmitz
- Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University, 53 Avenue de l'Observatoire, INSERM U1153, Paris, France.,Department of Obstetrics and Gynecology, Hopital Universitaire Mere-enfant Robert-Debre, Paris, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, DHU Risks in Pregnancy, Hopital Bichat - Claude-Bernard, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, DHU Risks in Pregnancy, Hopital Louis-Mourier, Colombes, France
| | - Candice Estellat
- Department of Biostatistics, Public Health and Medical Information, Clinical research unit, Pharmacoepidemiology center, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Armelle Andro
- French Collaborative Institute on Migrations, France, Paris, France.,Institute of demography research center, Université Paris 1 Panthéon-Sorbonne, Paris, France
| | - Virginie Ringa
- CESP Primary Care and Prevention Team, Université Paris-Saclay, UVSQ, Université Paris-Sud, INSERM, Villejuif, France
| | - Elie Azria
- Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University, 53 Avenue de l'Observatoire, INSERM U1153, Paris, France.,Department of Obstetrics, Groupe hospitalier Paris Saint-Joseph, Paris, France
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Abstract
Migrant women in industrialised countries experience high caesarean section (CS) rates but little is known about the effect of a previous delivery in the host country. This study set out to investigate this effect among migrant women in France, using data from the DSAFHIR study on healthcare access of migrant women living in emergency housing hotels, collected in the Paris Metropolitan area in 2017. Respondents reported life-long history of deliveries. We focused on deliveries occurring in France in 2000–2017: 370 deliveries reported by 242 respondents. We conducted chi-square tests and multivariate logistic regressions, adjusting for the clustering of deliveries among respondents by computing standard errors allowing for intragroup correlation. Mode of delivery was associated with duration of residence among multiparous women with no prior CS, with a higher CS rate with shorter duration of residence (16% vs. 7%, p = 0.04). In this group, a previous delivery in France was associated with a lower CS rate (5% vs. 16%, p = 0.008). In multivariate analysis, compared with women with previous birth in France, women giving birth in France for the first time had a higher risk of CS, regardless of duration of residence (aOR = 4.0, 95% CI = 1.3–12.1 for respondents with short duration of residence, aOR = 4.7, 95% CI = 1.2–18.0 for respondents with longer duration of residence). Efforts directed at decreasing the CS rate among migrant women should target women giving birth in the host country for the first time.
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Affiliation(s)
- Lorraine Poncet
- PhD Candidate in Public Health, Université Paris-Saclay (INSERM), UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France; French Collaborative Institute on Migration, Paris, France
| | - Henri Panjo
- Research Engineer, Université Paris-Saclay (INSERM), UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France
| | - Armelle Andro
- Professor, Institute of Demography, Université Paris I Pantheon-Sorbonne, Paris, France; French Collaborative Institute on Migration, Paris, France
| | - Virginie Ringa
- Researcher (INSERM), Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France
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Sylla F, Moreau C, Andro A. A systematic review and meta-analysis of the consequences of female genital mutilation on maternal and perinatal health outcomes in European and African countries. BMJ Glob Health 2020; 5:e003307. [PMID: 33380410 PMCID: PMC7780522 DOI: 10.1136/bmjgh-2020-003307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/23/2020] [Accepted: 10/20/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Key knowledge gaps remain to improve reproductive health outcomes for millions of women living with female genital mutilation (FGM). We aimed to update previous reviews and quantify more rigorously maternal and perinatal complications related to FGM across different settings. METHODS In this systematic review and meta-analysis, we searched 15 electronic databases for studies published between 1 August 1995 and 15 March 2020, reporting on maternal and perinatal complications related to FGM. We included studies comparing women with and without FGM while accounting for confounders. Pooled relative risks (RR) were calculated, using fixed-effects and random-effects models, for a range of maternal and perinatal outcomes, adjusting for individual characteristics and according to delivery settings and study design. RESULTS We identified 106 unique references, assessed 72 full-text articles and included 11 studies. We found non-significant elevated risks of instrumental delivery, caesarean delivery, episiotomy, postpartum haemorrhage, perineal laceration, low Apgar score and miscarriage/stillbirth related to FGM. Heterogeneity was present for most outcomes when combining all studies but reduced in subgroup analyses. The risk of caesarean delivery was increased among primiparous women (1.79, 95% CI 1.04 to 3.07) such as the risk of episiotomy in European specialised settings for women with FGM (1.88, 1.14 to 3.09). In Africa, subgroup analyses revealed elevated risks of postpartum haemorrhage (2.59, 1.28 to 5.25). The most common reported type was FGM II. However, few studies provided stratified analyses by type of FGM, which did not allow an assessment of the impact of the severity of typology on studied outcomes. CONCLUSION This review suggests maternal and perinatal morbidity related to FGM vary by study design, context and by subgroup of women. Our study also draws attention to the complications that may extend to the postpartum period. This work contributes to shaping a reference framework for future research and clinical guidelines.
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Affiliation(s)
- Fatoumata Sylla
- Center for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Villejuif, France
| | - Caroline Moreau
- Center for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Villejuif, France
| | - Armelle Andro
- Demography Institute Pantheon-Sorbonne University, National Institute for Demographic Studies, Paris, France
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Andro A, Cambois E, Lesclingand M. Long-term consequences of female genital mutilation in a European context: self perceived health of FGM women compared to non-FGM women. Soc Sci Med 2014; 106:177-84. [PMID: 24565761 DOI: 10.1016/j.socscimed.2014.02.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 12/02/2013] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Abstract
Female genital mutilation (FGM) concerns an estimated half a million women in Europe. The studies based in countries where migrant women have settled highlight the need for more accurate information on FGM health consequences, in a European health care context. Excision and Handicap (ExH) is a multi-centric survey based on case-control methodology and conducted in France to assess the long-term consequences of FGM, sampling both FGM and non-FGM adult women. The interviews were conducted in 74 mother-and-child health centres and hospital departments providing gynaecological and family planning services in five French regions. The two groups were compared on health indicators (self-perceived health, illnesses, symptoms) and functioning indicators (daily, sexual and reproductive life) for cases (n = 678) and controls (n = 1706). Multivariate logistic models highlighted FGM-related health problems. Among women living in France, FGM was significantly associated with poor health indicators: gynaecological and urinary infections (OR = 2.0), sleep disorders (OR = 1.4), intense pain (OR = 1.5), difficulties in daily life (OR = 1.5) and in sexual life (OR = 1.7) or tearing during childbirth (OR = 1.6). Our results suggest that, even in a favourable healthcare context, FGM exposes women to long-term health problems, including in areas neglected in previous research. They confirm the need to establish recommendations to help physicians understand these women's needs.
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Affiliation(s)
- Armelle Andro
- Demography Institute Pantheon-Sorbonne University, Paris, France; National Institute for Demographic Studies, Paris, France.
| | | | - Marie Lesclingand
- National Institute for Demographic Studies, Paris, France; Nice Sophia Antipolis University, Nice, France
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Helleringer S, Duthé G, Kanté AM, Andro A, Sokhna C, Trape JF, Pison G. Misclassification of pregnancy-related deaths in adult mortality surveys: case study in Senegal. Trop Med Int Health 2012; 18:27-34. [PMID: 23130912 DOI: 10.1111/tmi.12012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In countries with limited vital registration data, maternal mortality levels are often estimated using siblings' survival histories (SSH) collected during retrospective adult mortality surveys. We explored how accurately adult deaths can be classified as pregnancy related using such data. METHOD The study was conducted in a rural area of south-eastern Senegal with high maternal mortality, Bandafassi. We used data from a demographic surveillance system (DSS) in this area to identify deaths of women at reproductive ages between 2003 and 2009 and to locate the surviving adult sisters of the deceased and interview them. Siblings' survival histories were linked at the individual level to death records, and verbal autopsy data obtained by the demographic surveillance system. We compared the classification of adult female deaths as pregnancy related or not in interviews and DSS records. RESULTS There were 91 deaths at reproductive ages in the Bandafassi DSS between 2003 and 2009, but only 59 had known surviving sisters. Some deaths were omitted by respondents, or reported as alive or as having occurred during childhood (n = 8). Among deaths reported both in the SSH and DSS data, 94% of deaths classified as pregnancy related in the DSS data were also classified as such by siblings' survival histories. Only 70% of deaths classified as not pregnancy related in the DSS data were also classified as such by siblings' survival histories. CONCLUSION Misclassifications of pregnancy-related deaths in retrospective adult mortality surveys may affect estimates of pregnancy-related mortality rates.
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Pison G, Helleringer S, Kante AM, Duthé G, Andro A. Que valent les déclarations sur les frères et sœurs pour estimer la mortalité maternelle ? Rev Epidemiol Sante Publique 2012. [DOI: 10.1016/j.respe.2012.06.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
BACKGROUND Women who have undergone female genital mutilation rarely have access to the reconstructive surgery that is now available. Our objective was to assess the immediate and long-term outcomes of this surgery. METHODS Between 1998 and 2009, we included consecutive patients with female genital mutilation aged 18 years or older who had consulted a urologist at Poissy-St Germain Hospital, France. We used the WHO classification to prospectively include patients with type II or type III mutilation. The skin covering the stump was resected to reveal the clitoris. The suspensory ligament was then sectioned to mobilise the stump, the scar tissue was removed from the exposed portion and the glans was brought into a normal position. All patients answered a questionnaire at entry about their characteristics, expectations, and preoperative clitoris pleasure and pain, measured on a 5-point scale. Those patients who returned at 1 year for follow-up were questioned about clitoris pain and functionality. We compared data from the 1-year group with the total group of patients who had surgery. FINDINGS We operated on 2938 women with a mean age of 29·2 (SD 7·77 years; age at excision 6·1, SD 3·5 years). Mali, Senegal, and Ivory Coast were the main countries of origin, but 564 patients had undergone female genital mutilation in France. The 1-year follow-up visit was attended by 866 patients (29%). Expectations before surgery were identity recovery for 2933 patients (99%), improved sex life for 2378 patients (81%), and pain reduction for 847 patients (29%). At 1-year follow-up, 363 women (42%) had a hoodless glans, 239 (28%) had a normal clitoris, 210 (24%) had a visible projection, 51 (6%) had a palpable projection, and three (0·4%) had no change. Most patients reported an improvement, or at least no worsening, in pain (821 of 840 patients) and clitoral pleasure (815 of 834 patients). At 1 year, 430 (51%) of 841 women experienced orgasms. Immediate complications after surgery (haematoma, suture failure, moderate fever) were noted in 155 (5%) of the 2938 patients, and 108 (4%) were briefly re-admitted to hospital. INTERPRETATION Reconstructive surgery after female genital mutilation seems to be associated with reduced pain and restored pleasure. It needs to be made more readily available in developed countries by training surgeons. FUNDING French Urological Association.
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Affiliation(s)
- Pierre Foldès
- St Germain Poissy Hospital, St Germain en Laye, France
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Bajos N, Bozon M, Beltzer N, Laborde C, Andro A, Ferrand M, Goulet V, Laporte A, Le Van C, Leridon H, Levinson S, Razafindratsima N, Toulemon L, Warszawski J, Wellings K. Changes in sexual behaviours: from secular trends to public health policies. AIDS 2010; 24:1185-91. [PMID: 20299962 DOI: 10.1097/qad.0b013e328336ad52] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To explore the relative contribution of secular trends and public health policies to changes in sexual behaviour. DESIGN Three random probability surveys of the sexual behaviour of people aged 18-69 years were conducted in 1970, 1992 and 2006 in France. METHODS Data of the 2006 survey (n = 12,364) were compared with those from two surveys carried out in 1970 (n = 2625) and 1992 (n = 20,055). RESULTS Over the last decades, median age at first intercourse has decreased by 4 years for women (22.0 in the 1930s vs. 17.6 in the 2000s) and 1 year for men (18.1 vs. 17.2). Lifetime number of sexual partners increased for women (1.8 in 1970 vs. 4.4 in 2006), but not for men (11.8 vs. 11.6). At the same time, the proportion of respondents, especially women, who reported nonpenetrative sexual practices and considered sexual intercourse essential to well being was on the increase. These changes are mainly attributed to an increase in women's social status. A marked increase in condom use was observed following the first AIDS/HIV prevention campaigns in the 1980s. CONCLUSION Public health interventions that are synergistic with trends in social norms are likely to be more effective than those that run counter to them. In France, sexual health and HIV prevention policies aimed at harm limitation appear to have chimed with secular trends. The evidence of greater diversification of sexual practices offers potential to increase the range of safer sex messages used in public health interventions.
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Villani M, Andro A. Réparation du clitoris et reconstruction de la sexualité chez les femmes excisées : la place du plaisir. ACTA ACUST UNITED AC 2010. [DOI: 10.3917/nqf.293.0023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Andro A, Bajos N, Ferrand M, Giné L, Ferrand M, Gine L. De la contraception à l'avortement : Sociologie des grossesses non prévues. Population (French Edition) 2004. [DOI: 10.2307/3654979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Andro A, Hertrich V. La demande contraceptive au Sahel: les attentes des hommes se rapprochent-elles de celles de leurs epouses? Population (French Edition) 2001. [DOI: 10.2307/1534884] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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