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Contraceptive counseling protocols tend to focus narrowly on pregnancy intentions, which may overlook other factors that contribute to whether an individual wants or needs contraception. In this report, we demonstrate the potential of two measures of individual contraceptive need that could be assessed as part of contraceptive counseling: (1) a composite score constructed from pregnancy intentions, sexual frequency, and perceived fecundity and (2) a direct measure of contraceptive need ("do you feel it is necessary for you to be using contraception right now?") We compare the two measures using data from Umoyo wa Thanzi, a cohort study in Central Malawi (N = 906; 2017-2018). More frequent sex, perceptions of being more fecund, and a stronger desire to avoid pregnancy were associated with directly reporting contraceptive need (p < 0.001). Women who directly reported contraceptive need had a higher average composite score than women who directly reported they had no need (mean = 7.4 vs. 6.3; p < 0.01), but nearly all participants had scores indicating some risk of unintended pregnancy. Contraceptive counseling protocols should consider assessing women's direct report of contraceptive need, along with risk factors for unintended pregnancy, such as sexual frequency, perceived fecundity, and desire to avoid pregnancy, to better counsel clients.
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Comportamento Contraceptivo , Anticoncepção , Aconselhamento , Humanos , Feminino , Malaui , Comportamento Contraceptivo/psicologia , Gravidez , Adulto , Gravidez não Planejada , Anticoncepcionais , Anticoncepção/métodosRESUMO
Reproductive autonomy, or the extent to which people control matters related to their own sexual and reproductive decisions, may help explain why some people who do not intend to become pregnant nevertheless do not use contraception. Using cross-sectional survey data from 695 women aged 16 to 47 enrolled in the Umoyo Wa Thanzi (UTHA) study in Malawi in 2019, we conducted confirmatory factor analysis, descriptive analyses, and multivariable logistic regression to assess the freedom from coercion and communication subscales of the Reproductive Autonomy Scale and to examine relationships between these components of reproductive autonomy and current contraceptive use. The freedom from coercion and communication subscales were valid within this population of partnered women; results from a correlated two-factor confirmatory factor analysis model resulted in good model fit. Women with higher scores on the freedom from coercion subscale had greater odds of current contraceptive use (aOR 1.13, 95% CI: 1.03-1.23) after adjustment for pregnancy intentions, relationship type, parity, education, employment for wages, and household wealth. Scores on the communication subscale were predictive of contraceptive use in some, but not all, models. These findings demonstrate the utility of the Reproductive Autonomy Scale in more holistically understanding contractive use and non-use in a lower-income setting, yet also highlight the need to further explore the multidimensionality of women's reproductive autonomy and its effects on achieving desired fertility.
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Anticoncepcionais , Dispositivos Anticoncepcionais , Gravidez , Feminino , Humanos , Estudos Transversais , Malaui , ReproduçãoRESUMO
Infertility and unintended pregnancy are dual burdens in Malawi, where 41% of pregnancies are unintended and approximately 20% of people report infertility. Although preventing unintended pregnancy has been a focus in public health, infertility has rarely been explored as a factor that may be associated with contraceptive use. Using cross-sectional survey data (2017-2018; N = 749), we report on the prevalence of and sociodemographic characteristics associated with infertility and certainty of becoming pregnant among women in Malawi. We conducted multivariable logistic regressions examining the relationship between infertility, certainty of becoming pregnant, and contraceptive use. Approximately 16% of women experienced infertility, and three-quarters (78%) were certain they could become pregnant within one year. Women who experienced infertility had lower odds of contraceptive use than women who did not (Adjusted Odds Ratio [AOR]: 0.56; 95% Conficence Interval [CI]: 0.39-0.83). Women who said there was "no chance" or they were "unlikely" to become pregnant also had lower odds of contraceptive use compared to women who were certain they would become pregnant (AOR: 0.30; 95% CI: 0.10-0.92). Our findings indicate that experiences and perceptions surrounding fertility are associated with contraceptive use, underscoring their importance in understanding how people manage their fertility to reach their reproductive goals.
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Anticoncepcionais , Infertilidade , Comportamento Contraceptivo , Estudos Transversais , Feminino , Humanos , Malaui/epidemiologia , Masculino , Gravidez , Gravidez não PlanejadaRESUMO
BACKGROUND: Western China has undergone substantial sociodemographic change, yet little is known about the health status of ethnic minority populations living in these areas. METHODS: We report findings from two cross-sectional surveys conducted with female Tibetan nomads living in rural areas of Western China/Eastern Tibet. We present results of descriptive analyses of data collected from reproductive-aged females who attended community health fairs in 2014 (n = 193) and 2016 (n = 298). RESULTS: On average, sexual debut preceded marriage among study participants, with fertility near replacement levels (2.7 and 2.1 in 2014 and 2016, respectively). Contraceptive use was common, and dominated by use of IUDs and female sterilization. Although over three-quarters (76%) of 2016 survey participants reported ever having at least one sexually transmitted infection (STI) symptom, there was low awareness of STIs (59%) and action to prevent STIs (21%). Younger women (< 40) were more likely to report having had had an STI symptom, as compared to older women (84% versus 71%; p < 0.05). CONCLUSIONS: We demonstrate feasibility of collecting data with this hard-to-reach population. Reporting of STI symptoms warrants further investigation to identify and address health conditions in this population of Tibetan nomadic women, especially amidst broader social and contextual changes that may affect the Tibetan population.
Western China has undergone substantial sociodemographic change, yet little is known about the health status of ethnic minority populations living in these areas. We report findings from two cross-sectional surveys conducted with female Tibetan nomads living in rural areas of Western China/Eastern Tibet. We present results of descriptive analyses of data collected from reproductive-aged females who attended community health fairs in 2014 (n = 193) and 2016 (n = 298). On average, sexual debut preceded marriage among study participants, with fertility near replacement levels (2.7 and 2.1 in 2014 and 2016, respectively). Contraceptive use was common, and dominated by use of IUDs and female sterilization. Although over three-quarters (76%) of 2016 survey participants reported ever having at least one sexually transmitted infection (STI) symptom, there was low awareness of STIs (59%) and action to prevent STIs (21%). Younger women (less than 40 years old) were more likely to report having had had an STI symptom, as compared to women over 40 years old (84% versus 71%; p < 0.05). We demonstrate feasibility of collecting data with this hard-to-reach population. Reporting of STI symptoms warrants further investigation to identify and address health conditions in this population of Tibetan nomadic women, especially amidst broader social and contextual changes that may affect the Tibetan population.
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Conhecimentos, Atitudes e Prática em Saúde , Saúde Reprodutiva/etnologia , Adulto , Idoso , Estudos Transversais , Etnicidade , Feminino , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Grupos Minoritários , Gravidez , População Rural , Infecções Sexualmente Transmissíveis/epidemiologia , Fatores Socioeconômicos , Tibet/epidemiologiaRESUMO
Amidst persistently high unintended pregnancy rates and lags in contraceptive use, novel methodological approaches may prove useful in investigating sexual and reproductive health outcomes in the Philippines. Systematic Anomalous Case Analysis (SACA) - a mixed-methods technique - was employed to examine predictors of women's lifetime contraceptive use. First, multivariable, longitudinal Poisson regression models predicted fertility and sexual debut using the 1998-2009 Cebu Longitudinal Health and Nutrition Surveys (CLHNS), then regression outliers and normative cases were used to identify 48 participants for in-depth interviews (2013-2014) for further examination. Qualitative findings from 24 women highlighted 'control over life circumstances' was critical, prompting the addition of two items to the original quantitative models predicting any contraceptive use (n=532). Each of the items, 'what happens to [them] is their own doing' and '[I] do not [have] enough control over direction life is taking [me]', significantly and independently predicted any contraceptive use (aOR: 2.37 (CI: 1.24-4.55) and aOR: 0.46 (CI: 0.28-0.77), respectively). The findings demonstrate the utility of SACA to improve the understanding and measurement of sexual and reproductive health outcomes and underscore the importance of integrating psychosocial constructs into existing models of fertility and reproductive behaviour in the Philippines to improve sexual and reproductive health outcomes.
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The Philippines is characterized by sustained economic growth and political stability, yet sexual and reproductive health indicators have stalled or even worsened in recent decades. We employed an innovative, mixed-methods approach-Systematic Anomalous Case Analysis-to gain insights into these worsening trends by examining sexual and reproductive decision-making among a cohort of young adults in Metro Cebu, Philippines. We first analyzed longitudinal data (1998-2009) to predict reproductive outcomes (i.e., age of first sex, number of living children) among participants in the Cebu Longitudinal Health and Nutrition Survey to identify cases (predicted and anomalous) with whom we subsequently conducted qualitative, in-depth interviews in 2013-14 (n = 48). Analysis of the qualitative data revealed unique social and contextual factors that shaped patterns of sexual and contraceptive decision-making across three, distinct reproductive life stages: (1) at first sex, (2) after the birth of first child, and (3) after the birth of several children. However, gendered roles and expectations exerted strong influences on sexual and reproductive outcomes across these life stages. Finally, we identified two constructs from our qualitative analysis-sexual fluidity and sexual agency-that deserve further examination and integration into theoretical and empirical models of sexual and reproductive decision-making.
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Comportamento Reprodutivo/estatística & dados numéricos , Saúde Reprodutiva/tendências , Comportamento Sexual/estatística & dados numéricos , Saúde Sexual/tendências , Adolescente , Adulto , Anticoncepção/tendências , Feminino , Papel de Gênero , Humanos , Entrevistas como Assunto , Masculino , Filipinas , Pesquisa Qualitativa , Adulto JovemRESUMO
OBJECTIVE: To examine how receiving or being denied a wanted abortion affects the subsequent development, health, caregiving, and socioeconomics of women's existing children at time of seeking abortion. STUDY DESIGN: The Turnaway Study is a 5-year longitudinal study with a quasi-experimental design. Women were recruited from January 2008 to December 2010 from 30 abortion facilities throughout the US. We interviewed women regarding the health and development of their living children via telephone 1 week after seeking an abortion and semiannually for 5 years. We compare the youngest existing children younger than the age 5 years of women denied abortion because they presented for care beyond a facility's gestational limit (Turnaway group) with those of women who received the abortion (Abortion group). We used mixed-effects regression models to test for differences in outcomes of existing children of women in the Turnaway group (n = 55 children) compared with existing children of women in the Abortion group (n = 293 children). RESULTS: From 6 months to 4.5 years after their mothers sought abortions, existing children of women denied abortions had lower mean child development scores (adjusted ß -0.04, 95% CI -0.07 to -0.00) and were more likely to live below the Federal Poverty Level (aOR 3.74, 95% CI 1.59-8.79) than the children of women who received a wanted abortion. There were no significant differences in child health or time spent with a caregiver other than the mother. CONCLUSIONS: Denying women a wanted abortion may have negative developmental and socioeconomic consequences for their existing children.
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Aspirantes a Aborto/estatística & dados numéricos , Desenvolvimento Infantil , Resultado da Gravidez/epidemiologia , Gravidez não Desejada/psicologia , Aborto Induzido/psicologia , Aborto Induzido/estatística & dados numéricos , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Fatores Socioeconômicos , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Introduction Despite significant global improvements in maternal health, large disparities persist. In China, rural women and women who live in western regions experience lower rates of maternal healthcare utilization and higher rates of maternal mortality than women elsewhere in the country. This paper examines maternal health care-seeking among nomadic Tibetan women in rural western China, a particularly understudied group. Methods Secondary data analysis was conducted with survey data collected in 2014 in Qinghai Province, China. Participants (rural, nomadic, adult women) provided birth histories and information on care received during antenatal, intrapartum and/or postpartum period(s). Using bivariate and multivariable logistic regression models, these outcomes were explored in relation to maternal characteristics (e.g., educational attainment and parity), use of health insurance, and time. Results Approximately half of all women had ever used antenatal care, institutional delivery, and/or skilled birth attendance. The utilization of these services has increased over time, from 10% of births prior to the year 2000, to approximately 50% since 2000. Utilization increased by year (odds ratios ranging from 1.1 to 1.3) even after controlling for covariates. Women with health insurance coverage were significantly more likely to use these services than women without insurance, although less than 20% of women reported that insurance paid for any antenatal and/or childbirth care. Discussion Utilization of maternal care is improving among this population but rates remain low in comparison to other women in rural, western China. Further targeted interventions may be needed to reach and adequately address the maternal health needs of this unique population.
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Parto Obstétrico/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Serviços de Saúde Materna/estatística & dados numéricos , Saúde Materna , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Feminino , Humanos , Mortalidade Materna , Gravidez , Resultado da Gravidez , Prevalência , Tibet , Adulto JovemRESUMO
Syndemic Zika virus, HIV and unintended pregnancy call for an urgent understanding of dual method (condoms with another modern non-barrier contraceptive) and consistent condom use. Multinomial and logistic regression analysis using data from the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS), a nationally representative household survey of reproductive-aged women in Brazil, identified the socio-demographic, fertility and relationship context correlates of exclusive non-barrier contraception, dual method use and condom use consistency. Among women in marital and civil unions, half reported dual protection (30% condoms, 20% dual methods). In adjusted models, condom use was associated with older age and living in the northern region of Brazil or in urban areas, whereas dual method use (versus condom use) was associated with younger age, living in the southern region of Brazil, living in non-urban areas and relationship age homogamy. Among condom users, consistent condom use was associated with reporting Afro-religion or other religion, not wanting (more) children and using condoms only (versus dual methods). Findings highlight that integrated STI prevention and family planning services should target young married/in union women, couples not wanting (more) children and heterogamous relationships to increase dual method use and consistent condom use.
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Preservativos/estatística & dados numéricos , Comportamento Contraceptivo , Infecções por HIV/prevenção & controle , Casamento , Gravidez não Planejada , Infecção por Zika virus/prevenção & controle , Adolescente , Adulto , Brasil/epidemiologia , Coito Interrompido , Anticoncepcionais Femininos , Dispositivos Anticoncepcionais Femininos , Anticoncepcionais Orais , Implantes de Medicamento , Feminino , Infecções por HIV/epidemiologia , Humanos , Dispositivos Intrauterinos , Modelos Logísticos , Pessoa de Meia-Idade , Métodos Naturais de Planejamento Familiar , Gravidez , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Inquéritos e Questionários , Sindemia , Adulto Jovem , Infecção por Zika virus/epidemiologiaRESUMO
The circumstances surrounding sexual debut influence subsequent sexual and reproductive outcomes. We analysed longitudinal data from 397 women who participated in the Cebu Longitudinal Health and Nutrition Survey in Cebu, Philippines, to examine associations between unwanted first sex and number of pregnancies, unintended pregnancy, and use of modern contraception. 72% of women reported unwanted first sex. Women whose first sex was unwanted had increased odds of unintended pregnancy compared to women whose first sex was wanted (aOR = 2.2, 95% CI 1.3, 3.6). Nationally representative surveys should include culturally relevant questions about sexual debut to inform public health programmes aimed at improving sexual/reproductive health.
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OBJECTIVE: To examine HPV vaccine awareness and receptivity among adolescents and young adults in Senegal. METHODS: Participants from six high schools and five community centres across five regions of Senegal (n = 2286) completed a self-administered questionnaire in October and November 2014. The study assessed HPV awareness and receptivity towards receiving the HPV vaccine. Multivariable logistic regression explored statistically significant relationships between the predictor variables and both outcomes. RESULTS: Twenty-seven percent had heard of HPV. Among those who had heard of HPV (n = 616), only 28% indicated willingness to vaccinate. Multivariable analysis showed that respondents from rural areas had 63% higher odds (95% CI: 1.24, 2.12) of having heard of HPV than those in urban areas. Respondents with fathers who had completed higher education had 41% higher odds (95% CI: 1.04, 1.92) of being aware of HPV (P < 0.05); however, every level of father's education (as compared to no education at all) was negatively associated with willingness to vaccinate. Respondents who had previously spoken to a healthcare professional about the HPV vaccine had 80% higher odds (95% CI: 1.16, 2.81) of willingness to vaccinate than those who did not speak to a provider about the vaccine. CONCLUSIONS: Healthcare providers and parents are important stakeholders in disseminating HPV vaccine information. Given the overall low levels of awareness, there is a great opportunity for public health communication efforts to craft health messaging and information in a way to maximise receptivity, outlining benefits and providing information on the minimal risks associated with the vaccine.
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Conscientização , Conhecimentos, Atitudes e Prática em Saúde , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Feminino , Humanos , Masculino , População Rural , Senegal , Fatores Socioeconômicos , População Urbana , Adulto JovemRESUMO
BACKGROUND: Despite increased recognition of the important influences of women's status and empowerment on social and health outcomes for women and their families, there are few investigations that examine the extent to which any gains in women's empowerment may be transmitted intergenerationally, that is, between mothers and their daughters. METHODS: This study seeks to address this gap by using data from a unique, longitudinal, and intergenerational dataset from Cebu, Philippines (1994-2009), to examine potential influences of the status of mothers on subsequent reproductive health outcomes among their daughters. Using data from 648 mother-daughter dyads, we examine a multidimensional set of women's status and empowerment measures among the mothers to predict three outcomes among their daughters: sexual onset by 2009 (ages 25-26), use of family planning, and experience of an unintended pregnancy. RESULTS: We find that that while some of the mothers' characteristics and measures of empowerment and status were predictive of their daughters' sexual initiation, these effects were not consistent across empowerment indicators, nor were there significant effects on two of the outcomes: use of family planning or occurrence of an unintended pregnancy. Older mothers (45+ years in 1994) and mothers who were considered to be "well-kept", a locally defined measure of empowerment, were more likely to have daughters who had not engaged in sex by 2009 (ages 25-26). Daughters with higher educational levels were also more likely to delay sex, as compared to their peers. Among young women who had become sexually active, 54% reported an unintended pregnancy (mistimed or unwanted) by the age of 25-26, yet their mothers' empowerment and status were not predictive of daughters' reports of an unintended pregnancy. CONCLUSIONS: Overall, these findings suggest that further research is needed to explore more proximal impacts on young women's reproductive behavior in this setting, given other related investigations on women's empowerment and its linkages to sexual debut and educational attainment in this setting. Findings from this examination of daughters' reproductive outcomes suggest that there are likely additional intervening mechanisms between onset on sexual activity and mistimed or unintended pregnancy that need further elaboration.
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Relações Mãe-Filho , Mães/psicologia , Núcleo Familiar/psicologia , Poder Psicológico , Comportamento Sexual/psicologia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Filipinas , Gravidez , Reprodução , Direitos da Mulher , Adulto JovemRESUMO
BACKGROUND: Despite the reduction in maternal deaths globally, maternal mortality rates remain unacceptably high, particularly in some regions of the world. In sub-Saharan Africa, maternal mortality rates have even increased recently, with 201,000 deaths in 2015 as compared to 179,000 in 2013. Use of a skilled birth attendant (SBA) at delivery has remained low, despite evidence of the effectiveness of SBAs in reducing maternal deaths. Women's empowerment is increasingly recognized as a key determinant of maternal health care-seeking and outcomes, yet empirical examinations of the linkages between women's empowerment and delivery care use are particularly limited, especially from sub-Saharan Africa. METHODS: Using data from the 2010 Senegal Demographic and Health Survey (n = 7451), in this study we employed structural equation modeling (SEM) to investigate the complex and multidimensional pathways by which three women's empowerment domains (household decision-making, attitudes towards violence, and sex negotiation) directly and indirectly affect SBA use. RESULTS: Although variations were observed across measures, many of the women's status and empowerment measures were positively related to SBA use. Notably, women's education demonstrated a substantial indirect effect: higher education was related to older age at first marriage, which was associated with higher levels of empowerment and SBA use. In addition to age at first marriage, gender-role attitudes (e.g., progressive attitudes towards violence and sex negotiation) were significant mediators in the relationship between education and SBA use. However, household decision-making was not significantly associated with SBA use. CONCLUSIONS: Findings indicate significant effects of women's education, early marriage, and some dimensions of women's empowerment on SBA use. SEM was particularly useful in examining the complex and multidimensional constructs of women's empowerments and their effects. This study informs policy recommendations and programmatic efforts to reduce maternal mortality in sub-Saharan Africa by strengthening support for women's access to higher education, delaying marriage and childbearing among girls and young women, and supporting more equitable gender norms.
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Serviços de Saúde Materna/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Poder Psicológico , Gestantes/psicologia , Direitos da Mulher/estatística & dados numéricos , Adulto , África Subsaariana , Tomada de Decisões , Demografia , Feminino , Inquéritos Epidemiológicos , Humanos , Gravidez , Senegal , Fatores Sexuais , Adulto JovemRESUMO
Partnership and fertility patterns of young Filipinos have changed dramatically from previous generations, with a widening gap between sexual initiation and marriage, and concurrent increases in teenage pregnancy and unwanted fertility. Further understanding of young adults' social contexts and partnership patterns are needed to inform reproductive health programmes and policies affecting young Filipinos. Multivariate Poisson regression models were conducted with longitudinal and inter-generational data from the Cebu Longitudinal Health and Nutrition Survey (1998-2009) to examine the predictors of young women's fertility. Age at first sex, and number and duration of partnerships each independently and significantly predicted women's fertility by 2009 after controlling for contextual influences. Young women with more conservative attitudes towards dating, sex and marriage, and who perceived their mothers to have more conservative attitudes, had higher fertility than their peers, as did young women with mothers who reported more adolescent sexual behaviours. In contrast, fertility was lower among daughters who had higher levels of communication with their mothers. Given high levels of unintended fertility and teenage pregnancy in the Philippines, the findings indicate that the interval between sexual initiation and first and subsequent partnerships may be ideal intervention points for reproductive health services for young Filipinos.
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Fertilidade , Casamento , Gravidez na Adolescência/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adolescente , Adulto , Comunicação , Anticoncepcionais , Feminino , Serviços de Saúde/estatística & dados numéricos , Humanos , Relações Interpessoais , Mães/psicologia , Análise Multivariada , Núcleo Familiar/psicologia , Filipinas , Gravidez , Gravidez na Adolescência/prevenção & controle , Gravidez na Adolescência/psicologia , Análise de Regressão , Adulto JovemRESUMO
This paper reviews the literature examining the relationship between women's empowerment and contraceptive use, unmet need for contraception and related family planning topics in developing countries. Searches were conducted using PubMed, Popline and Web of Science search engines in May 2013 to examine literature published between January 1990 and December 2012. Among the 46 articles included in the review, the majority were conducted in South Asia (n=24). Household decision-making (n=21) and mobility (n=17) were the most commonly examined domains of women's empowerment. Findings show that the relationship between empowerment and family planning is complex, with mixed positive and null associations. Consistently positive associations between empowerment and family planning outcomes were found for most family planning outcomes but those investigations represented fewer than two-fifths of the analyses. Current use of contraception was the most commonly studied family planning outcome, examined in more than half the analyses, but reviewed articles showed inconsistent findings. This review provides the first critical synthesis of the literature and assesses existing evidence between women's empowerment and family planning use.
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Países em Desenvolvimento , Serviços de Planejamento Familiar , Identidade de Gênero , Poder Psicológico , Adulto , Ásia , Comunicação , Comportamento Contraceptivo , Tomada de Decisões , Características da Família , Feminino , Humanos , Casamento , Avaliação das Necessidades , Gravidez , Direitos da MulherRESUMO
The Philippines is one of seven countries in which HIV incidence has recently increased-much of this increase has been among men who have sex with men. Despite this trend, knowledge on sexuality and same-sex behaviors in the Philippines is limited. This study examines same-sex behavior, sexual outcomes, substance use, and psychological distress among young adults participating in the 2005 Cebu Longitudinal Health and Nutrition Survey (CLHNS). We use gender-stratified, multivariate models to compare young adults who reported same-sex behaviors and those who did not. Among a cohort of 1,912 Filipino young adults (ages 20-22), 58.2 % were sexually experienced and 15.1 % of them reported same-sex sexual contacts or romantic relationships. Compared to females, more males reported same-sex sexual contact (19.4 vs. 2.3 %) or same-sex romantic relationships (9.2 vs. 4.1 %). Young adults reporting same-sex behavior had higher odds of smoking, drug use, perceived stress, and more sexual partners as compared to their peers. Males who reported same-sex behavior initiated sex earlier than those males who did not report same-sex behaviors. There were no significant differences in depressive distress. Earlier sexual initiation and higher levels of substance use among Filipino young adults engaging in same-sex behavior highlight the need to address unique health issues within this population. Mixed findings for depressive distress and perceived stress indicate that further investigation is needed to explore the potential impacts of same-sex status on mental health outcomes, particularly in lower- and middle-income countries such as the Philippines.
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Inquéritos Epidemiológicos , Homossexualidade/estatística & dados numéricos , Comportamento Sexual , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudos Longitudinais , Masculino , Filipinas/epidemiologia , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Adulto JovemRESUMO
The barbershop has been used to target African American (AA) men across age groups for health screenings, health interventions, and for research. However, few studies explore the sociodemographic characteristics of barbers and their clients. Additionally, few have evaluated the client's relative comfort with receiving health information and screenings in barbershops and other non-clinical settings. Lastly, it is unknown whether barbers feel capable of influencing health-decision making of AA men. AA male clients and barbers completed a self-administered survey in barbershops in predominantly AA neighborhoods throughout Chicago, Illinois. We assessed sociodemographic characteristics and attitudes towards receiving physical and mental health education and screenings in barbershops and other settings. Barbers were also surveyed regarding their most and least common clients by age group and their perceived ability to influence the decision-making of AA males by age group. AAs surveyed in barbershops have similar rates of high school completion, poverty and unemployment as the AA residents of their neighborhood. AA males prefer to receive health education and screening in clinician offices followed by barbershops and churches. Barbers reported serving males age 18-39 years of age most frequently while men 50 years and older were the least served group. Overall, barbers did not believe they could influence the decision-making of AA men and in the best case scenario, only 33 % felt they could influence young men 18-29 years old. Barbershops reach AA men that are representative of the demographics of the neighborhood where the barbershop is located. Barbers reach a small population of men over age 49 and feel incapable of influencing the decisions of AAs over age 39. Further studies are needed to assess other locales for accessing older AA men and to evaluate the feasibility of mental health interventions and screenings within the barbershop.
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Barbearia , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Adolescente , Adulto , Idoso , Chicago , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Modelos Psicológicos , Inquéritos e Questionários , Adulto JovemRESUMO
Lower- and middle-income countries (LMICs) are experiencing rapid changes in access to and use of new internet and digital media technologies. The purpose of this study was to better understand how younger audiences are navigating traditional and newer forms of media technologies, with particular emphasis on the skills and competencies needed to obtain, evaluate and apply health-related information, also defined as health and media literacy. Sixteen focus group discussions were conducted throughout Senegal in September 2012 with youth aged 15-25. Using an iterative coding process based on grounded theory, four themes emerged related to media use for health information among Senegalese youth. They include the following: (i) media utilization; (ii) barriers and conflicts regarding media utilization; (iii) uses and gratifications and (iv) health and media literacy. Findings suggest that Senegalese youth use a heterogeneous mix of media platforms (i.e. television, radio, internet) and utilization often occurs with family members or friends. Additionally, the need for entertainment, information and connectedness inform media use, mostly concerning sexual and reproductive health information. Importantly, tensions arise as youth balance innovative and interactive technologies with traditional and conservative values, particularly concerning ethical and privacy concerns. Findings support the use of multipronged intervention approaches that leverage both new media, as well as traditional media strategies, and that also address lack of health and media literacy in this population. Implementing health-related interventions across multiple media platforms provides an opportunity to create an integrated, as opposed to a disparate, user experience.
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Letramento em Saúde/métodos , Comportamento de Busca de Informação , Internet , Meios de Comunicação de Massa/estatística & dados numéricos , Adolescente , Comportamento do Adolescente , Adulto , Países em Desenvolvimento , Feminino , Grupos Focais , Teoria Fundamentada , Humanos , Masculino , Saúde Reprodutiva/educação , Senegal , Adulto JovemAssuntos
Infertilidade , Direitos Sexuais e Reprodutivos , Feminino , Humanos , Masculino , Pesquisa , Direito à SaúdeRESUMO
BACKGROUND: Maternal mortality remains unacceptably high in sub-Saharan Africa with 179,000 deaths occurring each year, accounting for 2-thirds of maternal deaths worldwide. Progress in reducing maternal deaths and increasing Skilled Birth Attendant (SBA) use at childbirth has stagnated in Africa. Although several studies demonstrate the important influences of women's status and empowerment on SBA use, this evidence is limited, particularly in Africa. Furthermore, few studies empirically test the operationalization of women's empowerment and incorporate multidimensional measures to represent the potentially disparate influence of women's status and empowerment on SBA use across settings. METHODS: This study examined the relationship of women's status and empowerment with SBA use in two African countries--Senegal and Tanzania--using the 2010 Demographic and Health Surveys (weighted births n = 10,688 in SN; 6748 in TZ). Factor analysis was first conducted to identify the structure and multiple dimensions of empowerment. Then, a multivariate regression analysis was conducted to examine associations between these empowerment dimensions and SBA use. RESULTS: Overall, women's status and empowerment were positively related to SBA use. Some sociodemographic characteristics showed similar effects across countries (e.g., age, wealth, residence, marital relationship, parity); however, women's status and empowerment influence SBA use differently by setting. Namely, women's education directly and positively influenced SBA use in Tanzania, but not in Senegal. Further, each of the dimensions of empowerment influenced SBA use in disparate ways. In Tanzania women's higher household decision-making power and employment were related to SBA use, while in Senegal more progressive perceptions of gender norms and older age at first marriage were related to SBA use. CONCLUSIONS: This study provides evidence of the disparate influences of women's status and empowerment on SBA use across settings. Results indicate that efforts to increase SBA use and to reduce maternal mortality through the improvement of women's status and empowerment should focus both on improving girls' education and delaying marriage, as well as transforming gender norms and decision-making power. However, given the multi-dimensional and contextual nature of women's status and empowerment, it is critical to identify key drivers to increase SBA use in a given setting for contextually tailored policy and programming.