Meeting the needs of adolescent post-abortion care patients in the Dominican Republic.

Counselling on contraception and contraceptive method provision are key components of post-abortion care (PAC). Some studies have suggested that adolescent PAC patients receive worse care than older women seeking these services. This study aimed to evaluate an intervention whose goal was to improve the counselling and contraceptive uptake of PAC patients, with special attention given to the needs of adolescent patients, in the four public hospitals in the Dominican Republic where PAC services were not being routinely offered. The counselling intervention effort included provider training and the development of adolescent-friendly information, education and communication (IEC) materials. Eighty-eight providers were interviewed at baseline and 6 months after the intervention was implemented. Six months after providers were trained, 140 adolescent PAC patients (< or = 19 years of age) and 134 older PAC patients (20-35 years) were interviewed about the contraceptive counselling messages and contraceptive methods they received before they were discharged from hospital. The adolescent and older PAC patients were matched on study hospital and time of arrival. Significant improvements were noted in provider knowledge and attitudes. No changes were noted in provider-reported PAC counselling behaviours, with close to 70% of providers reporting they routinely assess patients' fertility intentions, discuss contraception, assess STI/HIV risk and discuss post-abortion complications. Adolescent and older PAC patients reported receiving PAC counselling messages at similar rates. Forty per cent of adolescent PAC patients and 45% of older PAC patients who wanted to delay pregnancy were discharged with a contraceptive method. Adolescents were more likely to receive an injectable contraceptive method whereas older women were discharged with a variety of methods. The PAC counselling intervention increased provider knowledge and improved their attitudes and benefited both adolescent and older patients.

Sexual violence and reproductive health among young people in three communities in Jamaica.

A secondary analysis of data collected from 1,130 young people ages 15 to 24 in a population-based household survey to assess the reproductive health needs of young people in three communities in Jamaica was conducted to determine the relationships among three measures of sexual violence, background variables, three measures of sexual risk taking (early sexual debut, multiple partners, and no condom at last sex), and two reproductive health outcomes (genital discharge within the past 12 months and pregnancy). In the multivariate analyses, forced first sex increased the likelihood of genital discharge among males (odds ratio, OR = 5.33) and females (OR = 2.02) and pregnancy among females (OR = 2.05), controlling for background characteristics and sexual risk taking. Associations between sexual violence and reported genital discharge and pregnancy that were not mediated by our measures of sexual risk taking were found. More research into the causal mechanisms for this association is needed.

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

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

The relationship between birth predictedness and violence during pregnancy among women in La Paz And El Alto, Bolivia.

OBJECTIVES: The main objectives were to estimate the prevalence of predicted and unpredicted last births using a prospective approach and to estimate the prevalence of violence during the last pregnancy. In addition, the relationship between birth predictedness and violence during pregnancy was examined. METHODS: The target population for this study was women who had participated in the 1994 Demographic and Health Survey (DHS) and lived in El Alto and La Paz Bolivia (n = 1308). In 1997, 816 women were located and re-interviewed. During this three-year interval, 127/816 women had given birth to their last child. RESULTS: Of the last births that occurred during the three-year interval, 82% were unpredicted (18% were to women who stated in 1994 that they wanted to postpone childbirth for more than three years and 64% were to women who stated they wanted to wanted to forego childbearing entirely). Twenty-eight percent of women reported that they had experienced violence during their last pregnancy. No statistically significant relationship was found between birth predictedness and violence during their pregnancy. CONCLUSIONS: The majority of births that occurred in the three-year study interval were unpredicted. The prevalence of violence during pregnancy was alarmingly high among this sample of women. Further investigation on violence during pregnancy is needed and should be expanded to examine how violence during pregnancy impacts maternal and infant outcomes, which have remained poor in this country. In addition, the high rates of unpredicted births illustrate that work remains to be done in addressing women's ability to control their fertility.