Bilateral effect following off label unilateral intravitreal brolucizumab injection in patient with pseudophakic cystoid macular edema.

PURPOSE: To report a bilateral reduction in pseudophakic cystoid macular edema (PCME) after unilateral intravitreal injection (IVI) of brolucizumab. OBSERVATIONS: A 64-year-old female with bilateral recalcitrant PCME was treated with one dose of intravitreal ozurdex implant and triamcinolone acetonide each in both the eyes, with an equivocal response. On switching to IVI brolucizumab in the right eye (OD), the patient showed significant improvement in the best-corrected visual acuity (BCVA) with a notable reduction in the intraretinal fluid (IRF) and central subfield thickness (CST) in both the eyes at one month. CONCLUSIONS AND IMPORTANCE: In conclusion, IVI brolucizumab is effective for the management of recalcitrant PCME with good visual and anatomical outcomes at one month. However, this molecule can also have therapeutic efficacy in the uninjected eye possibly due to systemic escape. More research into the pharmacokinetic properties of this novel molecule is needed to validate our findings.

Is the Decision Not to Use Contraception an Indicator of Reproductive Agency?

Women's engagement in the decision to use contraception, an indicator captured in the Demographic and Health Surveys (DHS), is frequently used to assess women's reproductive agency. In 2014, DHS added a corollary question to the women's questionnaire on decision-making not to use contraception. Study authors hypothesize that women's engagement in decision-making not to use contraception is also indicative of reproductive agency. Analyzing DHS microdata from 30 countries collected between 2015 and 2020 (n = 292,141), this country-level study examines data quality in terms of missingness of data (t-tests), indicator utility in terms of response pattern variability (descriptive statistics), and construct validity in terms of associations between engagement in the decision not to use contraception and engagement in household decision-making (multivariable linear regression). Findings indicate the measure is of good quality, provides nuanced insight, and has construct validity. Importantly, the new measure deepens our understanding of women's reproductive agency.

Mobile phone ownership, text messages, and contraceptive use: Is there a digital revolution in family planning?

OBJECTIVES: This study aims to clarify the associations between mobile phone ownership use on family planning outcomes. Secondary analysis of DHS data finds that in certain contexts, mobile phone ownership may be related to increased FP uptake. STUDY DESIGN: Using recent data for women 15-49 from the Demographic and Health Surveys for six countries - Ethiopia (2016), Uganda (2016), Tanzania (2015-16), Nepal (2016), Philippines (2017), and Haiti (2016-17) - we conduct multivariate logistic regression analysis to assess FP outcomes (contraceptive prevalence (CPR), modern contraceptive prevalence (mCPR), and unmet need for family planning) for mobile phone ownership and source of exposure to FP messaging. We use STATA14 for our analyses, and all results presented are weighted. RESULTS: We find that in Uganda, Tanzania, and Haiti, owning a mobile phone is significantly associated with overall contraceptive use (OR = 1.38, 1.38, 1.23 respectively), modern contraceptive use (OR = 1.34, 1.30, 1.24 respectively) net of socioeconomic factors. Further, our analysis demonstrated that receiving FP information via text message was significantly associated with contraceptive uptake only in Haiti (OR = 1.62 for overall contraceptive use and OR = 1.53 for modern contraceptive use), where SMS systems have more robust connections to clinic services. CONCLUSIONS: Our results indicate that in certain contexts, mobile phone ownership may be related to increased FP uptake. IMPLICATIONS: These findings help inform investments in mHealth programming for family planning and reproductive health. They help clarify the potential significance of demographic patterns of mobile ownership and health outcomes, and also demonstrate the limitations of SMS services in relationship to contraceptive behaviors, reinforcing the need to connect mHealth to clinic services.

Standardizing Measurement of Contraceptive Use Among Unmarried Women.

Historically, the family planning practices and needs of married women have been monitored and reported uniformly. However, the same uniformity does not hold for unmarried women. Because key data and information platforms employ different measurement approaches-namely, different definitions of sexual recency-reports of contraceptive prevalence and unmet need among unmarried women are inconsistent. We examine how the measurement approaches employed by 3 large organizations yield such divergent estimates. We find that contraceptive prevalence and unmet need estimates among married women do not vary much by sexual recency. For unmarried women, contraceptive prevalence is systematically lower and unmet need is systematically higher as the sexual recency window widens. In the short term, we recommend using the 1-month cutoff as analyses reveal it yields the most precise estimates for better recognizing the needs of this important demographic group.

Dynamic stagnation: reasons for contraceptive non-use in context of fertility stall.

Background: While most countries have experienced reductions in the total fertility rate (TFR), there are countries where the fertility transition has not begun and others where the fertility transition has stalled with TFR still well above replacement level.  We use these contexts of "fertility stagnation" to explore reasons behind contraceptive non-use among women who desire to delay or avoid a future birth.  Specifically, we explore whether women's reasons for not using contraception are stagnant as the population-level indicator, TFR, suggests or are more dynamic. This nuanced understanding can inform programmatic direction for countries especially in need.  Methods: Using Demographic and Health Survey (DHS) data from the two most recent surveys of ten study countries-five countries that have not yet experienced a fertility transition ("pre-transitional") and five countries that began the fertility transition but stalled ("transitional")-we explore trends in reasons for non-use.  Results: We find that that reasons for non-use are changing. Specifically, in pre-transition study countries, women are increasingly citing attitudes opposing contraception as reasons for non-use.  In transition countries, women are increasingly citing reasons related to service quality and method side effects. Perceived low fecundability is increasingly cited among both pre-transition and transition study countries. Geographical access and cost are not prominent frequently cited at either time point.  Conclusions: These findings highlight the need for prioritized programmatic attention aimed at: reducing opposition to contraception in pre-transitional countries; improving service quality and addressing issues of side-effects, both experienced and perceived, in transitional countries; and addressing fecundability perceptions in both types of country contexts.  We remind policy makers that even in contexts of fertility stagnation, underlying attitudes, norms, and barriers to contraceptive uptake are shifting.  Lack of change at the population-level can mask important changes at the individual-level that must be accounted for in program development and implementation.

INFORMED CHOICE AND FEMALE STERILIZATION IN SOUTH ASIA AND LATIN AMERICA.

Globally, female sterilization is one of the most popular contraceptive methods despite concerns about quality of care for women who report being sterilized. In this study, informed choice among sterilized women was quantified using Demographic and Health Survey (DHS) data from 2000 to 2012 for countries in South Asia and Latin America. Three responses measured informed choice and knowledge about whether women were informed by a health worker or provider: that sterilization is permanent, the potential side-effects of sterilization and other methods of contraception. An ascending composite Method Information Index with scores ranging from 0 (women received no information) to 3 (women received information across all three indicators) was used. Using ordinal logistic regression analysis, the results indicated that women younger than 25 and older than 35 at the time of sterilization, and those at high parities, had lower odds of a high score on the index, while the opposite was true for women sterilized in the private sector in Latin America. Educated women in India had higher odds of a high score on the index, while the same was true for educated and wealthy women in Colombia. These findings indicate that not enough health care providers spend time informing women in South Asia and Latin America about different aspects of sterilization, and that there are specific groups of women that are more affected. There is an urgent need to improve quality of care within health systems providing sterilization for this very important and effective type of contraception.

Widowhood and Depression in a Cross-National Perspective: Evidence from the United States, Europe, Korea, and China.

Objectives: We explore marital and depression trajectories over time for men and women, and distinguish between mood and somatic depression across contexts. Method: We use longitudinal data from 2002 to 2013 from the United States, England, Europe, Korea, and China to explore depression among individuals married at baseline and follow their trajectories into widowhood with married as the reference group. We use random effects models to estimate these trajectories using the Center for Epidemiologic Studies Depression Scale (CES-D) or EURO-D scales for men and women. Results: Depression peaks within the first year of widowhood for men and women, but women recover to levels comparable to married counterparts in all countries. Men sustain high levels of depression even 6-10 years post-widowhood everywhere except Europe. Widowed women have higher somatic depression compared to men, who have higher mood depression. Family plays differential roles in mediating depression across countries. Discussion: Our research shows the complex global relationship between widowhood and depression. Studies that do not compare depression trajectories over time may make incorrect inferences about the persistence of depression by gender and country. Interventions should target different components of depression: mood-related symptoms for men and somatic-related symptoms for women for most effective recovery.

Household sanitation facilities and women's risk of non-partner sexual violence in India.

BACKGROUND: Globally, one in ten individuals practice open defecation. Despite media speculation that it increases women's risk of sexual violence, little empirical evidence supports the claims. We investigate the relationship between household sanitation facilities and women's risk of non-partner sexual violence (NPSV) in India, where nearly half of the population lives without a pit or toilet. METHODS: We use the most recent NPSV data, from the National Family Health Survey-III, to estimate logistic regression models of the effects of household sanitation facilities (toilet, pit, or none) on NPSV in the last year among women who have resided in their current home for one year or more. These effects are estimated net of other socioeconomic factors, compared to effects of household sanitation facilities on child diarrhea, and, as a falsification test, compared to effects of household sanitation facilities on intimate partner sexual violence (IPSV) in the last year. RESULTS: Net of their socioeconomic status, women who use open defecation are twice as likely to face NPSV as women with a household toilet. This is twice the association between open defecation and child diarrhea. The results of our falsification test indicate that open defecation is not correlated with IPSV, thus disconfirming a simultaneous selection of women into open defecation and sexual violence. CONCLUSIONS: Our findings provide empirical evidence that lacking household sanitation is associated with higher risk of NPSV.

Domestic Violence and Abortion Among Rural Women in Four Indian States.

The prevalence of domestic violence and abortion in India is high, yet little is known about the relationship between these experiences. Data from two linked data sets, India's 1998-1999 National Family Health Survey (NFHS-2) and a follow-up survey in 2002-2003, were analyzed. The analysis examines how the experience of physical violence affects the subsequent uptake of abortion, and how the experience of abortion affects subsequent experience of physical, sexual, and verbal violence. Women who experienced physical violence have significantly higher odds of reporting a subsequent induced abortion, whereas women who had an induced abortion have significantly higher odds of reporting subsequent sexual and verbal violence. There was no significant relationship between domestic violence and spontaneous abortion.

Risky Behaviors among HIV-Positive Female Sex Workers in Northern Karnataka, India.

Purpose. Little is known about the risky sexual behaviors of HIV-positive female sex workers (FSWs) in the developing world, which is critical for programmatic purposes. This study aims to shed light on their condom use with regular clients as well as husband/cohabiting partner, a first in India. Methods. Multivariate logistic regression analyses for consistent condom use with regular clients and husband/cohabiting partner are conducted for the sample of 606 HIV-positive FSWs. Results. Older FSWs are 90% less likely and nonmobile FSWs are 70% less likely to consistently use condoms. FSWs on ART are 3.84 times more likely to use condoms. Additionally, FSWs who changed their occupation after HIV diagnosis are 70% less likely to use condoms. FSWs who are currently cohabiting are more likely to consistently use condoms with repeat clients and are 3.22 times more likely to do so if they have felt stigma associated with being HIV-positive. FSWs who have multiple repeat clients, and who do not know the sexual behavior of these clients, are more likely to use condoms consistently. Conclusion. This study would help inform programs to target the following particularly vulnerable HIV-positive FSWs: those who are older, those who changed their occupation post-HIV diagnosis, and those who are nonmobile.

Physical domestic violence and subsequent contraceptive adoption among women in rural India.

This study examines the relationship between male to female physical domestic violence and contraceptive adoption among women in four economically and culturally distinct areas of India. Data from India's 1998-1999 National Family Health Survey-2 and a follow-up survey in 2002-2003 for which the same women in four states were reinterviewed are analyzed. The focus of the analysis is on how baseline exposure to physical domestic violence is associated with the intersurvey adoption of contraception. Women who experience physical violence from their husbands are significantly less likely to adopt contraception in the intersurvey period, although this relationship varies by State. This study builds upon previous work by using an indicator of physical domestic violence exposure that is measured before contraceptive adoption, thus allowing the identification of how exposure to violence shapes the adoption of contraception. The results demonstrate that for women living in Bihar and Jharkhand there is a clear negative relationship between physical domestic violence and a woman's adoption of contraception; this relationship was not found for women in Maharashtra and Tamil Nadu. The results point to the need to include domestic violence screening and referral services into family planning services.