'If your husband calls, you have to go': understanding sexual agency among young married women in urban South India.

BACKGROUND: Early marriage is common in many developing countries, including India. Women who marry early have little power within their marriage, particularly in the sexual domain. Research is limited on women's ability to control their marital sexual experiences. METHODS: We identified factors affecting sexual communication among married women aged 16-25, in Bangalore, India, and how factors associated with sexual communication differed from those influencing non-sexual agency. We ran ordered logit regression models for one outcome of sexual agency (sexual communication, n = 735) and two outcomes of non-sexual agency (fertility control, n = 735, and financial decision-making, n = 728). RESULTS: Sexual communication was more restricted (83 women (11.3%) with high sexual communication) than financial decision-making (183 women (25.1%) with high financial decision-making agency) and fertility control (238 women (32.4%) with high fertility control). Feeling prepared before the first sexual experience was significantly associated with sexual communication (odds ratio (OR) = 1.8; 95% confidence interval (CI) = 1.13-2.89). Longer marriage duration (OR 2.13; 95% CI = 1.42-3.20) and having worked pre-marriage (OR 1.38; 95% CI = 1.02-1.86) were also significant. Few other measures of women's resources increased their odds of sexual communication. Education, having children, pre-marital vocational training and marital intimacy were significant for non-sexual outcomes but not sexual communication. CONCLUSIONS: Policy-makers seeking to enhance young married women's sexual communication need to consider providing sex education to young women before they marry. More broadly, interventions designed to increase women's agency need to be tailored to the type of agency being examined.

Potential role of traditional birth attendants in neonatal healthcare in rural southern Nepal.

The potential for traditional birth attendants (TBAs) to improve neonatal health outcomes has largely been overlooked during the current debate regarding the role of TBAs in improving maternal health. Randomly-selected TBAs (n=93) were interviewed to gain a more thorough understanding of their knowledge, attitudes, and practices regarding maternal and newborn care. Practices, such as using a clean cord-cutting instrument (89%) and hand-washing before delivery (74%), were common. Other beneficial practices, such as thermal care, were low. Trained TBAs were more likely to wash hands with soap before delivery, use a clean delivery-kit, and advise feeding colostrum. Although mustard oil massage was a universal practice, 52% of the TBAs indicated their willingness to consider alternative oils. Low-cost, evidence-based interventions for improving neonatal outcomes might be implemented by TBAs in this setting where most births take place in the home and neonatal mortality risk is high. Continuing efforts to define the role of TBAs may benefit from an emphasis on their potential as active promoters of essential newborn care.