Individual and community-level tolerance of spouse abuse and the association with the circumstances of first sex among youth from six sub-Saharan African countries.

Youth who engage in early and premarital sex are at risk of HIV and sexually transmitted infections. Most prevention programs ignore the mediating influence of the threat and experience of violence on these outcomes. Using nationally representative data from Lesotho, Malawi, Zimbabwe, Kenya, Tanzania, and Uganda, multivariate analyses examined the association between individual- and community-level tolerance of spouse abuse on the age and circumstances of sexual debut among female youth. The youth sample sizes ranged from a high of 5007 in Malawi to a low of 3050 in Lesotho. In the study countries, there were between 521 and 367 communities included in the analysis. Youth who approved of spouse abuse were more likely to have sexually debuted at each age. In Kenya, youth from communities with high female spouse abuse tolerance were more likely to have initiated sex at each age. In Malawi and Zimbabwe, youth from high tolerance communities were less likely to have sexually debuted at each age or to have had premarital sex; the same effect on premarital sex was found for men's tolerance in Kenya and Tanzania. Programs are needed to reduce violence risk and increase youth negotiating power and delayed sexual debut, with the objective of reducing young people's risk of negative outcomes.

An evaluation of the "Entre Nous Jeunes" peer-educator program for adolescents in Cameroon.

A quasi-experimental design is used in this study to evaluate the "Entre Nous Jeunes" peer-educator program to promote STI/HIV-preventive behaviors in Nkongsamba, Cameroon. The main objective of the study is to assess whether the young people exposed to a peer educator gained greater knowledge and practiced more protective behaviors than did those in the control community and those who were not exposed. During the 18-month intervention period, the peer educators were able to reach a large number of young people, specifically those who were sexually experienced and in need of reproductive health information. Multivariate analyses indicate that contact with a peer educator is statistically significantly associated with greater spontaneous knowledge of modern contraception, the symptoms of sexually transmitted infections, and greater use of modern contraceptives, including the condom. In the absence of a peer-education program, current contraceptive use in the intervention community would have been significantly lower.

How well do perceptions of family planning service quality correspond to objective measures? Evidence from Tanzania.

This study examines the relationship between common objective measures of quality and perceptions of the quality of family planning facilities. Results of prior research indicate that such perceptions are an important determinant of contraceptive use in rural Tanzania. The data for this study are drawn from two surveys conducted in rural Tanzania. Three models are tested separately for women and for men. The important determinants of perceptions of quality among women and men are: perceived travel time to the facility, availability of immunizations, and availability of maternal and child health services. Additionally, the ratio of the number of staff to outpatients is important to men. The data explain a moderate amount of the variance in the quality measures, indicating that perceived quality is not fully predicted by common objective measures of quality. Future surveys of facility quality should develop objective measures to better predict the perceived quality, with the underlying goal of increasing contraceptive use.

Quality, accessibility, and contraceptive use in rural Tanzania.

We examine how informants' reports on community perceptions of the quality and accessibility of family planning facilities relate to the use of modern contraceptives by individuals in rural Tanzania. Using information on individual-level contraceptive use in conjunction with community-level information on the accessibility and quality of family planning facilities, we employ two distinct statistical procedures to illustrate the impacts of accessibility and quality on contraceptive use. Both procedures treat the community-level variables as imperfect indicators of characteristics of the facilities, and they yield nearly identical implications. We find that a community-level, subjective perception of a family planning facility's quality has a significant impact on community members' contraceptive use whereas other community measures such as time, distance, and subjective perception of accessibility have trivial and insignificant direct impacts, net of the control variables. Future research that uncovers the determinants of perceptions of both community-level and individual-level quality could provide key insights for developing effective and efficient family planning programs.

Are husbands a barrier to women's family planning use? The case of Morocco.

Little is known about men's role in the adoption of family planning. Recent studies suggest that men may be a barrier to women's use of family planning. However, it is not clear whether husbands represent a true or a perceived barrier. Using the 1992 Morocco Demographic and Health Survey data, this study examines (1) whether women and men report concordant fertility desires, discussions, and contraceptive use; (2) the accuracy of women's perceptions of their husbands' fertility desires; and (3) whether husbands are a barrier to women's family planning use. The results demonstrate that, controlling for women's own fertility desires, husbands' true fertility desires are associated with family planning use. Likewise, women who perceive their husbands to want fewer children than they want are more likely to use family planning. Future fertility and family planning programs need to include men to reduce their role as both perceived and true barriers to family planning use.

PIP: This study examines the following: 1) whether women and men report concordant fertility desires, discussions, and contraceptive use; 2) the accuracy of women's perceptions of their husband's fertility desires; and 3) whether husbands are a barrier to women's family planning use. Data were drawn from the 1992 Morocco Demographic and Health Survey, in which a sample of 9256 women aged 15-49 years was interviewed. The results demonstrate that, controlling for women's own fertility desires, husband's true fertility desires are associated with family planning use. Likewise, women who perceive their husbands to want fewer children than they want are more likely to use family planning. This study suggests the need for fertility and family planning programs that would include men to reduce their role as both perceived and true barriers to family planning use.

The impact of a family planning multimedia campaign in Bamako, Mali.

An integrated multimedia campaign featuring family planning messages saturated the 900,000-person city of Bamako, Mali, for three months during the spring of 1993. With traditional theater and music, family planning messages were repeatedly broadcast on radio and television that conveyed information about modern contraceptive methods, the need for male sexual responsibility, the health and economic advantages of family planning, the need for communication between spouses, and that Islam, the predominant faith of Mali, does not oppose family planning. A separate sample pretest-post-test quasi-experimental research design was used to evaluate the effects of the campaign and exposure to specific messages on changes in contraceptive knowledge, attitudes, and practice. Results indicate a high level of exposure to and agreement with the messages. A dramatic drop was found in the proportion of men and women who believe that Islam opposes family planning. Logistic regression results indicate that contraceptive knowledge and use and more favorable attitudes toward family planning are positively associated with intensity of exposure to the project interventions, after controlling for relevant variables.

PIP: According to the Demographic and Health Surveys conducted in Mali in 1987 and 1995-96, the current use of any form of contraception among currently married Malian women increased from 5% to 7% during the period between the 2 surveys. Family planning messages were disseminated throughout Bamako through radio and television for 3 months in a spring 1993 information, education, and communication (IEC) campaign. With traditional theater and music, family planning messages were repeatedly broadcast on radio and television to convey information about modern contraceptive methods, the need for male sexual responsibility, the health and economic advantages of family planning, the need for spouses to communicate with each other, and that Islam, the predominant religious faith of Mali, does not oppose family planning. Impact evaluation found a high level of exposure to and agreement with the campaign messages. The campaign also led to a dramatic decline in the proportion of men and women who believe that Islam opposes family planning. Logistic regression results indicate that contraceptive knowledge and use and more favorable attitudes toward family planning are positively associated with the intensity of exposure to the project interventions, after controlling for relevant variables.

Programs and services to prevent pregnancy, childbearing, and poor birth outcomes among adolescents in rural areas of the southeastern United States.

PURPOSE: To illustrate how rural adolescents' needs for pregnancy prevention and improved birth outcomes are currently being addressed, and to suggest strategies for future programs. METHODS: Local and state-level informants knowledgeable about services to adolescents in the Southeastern United States were identified. Semistructured interviews were used to determine the program start date and time frame, funding sources, target population, participating counties, implementing agency or organization, specific program services, and status of program activities. These programs were categorized by the type of services offered and the population targeted. RESULTS: The most common adolescent services in the rural Southeast attempt either to improve life options of youth, reduce sexual activity, or provide prenatal and postnatal care. Unlike urban areas where there are a variety of family planning providers, in the rural Southeast, health departments are the primary source of family planning for adolescents. There are no abortion providers in most rural areas of the Southeast. The majority of rural programs that include adolescents among the population served are developed for all women rather than specifically for adolescents. Programs specific to rural adolescents are described. CONCLUSIONS: The majority of programs in the rural Southeast address only selected adolescent health issues. Successful interventions require locally supported, multipronged, intensive approaches with consistent messages targeted to high-risk populations. Evaluation tools are needed to determine the effectiveness of each component of prevention programs.

A marriage trichotomy and its applications.

This paper promotes research methods specific to men, the new focus of fertility and family planning studies (especially in sub-Saharan Africa). I propose a novel marriage categorization based on married men's intentions to take another wife. The three marriage groups are currently monogamous men who intend to remain so, currently monogamous men who intend to become polygynous, and currently polygynous men. The first analysis demonstrates that typical marriage analyses may misclassify men who intend to become polygynous. Applications of the marriage trichotomy illustrate that men with varying marital intentions have differing desires regarding fertility and family planning.

Men's desire for additional wives and children.

In sub-Saharan Africa, the majority of fertility and family planning studies are of women. By ignoring men, these studies overlook the primary fertility and family decision makers. This study uses male data from Cameroon to examine how currently monogamous men make fertility and nupital decisions. Three analyses are discussed. First, an analysis of monogamous men's desire for additional wives is presented. Second, an analysis of monogamous men's desire for additional children is presented. Finally, the two desires are examined simultaneously to disentangle the relationship between these two family desires. Three possible interrelationships between monogamous men's two family desires (desire for wives and desire for children) are examined and discussed. The results indicate that men's desire for more children drives their desire for additional wives and not the contrary. The implications of this finding for high fertility in areas where polygyny is common are discussed.

Trends in the incidence of outcomes defining acquired immunodeficiency syndrome (AIDS) in the Multicenter AIDS Cohort Study: 1985-1991.

Incidence of clinical outcomes defining acquired immunodeficiency syndrome (AIDS) may be expected to change as a consequence of progressive immunosuppression and use of chemoprophylaxis before the onset of AIDS. Using Poisson regression methods, we examined trends in the incidence of initial and secondary AIDS-defining illnesses from 1985 to 1991 among 2,627 homosexual men participating in the Multicenter AIDS Cohort Study who were seropositive for human immunodeficiency virus type 1. The incidence of Pneumocystis carinii pneumonia rose steeply until 1987 but has declined since then (p < 0.001), while the other AIDS-defining conditions have showed significant (p < or = 0.039) upward trends. Trends for Kaposi's sarcoma, lymphoma, neurologic disease, and cytomegalovirus/herpes simplex virus infections were explained by progressive immunosuppression, but residual downward and upward trends were present for P. carinii pneumonia and other opportunistic infections (bacterial, fungal, and protozoal infections and wasting syndrome). Despite selection bias, those receiving P. carinii pneumonia chemoprophylaxis showed a significantly lower incidence of P. carinii pneumonia (relative risk = 0.32, 95% confidence interval 0.16-0.63), and the time trends of P. carinii pneumonia were explained by progressive immunosuppression and use of prophylaxis. No significant effects on all other diagnoses were seen in those selected to receive antiretroviral therapy. Secondary diagnoses showed a strongly significant (p < 0.001) increase in non-P. carinii pneumonia and non-Kaposi's sarcoma among those with initial diagnoses of Kaposi's sarcoma. Overall, the trend observed in the incidence of other opportunistic infections underscores the need for developing and testing new strategies to curtail or delay the onset of these diseases.