Sexual initiation and contraceptive use among adolescent women in northeast Brazil.

To estimate trends and determinants of sexual initiation and contraceptive use among adolescent women in Northeast Brazil, multivariate logistic hazard models are used that draw on data from three Demographic and Health Surveys conducted there between 1986 and 1996. Educational attainment is among the variables found to be associated most consistently with differential risk of engaging in first intercourse during adolescence, including premarital intercourse, and of contraceptive use during sexual initiation. Greater frequency of attending religious services and greater exposure to television are also associated with lower rates of sexual initiation and higher use of contraceptives. Seemingly diminishing returns of education on delayed sexual activity may help explain, in part, observed increases in the absolute level of adolescent sexual experience across survey periods, however. Multilevel modeling techniques pointing to the existence of cluster-level random variances underline the need for further research into community influences on individual sexual activity.

In Mexico, abortion rights strictly for the books.

PIP: This paper characterizes the Mexican abortion laws using the case of a girl aged 14 years, Paulina Ramirez Jacinta, who was raped, became pregnant, and chose to terminate the unwanted pregnancy, yet was denied an abortion. This case clearly showed that Mexican abortion law, despite its legality, is highly restrictive in nature and, in a way, violated the human rights of Paulina. Even though it permits first-trimester abortion procedures for rape victims or women whose lives are endangered by the pregnancy, many pregnant women still resort to illegal abortion. To further aggravate the restrictive nature of the law, Baja California state Rep. Martin Dominguez Rocha made a proposal to eliminate the rape exception in the state's penal code. The case of Paulina will be handled by the lawyers at the Center for Reproductive Law and Policy in order to arrive at a settlement favorable to Paulina.^ieng

Geographical variations in AIDS knowledge and attitude among adolescent girls of Jamaica.

This article examines geographical differences in AIDS knowledge and attitudes. Data from a survey of 900 adolescent girls in the Caribbean nation of Jamaica indicate significant differences across geography in AIDS knowledge and attitude. Adolescent girls in more central areas have access to different and more sources of information than those in more remote areas. They are also more likely to know persons with AIDS, be more knowledgeable about the clinical manifestations of AIDS, and be more realistic in assessing their susceptibility of HIV. The implications of geographical differences for AIDS education efforts are discussed.

PIP: This paper examines geographical differences in AIDS knowledge and attitudes among adolescent girls in Jamaica. A total of 900 respondents aged 14-17 were chosen; 714 of them were from urban areas, and 186 were from rural areas. Questions covered awareness of AIDS existence, information sources, the number of persons with AIDS the respondent was aware of, knowledge of AIDS transmission, and knowledge of risks. Findings showed that geography influenced the levels of knowledge and attitudes of adolescent girls toward AIDS. Young women who lived in more central areas were had an advantage over girls in remote areas with respect to access to AIDS information. It was concluded that efforts toward the dissemination of AIDS information to adolescents in rural areas should be implemented and that these should incorporate the development of educational resources for AIDS education. The results of this survey suggest generally that geographic type should be considered in educational efforts.

Cultural factors affecting diet and pregnancy outcome of Mexican American adolescents.

PURPOSE: To describe the nutrition knowledge, cultural beliefs, food intake, and attitudes about weight gain of Mexican American adolescents and their relationship to pregnancy weight gain and infant's birth weight. METHODS: A convenience sample of 46 pregnant adolescents, who were self-identified as Mexican American, primigravidas, and aged 13-18 years, was eligible. Two personal interviews were conducted with each participant, at the second trimester (18-22 weeks' gestation) and third trimester (30-34 weeks' gestation). The measurements were nutrient intake, nutrition knowledge, and attitudes toward weight gain. The proxy measure for acculturation was the length of residence in the United States [Group 1 (G1), n = 14; 3-12 months), G2 (n = 19; 12-48 months), and G3 (n = 13; 48-216 months). Descriptive statistics and analysis of variance were performed on the data as appropriate. Qualitative methods were used to describe cultural beliefs, behaviors, and attitudes during pregnancy. RESULTS: The mean age of the sample was 16.34 +/- 1.56 years. A total of 21.74% (n = 10) was American-born and 78.26% (n = 36) was Mexican-born. G3 was significantly (p < .05) the youngest at the time of conception, gained the most weight during pregnancy, was more knowledgeable about nutrition, was more educated, and was single and living with parents. There were no differences regarding the adequacy of diets during pregnancy among the three groups, and all diets adhered to up to 85% of the mean adequacy ratio (MAR). The mean total weight gain was 31.83 +/- 9.88 lb. There were no statistically significant differences of birth weight; the mean value for the three groups was 7.23 +/- 0.98 lb. CONCLUSIONS: The most powerful factors that reportedly contributed to good food practices during pregnancy were maternal concern about the well-being of the baby, role of motherhood, and family support system. It was found that with acculturation, adolescents lost most of the traditional Mexican cultural beliefs related to pregnancy, and their attitudes about weight gain were more negative. There was no relationship between nutrition knowledge and diet adequacy during pregnancy; they chose the traditional foods thought most nutritious by parents and family, for the benefit of their baby.

PIP: A study was conducted to describe the cultural beliefs, nutrition knowledge, food intake, and attitudes about weight gain of Mexican American adolescents, and their relationship to pregnancy weight gain and infant's birth weight. A convenience sample of 46 pregnant adolescents, who were self-identified Mexican American primigravidas aged 13-18 years, were recruited from 6 San Francisco Bay Area and San Jose clinic sites. Data were collected over an 18-month period from Winter 1994 to Spring 1995. Results showed that acculturation affected nutritional knowledge, attitudes about weight gain during pregnancy, and the psychosocial and educational level of pregnant Mexican American adolescents. There were no differences in the quality of diet and pregnancy outcomes, gestational weeks at delivery, or birth weight among acculturated, versus the nonacculturated adolescents. Both benefited from cultural protective factors related to their dependence on the family for emotional, economic, and social support. Nutrition recommendations should emphasize the importance of maintaining traditional food habits and nutritive value information of American foods.

Correlates of first intercourse among women in Jamaica.

This study examines retrospective reports of factors anticipated to impact first intercourse in a random sample of 897 Jamaican women, and contributes to our understanding of the relationship between sexual risk, knowledge, and economic and demographic correlates of first intercourse. A relationship between initiation of intercourse prior to the age of consent (16 years) and factors occurring at or around the time of first intercourse was found. Early initiators were more likely to have had less early family stability and to have experienced menarche at a younger age than late initiators. Although early initiators of intercourse were more likely to report lower socioeconomic status, less STD knowledge, and greater numbers of pregnancies, they were no more likely to report more sexual partners than women who engaged in first intercourse after the age of consent, and had a greater number of long-term relationships. Regardless of age of first intercourse, women need to be made aware of the risks of sexual contact so that they can make informed decisions about the consequences of sexual activity. Overall, results are consistent with work conducted in other parts of the Caribbean and America regarding the age at which young women engage in first intercourse. Findings suggest the need for further work exploring expectations at first intercourse such as marriage, economic support, or relationship stability. Implications of these findings are discussed within the context of economic and structural factors that both increase and decrease risks.

PIP: This study examines retrospective reports of factors anticipated to impact first intercourse among 897 women selected randomly in Jamaica. Three groups of factors were associated with early vs. late initiation of intercourse. A significant association was noted between family structure in childhood and age of first intercourse. Women growing up in one-parent families were more likely to engage in intercourse before the age of 16. The age of menarche was also significantly associated with age of intercourse. The characteristics of the first sexual partner and the characteristics of the relationship were significantly associated with the age of intercourse. On the other hand, there are four sets of variables assessing current demographic characteristics, current relationship status, and factors such as religiosity and knowledge on sexually transmitted diseases (STDs). It was observed that early initiators of intercourse were more likely to report lower socioeconomic status, less STD knowledge, and a greater number of pregnancies. This study identifies some of the circumstances of first intercourse, which highlight the need to develop health and educational intervention programs that offer more options to young adolescents who may consider early childbearing to stabilize relationships.

Family risk factors associated with adolescent pregnancy: study of a group of adolescent girls and their families in Ecuador.

PURPOSE: To identify characteristics within the family that were associated with adolescent pregnancy in a group of adolescent girls in Quito, Ecuador. METHODS: Of 135 female adolescents (12-19 years of age), 47 were pregnant and seen at the adolescent prenatal care clinic at an inner city hospital in Quito, and 88 were students from schools located within the same geographic area. Family variables were compared for pregnant and nonpregnant adolescents using chi-square, Student's t-test, and analysis of variance. RESULTS: More nonpregnant adolescents lived with their biological parents when compared with their pregnant peers (p < .002). Pregnant adolescents reported lower mother-daughter and father-daughter communication (p < .02), lesser life satisfaction and happiness in general, and more school and economic difficulties (p < .001). They were less likely to find support for their problems in or outside the family (p < .0001) and showed higher levels of depression and sexual abuse than their nonpregnant peers (68.8% vs. 34.5%, and 14.9% vs. 4.5%, respectively). Nonpregnant adolescents showed higher school performance and expectations regarding school achievement and future perspectives (p < .001). Values such as respect for others and religiosity were higher among nonpregnant adolescents (p < .0001). Parental education was lower in the families of pregnant adolescents (p < .05). Among nonpregnant adolescents, both parents worked outside the home (p < .006), whereas mothers of pregnant adolescents usually stayed at home. CONCLUSION: The current study showed that parental separation or divorce, and poor parent-daughter communication were associated with adolescent pregnancy. Families of nonpregnant adolescents had a higher educational level, and both parents worked to provide financial support to the family in an environment where family authority is shared by both parents. There were also better problem-solving strategies and parent-daughter communication, higher levels of cohesion, connectedness, and life satisfaction in general, and higher future expectations.

PIP: This paper presents the study on the family risk factors associated with adolescent pregnancy among adolescent girls and their families in Quito, Ecuador. The study aimed to identify characteristics within the family associated with adolescent pregnancy. A total of 135 female adolescents (aged 12-19 years) and their families were separately interviewed. 47 were pregnant and attending prenatal care at an inner city hospital in Quito, and 88 were nonpregnant students from schools located within the same geographical area. Results showed that when compared to their pregnant peers, more nonpregnant adolescents lived with their biological parents (p 0.002); they showed higher school performance (p 0.001); and more values and religiosity (p 0.0001). Pregnant adolescents reported lower mother-daughter and father-daughter communication (p 0.02), lesser life satisfaction in general, and more school and economic difficulties (p 0.001). Moreover, they were less likely to find support for their problems in or outside the family (p 0.0001) and showed higher levels of depression (68.8%) and sexual abuse (14.9%). Parental education was higher in the families of nonpregnant adolescents and both parents worked to provide financial support for the family.

The costs of adolescent childbearing: evidence from Chile, Barbados, Guatemala, and Mexico.

Findings from Chile, Barbados, Guatemala, and Mexico are reviewed in this article to shed light on the consequences of adolescent childbearing for mothers' economic and social opportunities and the well-being of their first-born children. The studies include retrospective information and a comparison group of adult childbearers to account for the effects of background factors (poverty) and the timing of observations. The findings show that early childbearing is associated with negative economic rather than social effects, occurring for poor rather than for all mothers. Among the poor, adolescent childbearing is associated with lower monthly earnings for mothers and lower child nutritional status. Also, among this group of women only, improvements in the child's well-being are associated with mother's education and her contribution to household income. These findings suggest that social policy that expands the educational and income-earning opportunities of poor women could help to contain the intergenerational poverty associated with early childbearing among the poor.

PIP: The consequences of adolescent childbearing for women's social and economic opportunities and the well-being of their first-born child were investigated in studies conducted in Barbados (n = 303), Chile (n = 505), Guatemala (n = 2850), and Mexico (n = 462). The studies included retrospective information and a comparison group of adult childbearers. There was no evidence that early childbearing has negative consequences on the marriage options of young women. Adolescent childbearing was associated with higher fertility, a greater tendency to be a boarder, father absence and lack of financial support, and more grandparents taking over responsibility for child care. Adolescent motherhood was further associated with poor earning opportunities for the teenage mother and poverty. The first-born child's height-for-age was below the norm only when the mother was poor. Overall, these findings suggest that social policies aimed at significantly expanding the educational and income-earning opportunities of young mothers and providing them with access to high-quality reproductive health services could contribute to breaking the cycle of poverty associated with early childbearing.

Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents.

Data from a 1993-1994 survey of 150 black and Hispanic teenagers were used to examine differences in HIV risk-related behavior between young women who have a first sexual partner three or more years older than themselves and those whose first partner is their age. Compared with teenagers whose first partner had been roughly their age, the 35% of adolescents with an older partner had been younger at first intercourse (13.8 years vs. 14.6) and less likely to use a condom at first intercourse (63% vs. 82%). They also were less likely to report having used a condom at last intercourse (29% vs. 44%) or having used condoms consistently over their lifetime (37% vs. 56%) or in the previous six months (44% vs. 66%). Some 38% of teenagers with an older first partner had ever been pregnant, compared with 12% of those with a peer-age first partner. The mean number of partners and history of sexually transmitted diseases did not differ between the two groups.

"They were concerned about my future".

PIP: In this article, the financial manager of the Women's Centre of Jamaica Foundation (WCJF) recalls how the WCJF's program for adolescent mothers helped her continue her education 10 years ago when she was 15 and pregnant with her only child. She was referred to the WCJF by teachers at her high school. Counselors at the WCJF helped her realize she could achieve her educational goals despite her pregnancy, and she attended weekly family life classes at the Centre to learn about contraception and child care. Her family life counselor helped her gain the support and understanding of her mother. Teachers guided her continuing education throughout her pregnancy and made it possible for her to return to school after giving birth. Today, this successful woman encourages all the pregnant adolescents she encounters to take advantage of the programs offered by the WCJF.^ieng

Adolescent women face triple jeopardy: unwanted pregnancy, HIV / AIDS and unsafe abortion.

PIP: This article reports the risks of unwanted pregnancy and unsafe abortion relative to HIV/AIDS by adolescent women. Data presented at the XI International Conference on AIDS indicated that adolescents aged 15-19 years form the highest risk group for newly acquired HIV infections and also with the highest rate worldwide of unwanted pregnancy. Contributing factors of this high rate includes physical violence and other forms of coercion; an earlier age of sexual initiation for girls than boys; so-called "sexual mixing", wherein young girls may have sex with older men for a variety of cultural and economic reasons; social pressures faced by young girls; the lack of access to formal education including sex education; the lack of access to contraception and reproductive health services; the high-risk sexual behavior of adolescent female partners; and young women's lack of power to negotiate terms of sex with their partners. When faced with an unwanted pregnancy, adolescent women have always found it difficult to obtain appropriate services to meet their needs, including safe abortion care. The AIDS epidemic exacerbates these difficulties and adds new medical, legal and ethical dimensions to the practice of unsafe and illegal abortion procedures that put young women's health and lives in danger.^ieng

A prospective comparison of bone density in adolescent girls receiving depot medroxyprogesterone acetate (Depo-Provera), levonorgestrel (Norplant), or oral contraceptives.

OBJECTIVE: To examine bone density among adolescents receiving different forms of hormonal contraception along with that of control subjects. METHODS: Baseline and 1-year measures of lumbar vertebral bone density were obtained in girls receiving depot medroxyprogesterone acetate (Depo-Provera) (n = 15), levonorgestrel (Norplant) (n = 7), or oral contraceptives (n = 9) and in girls receiving no hormonal treatment (n = 17). In a subsample of Depo-Provera users (n = 8), Norplant users (n = 3), and control subjects (n = 4), bone density measurements were repeated after 2 years. Bone density was measured by dual-energy x-ray absorptiometry. RESULTS: Body mass indexes, level of pubertal development, substance use, and reproductive histories were not significantly different among the groups. More black girls were represented in the initial Depo-Provera group (p < 0.02), girls in the Norplant group exercised more hours per week (p < 0.02), and control subjects were older (p < 0.01) than those in the other groups. These variables did not significantly affect bone density results. After 1 year, bone density decreased 1.5% in Depo-Provera users, compared with increases of 2.5% in Norplant users, 1.5% in oral contraceptive users, and 2.9% control subjects (p < 0.02). After 2 years, bone density increased a total of 9.3% in Norplant users and 9.5% in control subjects but decreased a total of 3.1% in Depo-Provera users (p < 0.0001). CONCLUSION: These data suggest that Depo-Provera may, at least temporarily, suppress the expected skeletal bone mineralization in adolescents, whereas Norplant and oral contraceptives are associated with the expected increase in bone density in this population.

PIP: In Ohio, data on 31 postmenarcheal women, 12-21 years old and using hormonal contraception (Norplant = 7, Depo Provera = 15, and oral contraceptives [OCs] = 9) were compared with data on 17 controls of similar age to prospectively examine lumbar bone density in girls before and after 1 and 2 years of hormonal contraceptive use and to compare the results with young women not using hormonal contraceptives. The subjects attended a general adolescent clinic at Children's Hospital in Columbus. There was an insufficient number of OC users at 2 years, so they were not included in second year analyses. Initial height and weight were significantly associated with bone density values (p 0.05). Weight accounted for the most variance both at baseline (p 0.001) and after 1 year of treatment (p 0.01). At baseline and 1 year, bone density values between patient groups were not significantly different. At 2 years, however, Norplant users had higher bone density than Depo- Provera users and controls (1.308 vs. 1.004 and 1.087, respectively; p 0.01). After 1 year, Depo-Provera users experienced a decrease (1.53%) in bone density while Norplant users, OC users, and controls experienced an increase in bone density (2.46%, 1.52%, and 2.85%, respectively). The change in bone density between Depo-Provera users and controls was significant (p 0.02). At 2 years, Depo Provera users experienced a decrease in bone density while Norplant users and controls experienced an increase (-3.12% vs. 9.33% and 9.49%, respectively; p 0.0001). This study is important because 50% of adult bone mass is accrued during adolescence. In fact, bone mass peaks during adolescence. It is not known whether bone loss during Depo Provera use is reversible after treatment discontinuation. These findings show that Depo Provera inhibits skeletal bone mineralization in adolescents, at least temporarily, while Norplant and OCs appear to increase bone density.

Behavioral intervention to increase condom use among high-risk female adolescents.

OBJECTIVE: To determine whether condom use among high-risk female adolescents could be increased by a behavioral intervention, with the use of infection with Chlamydia trachomatis as a biomarker of condom practices. DESIGN: Prospective, randomized, controlled intervention. SETTING: Urban family planning and sexually transmitted disease clinics. PARTICIPANTS: Two hundred nine female adolescents, aged 15 through 19 years, who were treated for C. trachomatis genitourinary infection, were randomly assigned to standard (control) or experimental (behavioral intervention) groups. One hundred twelve subjects returned for follow-up 5 to 7 months after enrollment and comprise the study subjects. MEASUREMENTS: Subjects completed a multiinstrument questionnaire measuring sexual behavior, condom practices, attitudes and beliefs, cognitive complexity, sociodemographics, and motivation at enrollment and follow-up. Endourethral and endocervical sites were sampled for C. trachomatis. RESULTS: Among the 112 subjects who returned for repeated examination, those who had received the experimental intervention reported increased use of condoms by their sexual partners for protection against sexually transmitted diseases (odds ratio = 2.4; p = 0.02) and for vaginal intercourse (odds ratio = 3.1; p = 0.005) at the 6-month follow-up. Multivariable logistic regression analysis controlling for condom use at enrollment demonstrated that the experimental intervention (odds ratio = 2.8; p = 0.03) and the higher cognitive complexity (odds ratio = 4.6; p = 0.02) independently contributed to greater condom use at follow-up. Despite greater use of condoms among the group who had received the intervention, use remained inconsistent and rates of reinfection with C. trachomatis were not significantly different (26% vs 17%; p = 0.3). CONCLUSION: Although a brief behavioral intervention among high-risk female adolescents can increase condom use by their sexual partners, incident infection does not appear to be reduced, because condom use remained inconsistent.

PIP: In Indianapolis, Indiana, health workers randomly assigned 209 female adolescents, 15-19 years old, all of whom were sexually active and had Chlamydia trachomatis infection, to either the standard education group or to the behavioral intervention group to determine whether a behavioral intervention could increase condom use among this high-risk group. Researchers used infection with C. trachomatis as a biomarker of condom practices. The standard intervention was an individual discussion with the clinic nurse about sexually transmitted diseases (STDs) (e.g., importance of partner treatment and condom use) using the normal clinic procedure and printed material on chlamydia infection. The behavioral intervention included a discussion of chlamydia infection using the printed pamphlet as a guide, demonstration of how to use a condom correctly using a plastic banana, encouragement to practice putting a condom on the proxy phallus during the visit, and providing skills to negotiate condom use with sexual partners. 54% (112) of the adolescents returned for follow-up 5-7 months after enrollment. Adolescents in the intervention group were much more likely to use condoms for protection against STDs at follow-up than at baseline (odds ratio [OR] = 2.4; p = 0.02) and for vaginal intercourse (OR = 3.1; p = 0.005). They were not more likely to use condoms during last intercourse, however. When the researchers controlled for the frequency of use of condoms for vaginal intercourse at enrollment, adolescents in the intervention group were significantly more likely to use condoms during vaginal intercourse at follow-up than at baseline (p = 0.01). The multivariable logistic regression revealed that the experimental intervention and higher cognitive complexity among some adolescents had an independent positive influence on condom use at follow-up (OR = 2.8, p = 0.03 and OR = 4.6, p = 0.02, respectively). Despite higher condom use rates in the intervention group, the rate of reinfection with C. trachomatis was not significantly different than the control group (26% vs. 17%; p = 0.3). In conclusion, the intervention did not achieve consistent condom use.

Anthropometry in adolescent girls in Kingston, Jamaica.

There is little information on the nutritional status of adolescents in developing countries. In particular there is a lack of data concerning black adolescents. We measured height, weight, and triceps and subscapular skinfolds in 452 13-14-year-old girls, randomly selected from those attending nine schools in Kingston, Jamaica. The girls' heights and body mass indices were appropriate for their age. This suggests that undernutrition was not a significant problem in this population. However, the girls' skinfolds were smaller than the US references, both those for the total population and those for blacks only. The fat pattern (triceps/subscapular ratio) was similar to that reported for adult black women in the United States. It is possible that the levels of fat in the references are not appropriate for this population. Data from other black populations are needed for comparison.

PIP: To obtain further information on the anthropometry of Black female adolescents in developing country settings, height, weight, and skinfold measurements were recorded for 452 randomly selected 13-14 year old girls attending nine secondary schools in Kingston, Jamaica. Although the heights and body mass index values of the Jamaican girls were comparable to those of the US reference population, the Jamaican teens had less fat at both triceps and subscapular skinfold sites. 23% of girls in the Jamaican sample had triceps skinfold thicknesses below the 5th percentile of the American references. The median triceps skinfold of Jamaican girls was also less than that of US Black females. The fat pattern (indicated by the mean triceps/subscapular ratio) among Jamaican girls was similar to that reported for adult Black women in the US and smaller than that among US White adult women. A correlation of anthropometric values and housing ratings indicated that more affluent Jamaican girls were slightly taller and heavier than their poorer counterparts and had more fat. Overall, these findings suggest that undernutrition is not a significant problem among low-income adolescent girls in Jamaica. The data from this study can be used for comparison with other Black populations in developing countries.

Power through education. IEC materials.

PIP: This news brief is about a video on adolescent reproductive health in developing countries, which was produced in preparation for the Beijing Fourth World Conference on Women. The video documents the adolescent experiences of a rural girl in Bangladesh, an urban girl in Mexico City, and a poor girl from rural Thailand. The photos and story explain the actual lives of these adolescent women and give voice to their thoughts about their lives. Moni, who is 13, lives in a remote rural village in Bangladesh. She began menstruating 6 months after her marriage. Her role is to do the housework for her husband's family of 12 people. There is no choice. Luz, who is 15 years of age and lives in Mexico City, experienced a nonmarital pregnancy and cessation of education. The unplanned pregnancy occurred due to lack of knowledge. The 19-year-old Nagor lived in a small Thai village until she became involved in prostitution through her sister and other village girls. The attraction was income to help her family. Lack of knowledge and being the youngest of 9 children contributed to her situation. The video uses these cases to illustrate the importance of empowerment of women through equal educational opportunity, access to reproductive health information and services, and economic independence. The cases illustrate dramatically how the lack of information can impact strongly on women's lives. The video is available with English narration. JOICFP has a variety of audio-visual materials on reproductive health education, family planning, and empowerment of women.^ieng

Focusing on reproductive health for adolescents.

PIP: JOICFP is producing a still photo video consisting of three segments from photos shot in Bangladesh (April 22 - May 2), Thailand (May 2-15), and Mexico (June 29 - July 7) in 1995. The first segment highlights the daily life of a husband, aged 20, and his wife, Moni, aged 14. Moni married at age 13, before the onset of menstruation, and now serves and feeds her husband's large extended family. The Family Planning Association of Bangladesh (FPAB), the local implementing agent of the Sustainable Community-based Family Planning/Maternal and Child Health (FP/MCH) Project with Special Focus on Women, which is supported by the United Nations Population Fund (UNFPA) and executed by JOICFP, introduced Moni to the concept of reproductive health and encouraged her to join other women in activities designed to improve their health and raise their economic status. The second segment depicts the life of a former commercial sex worker who is undergoing occupational skill development training promoted by the Population and Community Development Association. The girl is now a leader of teenagers in her village; she works to change attitudes that sent her to work as a prostitute with an estimated 150,000 other poor rural teenage women. The third segment focuses on teen pregnancy and the efforts of the Mexican Foundation for Family Planning (MEXFAM) in the areas of health care and education for adolescents.^ieng

Sexual abuse during childhood and adolescence as predictors of HIV-related sexual risk during adulthood among female sexual partners of injection drug users.

PIP: This study explores the relationship of sexual abuse during childhood and adolescence with HIV-related sexual risk behaviors during adulthood among female sexual partners of injection drug users. It analyzed data that was gathered between 1990 and 1993, which included a sample of 2794 women from the US, Mexico, and Puerto Rico. 6 HIV-related sexual risk behaviors that occurred during the month prior to interview were examined; namely, number of sexual partners, number of drug-injecting sexual partners, number of sexual intercourse while high on alcohol and/or other drugs, number of times trading sex for drugs and/or money, proportion of all sexual acts involving protection, and overall HIV-related sexual risk. The results showed that more than one-third of the women (36.3%) experienced some form of sexual abuse during childhood, whereas 34.4% reported that they had been abused sexually during adolescence; 1 in 5 women (18.4%) stated being abused during both periods. The results further indicate that there is a strong link between sexual abuse victimization early in life and involvement later in life in HIV-related sexual risk behaviors. It was found out that certain forms of sexual abuse, such as forced exposure and touching of one's sexual parts were more strongly related than other forms of sexual abuse to subsequent involvement in HIV-related sexual behaviors.^ieng

Rescue for sexually abused girls in Costa Rica.

PIP: In San Jose, Costa Rica, the nongovernmental organization PROCAL has established two rescue homes for sexually abused girls 10-15 years of age. One of these homes is devoted to the care of pregnant girls. In almost all cases, the perpetrator was a male relative. Since girls are taught they must obey older male relatives, they are powerless to stop the abuse. When girls become pregnant as a result of sexual abuse, they face social ostracism and are blamed for their participation in sexual activity. PROCAL counsels the girls that they are victims of their own lack of power and provides them with skills and education they need to return to society and start a new life. The stories of two young girls who became pregnant as a result of sexual abuse and were helped by PROCAL are presented.^ieng

U.S.- and Mexico-born Hispanic teen mothers: a descriptive study of factors that relate to postpartum compliance.

PIP: Compliance with postpartum visits after teenage births in the US was examined among 289 Hispanic teenagers, of whom 127 were born in Mexico or border towns, who delivered at Harris County Hospital District and scheduled postpartum appointments at the Teen Health Clinic. The mean age was 17.31 years for mothers and 21.95 years for fathers. 56.7% (164) were married. 49.8% lived with husbands, 25.8% with parents, 22.3% with friends/relatives, and 2.1% alone. 74.7% stated that they had no social supports. 88.9% had a term delivery, 8.3% a preterm delivery, and 2.8% a fetal loss. 67.5% were first births, 5.5% had a previous abortion, and 3.1% had a previous miscarriage. 23.2% had a previous child, and 0.7% had a previous preterm delivery. Some form of prenatal care was received by 85.1%. 34.3% reported no further educational plans. 17.3% (50) returned for a scheduled postpartum visit. Mothers with a prior history of a premature birth or miscarriage were more likely to return postpartum compared to mothers with a first or prior birth. The differences are marginally significant. None of the mothers with a prior abortion returned. 34.9% of the returning teen mothers were more likely to have had prenatal care. Returning mothers also were a larger percentage of those with no future educational plans. 13.4% of returning mothers had an available social support system. Country of origin was not associated with support systems, prenatal care, return status, educational plans, pregnancy history, or current birth outcome. Out of the 50 returning, 20 were Mexican-born and married. Only Mexican marital status was found to be a significant variable explaining differences. Marital status had no effect on the 26 US native-born returnees. 92% of the Mexican-born teens were married and had a support system. The most dramatic feature of this study is the high level of noncompliance among both US-born and Mexican-born adolescents. There were few distinguishing features between these two groups. Return status was affected by very few features and was achieved by a very small percentage of the study population. The suggestion is made that poverty, a lack of health insurance, and poor knowledge of English, as representative of cultural dissimilarity, may be responsible for poor use of preventive care.^ieng

Weight gain during pregnancy in adolescents: evaluation of a non-nutritional intervention.

The goal of the present work is to report the impact of psychological support, given during pregnancy to a group of adolescents, on maternal weight gain and their infants' birth weight. A total of 54 clinically healthy pregnant women of middle educational level were studied in Mexico City, beginning on the 20th week of pregnancy throughout the end of it. Before pregnancy there were no significant intergroup differences in height, age at menarche or expected weight for height; the groups were adolescents without psychological support (group I), adolescents with support (group II), and adults (group III). The median weight gains were 8.2, 11.0 and 12.2 kg for groups I, II and III respectively. Our results suggest that in favorable socioeconomic conditions, psychological support can be a non-nutritional intervention which can promote an adequate weight gain during pregnancy in adolescents, probably by diminishing their anxiety level.

PIP: A total of 54 healthy primiparous women with an uneventful full-term pregnancy were studied starting from the 20th week of pregnancy through the end of it at the Instituto Nacional de Perinatologia in Mexico City (INPer). They were divided into Group I (14 adolescents aged 15-18 years regularly attending the outpatient prenatal care clinic at INPer); Group II (18 adolescent women aged 14-18 years also attending the clinic but also receiving additional psychological support by a psychotherapy team); Group III (22 adult women aged 20-44 years who also were attending the clinic, but as Group I, did not receive psychological support). All women were studied at 20, 24, 30 and 34 weeks of pregnancy to establish the cumulative weight gain throughout pregnancy as well as their newborns' birth weight. All women were attended at monthly intervals in the prenatal care of the INPer. In terms of marital status, 53/54 of the women did have clear family support. Furthermore, 15/54 of the unmarried women also received emotional support from their partners. Group I, the adolescents lacking psychological support, had systematically lower weight gain than the other two groups, that is, Group I gained almost 3 kg less than the adolescents with support, and 4 kg less that the adult women. One quarter of the women of Group I did not gain any weight between weeks 20 and 24 and when their weight in the 20th week was compared to their pregestational weight, a weight loss of almost 1 kg was found. There were no differences in the infants' birth weight in the three groups (3.05, 2.95, and 3.00 kg for Groups I, II, and III). Systematic psychological support as a non-nutritional intervention throughout pregnancy can promote an adequate weight gain during pregnancy in adolescents aged 14 to 18 years, probably by diminishing their anxiety level and thus, their energy expenditure.

Psychosexual characteristics of female university students in Brazil.

Freshmen women (N = 240) at the State University of Campinas (UNICAMP) in the state of Sao Paulo, Brazil responded to a questionnaire concerning several aspects of their sexuality from the beginning of adolescence. Topics such as body changes during puberty, menarche, menstruation, masturbation, sexual identity, virginity, sexual relations, maternity, contraceptives, abortion, and attitudes toward AIDS were investigated, as well as the level and sources of information about sex and the quality of the subjects' relationships with their parents. The majority of the subjects revealed satisfactory development in most of the aspects surveyed, as well as in their relationships with their parents except where sexual issues were concerned. Nevertheless, most of the students reported menstrual disturbances, and a significant number of the sexually active reported inappropriate behavior in relation to contraception and AIDS prevention. The results of the research are analyzed using psychodynamic theories of sexual development.

PIP: A survey of 240 randomly selected female students (average age, 19.9 years) at the State University of Campinas in Sao Paulo, Brazil, provided comprehensive information about the physical, psychological, and psychosexual dimensions of adolescence. Over half reported negative feelings or indifference to body changes associated with puberty and 54% stated they did not receive information on sexual development from their parents. The average age at menarche was 12.3 years. 79% reported persistent menstruation-related discomfort (e.g., cramps, moodiness). Virginity until marriage was considered essential by 14%; to 42%, it made no difference in the context of a loving relationship. 44% of female students had experienced intercourse; the average age at initiation of sexual relations was 17.6 years. 78% stated the idea of having a child was fundamental or agreeable. 84% of sexually active students were using contraception (including unreliable methods such as rhythm). Although 65% viewed abortion as a theoretically acceptable option, only 8% indicated they would make this choice and just 6% had had an abortion. 6% of students considered themselves at risk of AIDS. Most students characterized their relationship with their parents as good, yet they preferred to talk to friends or siblings about sexual matters. Although these students appear to have satisfactorily negotiated most of the developmental tasks of adolescence, there was some evidence of failure to resolve independence-dependence conflicts.