The Effect of Mass Media Campaign on the Use of Insecticide-Treated Bed Nets among Pregnant Women in Nigeria.

Background. Malaria during pregnancy is a major public health problem in Nigeria especially in malaria-endemic areas. It increases the risk of low birth weight and child/maternal morbidity/mortality. This paper addresses the impact of radio campaigns on the use of insecticide-treated bed nets among pregnant women in Nigeria. Methods. A total of 2,348 pregnant women were interviewed during the survey across 21 of Nigeria's 36 states. Respondents were selected through a multistage sampling technique. Analysis was based on multivariate logistic regression. Results. Respondents who knew that sleeping under ITN prevents malaria were 3.2 times more likely to sleep under net (OR: 3.15; 95% CI: 2.28 to 4.33; P < 0.0001). Those who listened to radio are also about 1.6 times more likely to use ITN (OR: 1.56; 95% CI: 1.07 to 2.28; P = 0.020), while respondents who had heard of a specific sponsored radio campaign on ITN are 1.53 times more likely to use a bed net (P = 0.019). Conclusion. Pregnant women who listened to mass media campaigns were more likely to adopt strategies to protect themselves from malaria. Therefore, behavior change communication messages that are aimed at promoting net use and antenatal attendance are necessary in combating malaria.

The impact of exposure to mass media campaigns and social support on levels and trends of HIV-related stigma and discrimination in Nigeria: tools for enhancing effective HIV prevention programmes.

People living with HIV and AIDS (PLWHAs) often face stigma and discrimination, especially in developing countries. HIV-related stigma is expressed through social ostracism, personal rejection, direct and indirect discrimination, and denial from families and friends. Consequently, it is associated with reduced adoption of preventive and care behaviours, including condom use, seeking for HIV test and care-seeking behaviour subsequent to diagnosis. Ignorance about the epidemiology of the disease on modes of transmission and prevention aggravates HIV-related stigma in Nigeria. Behaviour change communication activities through mass media have been shown to be an effective approach in improving people's knowledge about the disease. This paper monitors trends in the level of accepting attitudes towards PLWHAs in Nigeria between 2003 and 2007. It also evaluates the impact of exposure to mass media and social support on the levels of accepting attitudes towards PLWHAs. A significant and positive trend was evident between 2003 and 2007 (p<0.0001). Furthermore, exposure to mass media communications on HIV and AIDS issues and social support were significantly related to the reduced stigma and discrimination against PLWHAs (p<0.0001).

Sex preference and contraceptive behaviour among men in Mbeya region, Tanzania.

While recent studies confirm parental child sex preference in less developed countries, its pattern varies. Son preference is especially prevalent in Bangladesh, China, India, and Pakistan. Sex preference in sub-Saharan Africa is a neglected area of enquiry. Completed research focuses on women's views to the neglect of men, despite the latter's importance as primary decision-makers. This study identifies factors influencing contraceptive behaviour among men in Mbeya region, Tanzania, demonstrating how it is affected by their preferred family sex composition. Data used were collected from a cross-sectional survey of 600 men aged 16-50 and six focus groups conducted in the region's rural and urban areas. Using single statements and Coombs' Scales, sex preference was found to be prevalent in the study area, with sons strongly preferred to daughters. Sex preference is significantly associated with the number of existing daughters a man has, his marital status, residence and occupation. Findings suggest programmes should be initiated to challenge men's attitudes towards one-sex family composition. Men should be educated about the advantages of small family sizes and persuaded that both children's sexes are equally important. Such measures can assist men in reconsidering their desired family sizes, reduce biases towards one sex, minimise marital problems and improve women's status. Efforts to increase contraceptive use in Tanzania will be hampered, however, if men maintain their preference for sons over daughters.

Attitudes of men towards family planning in Mbeya region, Tanzania: a rural-urban comparison of qualitative data.

Family planning programmes in Tanzania date back to the 1950s. By the early 1990s, however, only 5-10% of women of childbearing age used contraceptives in the country. Low contraceptive prevalence in Tanzania is reportedly attributable to men's opposition to family planning. This paper employs focus groups to explore the role of Tanzanian men in family planning. More specifically, it presents a rural-urban comparison of the attitudes of men in Mbeya region, Tanzania, to family size preference, sex composition, partners' communication on family planning matters and contraceptive behavior. Findings indicate that men express positive attitudes towards fertility-regulating methods. There is, moreover, little rural-urban variation in male attitudes towards family planning in the study area. Possible reasons for this normative convergence (including structural similarities and rural-urban migration between the two communities) are discussed.

PIP: This study explored the attitudes of rural and urban men toward family planning (FP) in Tanzania. Data were obtained from focus groups conducted among a sample of men aged 16-50 years living in both urban (Mabatini, Ruanda, and Sisimba) and rural (Iwindi, Mapogoro, and Tembela) districts of Mbeya region in the southern highlands in 1994. The total fertility rate was 7.4 children/woman in the region. Focus group discussions addressed four themes: attitudes toward family size, sex composition, communication about FP, and contraceptive use. Findings indicate that male attitudes toward FP did not vary between urban and rural areas. The similarities are attributed to pervasive cultural norms and little structural variation between areas. Men preferred more sons and believed that larger families cost more. Men in urban areas were more aware of the cost of large families. Men considered it their responsibility to allow women to use FP. Men were suspicious of modern methods, doubted their safety, and feared that women would be unfaithful if allowed to use contraception. Men believed that condoms were useful for prevention of HIV/AIDS with prostitutes and did not associate use with FP. Men believed that FP was directed to women and not sufficiently directed to men, and that women knew more about FP. The family size desired ranged from 4-6 children in rural areas, to 2-4 children in urban areas, which suggests unmet need. Negative attitudes of men towards FP should be addressed in IEC campaigns.

Condom use in sexual exchange relationships among young single adults in Ghana.

This article discusses some personal and situational factors which hinder the use of condoms among young single adults ages 18 to 25 years engaged in sexual exchange relationships in a Ghanaian town. Based on focus group discussions and in-depth interviews, this article highlights some key impediments often not adequately discussed in the discourse on condom use but considered vital in any attempt to increase condom use and ultimately reduce HIV transmission. The includes the dilemma facing women who want to use condoms for HIV prevention in premarital sexual exchange relationships (quite different from prostitution) contracted with material gain in mind. Women may face the risk of losing material benefits from sexual exchange relationships if the man is unwilling to use condoms. It is recommended that HIV health educators must increase the involvement of young single adults in exploring these and situational impediments and together design interventions to improve condom use.

PIP: Focus group discussions and in-depth interviews conducted in Cape Coast, Ghana, revealed significant obstacles to condom use among single women 18-25 years of age. Most female respondents were self-employed small-scale traders with low incomes, while male participants tended to be clerks or fishermen. In this society, men are considered the source of economic and physical power and in a position to demand sexual favors. Material recompense (e.g., money, food, or clothing) for premarital sex is standard practice outside the commercial sex work establishment and women often switch rapidly from relationship to relationship in search of a more materially rewarding arrangement. Such behavior is condoned--often encouraged--by young women's mothers. Condom use is rare and associated with infidelity. Thus, Ghanaian women face the dilemma of choosing between economic survival and unsafe sex. Since men perceive condoms as reducing sexual sensitivity, they are unlikely to remain with a partner who insists on condom use. Moreover, sexual relationships are embedded in an atmosphere of fear of violence. If women are to insist on condom use, they must believe the risk of HIV infection is not adequately compensated by the material gains received from the sexual encounter. It is recommended that community-level HIV preventive interventions target men with messages about the importance of trying condom use. Ultimately, however, reconstruction of gender-based power relationships and improvements in women's economic status are essential to reduce women's dependence on sexual networking.

Unsafe abortions: methods used and characteristics of patients attending hospitals in Nairobi, Lima, and Manila.

Using quantitative and qualitative data, the authors present selected characteristics of 626 women who reported complications of induced abortion in five hospitals: one in Nairobi, two in Lima, and two in Manila. Although there are some similarities, the findings show some marked differences in demographic characteristics. In Nairobi nearly all respondents were single, nulliparous, and 25 years or younger; in Lima and Manila most were either married or in union, usually aged 25 years or older and had at least 1 child. There was evidence of repeat abortions, especially in Nairobi where 26% had had at least one previous abortion. Access to safe abortions is severely restricted and is obtained through a secret referral system. A list of potentially hazardous local abortifacients range from the drinking of strong Kenyan tea to dangerous practices such as insertion of sharp objects into the uterus or drinking chemicals and toxic substances.

PIP: Interviews with 626 women treated in 1993 for complications of unsafe abortion at five hospitals in Nairobi (Kenya), Lima (Peru), and Manila (Philippines) revealed marked differences in their demographic characteristics. The percentage under 25 years of age was 26% in Manila, 45% in Lima, and 91% in Nairobi. 84% of abortion patients in Nairobi were single compared with 77% in Manila and 21% in Lima; 77% of women in Nairobi had no children compared with 29% in Lima and 11% in Manila. In general, Nairobi abortion seekers tended to be young women who migrated to the city and were concerned pregnancy would impede their social mobility. In Lima and Manila, abortion was sought to limit births within union, generally for financial reasons. Never-use of contraception was reported by 80% of Kenyan women, 65% of Manila women, and 48% of those in Lima. When presented with 11 scenarios that might justify an abortion, the only indication the majority in all three cities supported was pregnancy resulting from rape. Women reported use of abortifacient agents such as livestock droppings, drinking chemicals and detergents, herbal medicines, and overdoses of over-the-counter medications, as well as insertion of sharp objects into the uterus. 98% of Kenyan respondents compared with 36% in Peru and 24% in the Philippines claimed illegal abortion was common; 92%, 75%, and 35%, respectively, were aware of at least one woman who died after an unsafe abortion. All of the women in Kenya and 89% in the Philippines reported it was difficult or very difficult to obtain an abortion; most were obtained through a secret referral system and involved unsanitary conditions. These findings indicate a need for postabortion family planning counseling as well as scrutiny of existing abortion laws and policies.

Premarital relationships and livelihoods in Ghana.

PIP: This study is based on interviews with a sample of 400 single women aged 18-25 years from the Fante ethnic group in Cape Coast, Ghana, in 1991, and on focus groups. This case study illustrates the importance of economic and living arrangement support expected from partners in premarital relationships. Support may be for living and maintenance ('chopmoney', provisions, household items, and rent); for financial security (provision of capital); and for clothing and hairdressing. Women did not always require economic support in premarital relationships. Women expect boyfriends to provide 'chopmoney' (money for food and general upkeep) and contribute some money for the rent. Only 36% of sexually active women expected their boyfriends to supply food provisions. Premarital sexual relationships are used to obtain start-up capital. The author refers to evidence that senior government officials engaged in sexual transactions with clients before loans and credit facilities were offered. 87% of sexually experienced women expected their partners to pay for at least part of clothing expenses. The study revealed that there was considerable disparity between women's expectations and actual receipt of economic support. 56% desired, but only 36% received, 'chopmoney' in full. 40% expected their partners to pay for household furnishings in full, while only 10% did so. 55% expected capital, but only 15% received it. The three most frequently received benefits in full were hair dressing, shoes, and dresses. Men provided most non-negotiable items as a means of "boosting their egos." Many young women rely on the support of men in order to improve their status. Ghanaian men control financial resources and economic power. Mothers of adolescent daughters encourage premarital sexual behavior. Prostitution is considered different from sexual exchange relationships. It is argued that gender inequalities and domestic abuse are perpetuated through sexual exchange relationships.^ieng

Community control of health services for Canadian Indians.

Many countries have a dominant culture and one or more minorities. Can a single type of health care therefore meet the needs of diverse populations? The health situation among the Indian populations in Canada could be improved by the "health transfer" initiative, which is described below.

Significance of beliefs and values in predicting fertility and contraceptive behaviour in Pakistan.

A comparative study of 1100 women aged 25-45 years, users and non-users of modern methods of contraception, in the urban centres of Lahore and Faisalabad was conducted in 1991. The objective of the study was to investigate reproductive behaviour and the extent to which social, cultural and attitudinal variables, such as beliefs and values about family life, religiosity and fatalism, influence the fertility decision-making process. Preferences for smaller families were found to be consistently associated with modern attitudes and behaviour towards family and religious values and obligations. Family income, husband's occupation and religiosity offered no explanation of reproductive behaviour. It is concluded that cultural setting and tradition exert an important influence on reproductive behaviour, independent of economic development.

PIP: A comparative study was carried out to assess the effects of variables on fertility preferences. The variables were: (a) socioeconomic and demographic, (b) intermediate (beliefs and values), and (c) contraceptive use and fertility preferences (dependent variables). Two groups of women, users and nonusers of modern contraception (n = 1100), were selected from the cities of Lahore and Faisalabad, Pakistan. The user group consisted of fecund women aged 25 years with at least two living children, using any method of contraception (excluding sterilization) and living with their husbands. The nonuser group was matched for age, parity, and residence, but they were not using any method of contraception. A multistage cluster sampling design was used. Factor analysis of the indicators of value of son, family orientation, religiosity, conservatism, and fatalism showed that they explained 54.8% of the total variance. The beliefs and values indicator represented mainly the factor value of a son, which accounted for 22.9% of the total variance. For the bivariate analysis, the predictor variable categories of low, medium, and high indicated movement from traditional to modern attitudes regarding family values. Among women who preferred a very large family, 79% scored low on the family orientation variable whereas only 19% scored high. Women who were modern in outlook were more likely to accept small families and practice contraception than women who were conservative. There were more women who scored low on the conservatism index and preferred a very large family (72%) than women who had the same fertility preference and achieved a high score (46%). Focus group discussions showed that son preference plays a crucial role in determining family size. 44% of users as compared to 67% of nonusers had low scores on the fatalism index. The persistence of values, norms, and traditions unfavorable to family limitation and small family norms is the explanation for high fertility and low contraceptive use in Pakistan.