Being dragged into adulthood? Young people's agency concerning sex, relationships and marriage in Malawi, Mozambique and Zambia.

This study aimed to explore how young people exercise agency in rural Malawi, Mozambique and Zambia in relation to sex, relationships and marriage, to inform local programmes aiming to prevent teenage pregnancy and child marriage. In each country, focus group discussions with young people and parents, in-depth interviews with young people and a variety of other participants, and a household survey with young people (15-24 years) were conducted. We found that (child) marriage was often a response to teenage pregnancy, which was highly prevalent in all study areas. Young people's aspirations to enter adulthood were influenced by their life circumstances. Initiation ceremonies symbolised the transition to adulthood and gave social endorsement to young people to start engaging in (often unprotected) sexual activity. Given the uncertain socio-economic context, resource constraints led families to marry off their daughters; or girls themselves to marry early to relieve the burden on their families, but also to get pregnant as a 'next step' towards adulthood. Transactional sex was common. These intersecting cultural, social and economic contextual factors constrained young women's agency, more as compared to young men. However, young women did manoeuvre within contextual constraints to exercise a degree of agency.

Factors Influencing Modern Contraceptive Use among Adolescents in Nepal.

In Nepal, contraceptive use among married adolescents is low and has remained nearly stagnant since 2006, while little information is available about contraceptive use among unmarried adolescents. Nepal is committed to improve sexual and reproductive health rights among all the adolescents. Promoting modern contraceptive use especially among married adolescents is one of the key approaches in practice, to prevent HIV or sexual transmitted infections, avoid unintended pregnancy and sub-sequent unsafe abortion. In spite of these efforts, modern contraceptive use among married adolescents is not increasing. In this study, we aimed to review the prevalence and trends as well as factors influencing modern contraceptive use among both married and unmarried adolescents in Nepal. A review of existing published and unpublished articles, documents, and reports were conducted. An adapted and modified socio-ecological model was used to explore the factors influencing contraceptive use. Contraceptive use is persistently low among adolescents. Various interrelated factors like socio-cultural norms and traditions, lack of comprehensive knowledge on contraceptive methods among adolescents, inadequate adolescent friendly Services and health workers not having the competencies to work with adolescents, are the major influential factors that limit adolescents to seek and use contraceptive services and information. A multilevel approach is required to address the interrelated factors and to create an enabling environment in which adolescent are fully informed and equipped to make use of contraceptives and related services. For this to happen, Government and NGOs working on sexual and reproductive health rights have to work towards translating the existing policies into practice. Involving adolescents, their families and communities; equipping teachers to provide comprehensive sex education within school and sex education programme for out of school and enhancing the competencies of health workers to provide adolescent friendly services - all in line with the written policy - is urgently needed. Keywords: Adolescent; barriers; contraceptive; Nepal; SRHR.

SegWeigh: a mixed-method approach to segmenting potential contraceptive user groups and meeting Family Planning 2020 goals.

OBJECTIVE: To evaluate a low-cost mixed-method research tool (SegWeigh) that informs awareness raising and family planning interventions for potential contraceptive users. METHODS: A pilot study of SegWeigh was conducted in Uganda and Vietnam between September 3, 2012, and February 21, 2013. User archetypes were produced in four steps by triangulating Demographic and Health Survey (DHS) data; a secondary literature review; family planning service provision data; and primary qualitative investigation. RESULTS: Triangulation of DHS analysis, secondary literature and service data revealed three potential user profiles: Ugandan women wanting to space pregnancies; Ugandan men wanting to limit pregnancies; and unmarried Vietnamese women having infrequent sex. Archetypes were subsequently created of "Kibuuka," a 52-year-old semi-literate subsistence farmer in rural Uganda, and "Anh," a 20-year-old student in Hanoi, Vietnam. CONCLUSION: SegWeigh rapidly produced data-rich "real life" user profiles that might help to tailor family planning interventions.

Epidemiology and etiology of sexually transmitted infection among hotel-based sex workers in Dhaka, Bangladesh.

The prevalence of sexually transmitted infections (STIs) and reproductive tract infections (RTIs) among hotel-based sex workers (HBSWs) in Dhaka, Bangladesh, was studied. A total of 400 HBSWs were enrolled in the study during April to July 2002. Endocervical swabs, high vaginal swabs, and blood samples from 400 HBSWs were examined for Neisseria gonorrhoeae (by culture), Chlamydia trachomatis (by PCR), Trichomonas vaginalis (by microscopy), antibody to Treponema pallidum (by both rapid plasma reagin and Treponema pallidum hemagglutination tests), and antibody to herpes simplex virus type 2 (HSV-2) (by enzyme-linked immunosorbent assay). Sociodemographic information as well as gynecological and obstetric information was collected. Among the HBSWs, 228 women (57%) were symptomatic and 172 (43%) were asymptomatic, 35.8% were positive for N. gonorrhoeae, 43.5% were positive for C. trachomatis, and 4.3% were positive for T. vaginalis. A total of 8.5% had syphilis, 34.5% were positive for HSV-2, and 86.8% were positive for at least one RTI or STI. There was no significant difference between the prevalences of STIs among the symptomatic and asymptomatic HBSWs. These data suggested a high prevalence of STIs, particularly gonorrhea and chlamydia, among HBSWs in Dhaka.