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The purposes of this paper are: to assess how comprehensive sexuality education (CSE) is implemented in schools in the World Health Organisation's European Region; and to investigate the evidence supporting its effectiveness. Data were collected in 2016-2017, using a validated questionnaire sent to representatives of governmental and nongovernmental institutions in 25 countries of the WHO European Region. The results demonstrated that, in nine countries, sexuality education can be classified as comprehensive; in ten countries it is non-comprehensive; in four countries there is no programme in place; and two countries were excluded from the analysis. In contrast to non-comprehensive sexuality education programmes, CSE programmes address a wider range of topics, including the social, emotional and interpersonal aspects of sexuality. Furthermore, teachers are more often trained to deliver sexuality education and participatory teaching methods are widely used. CSE programmes are more valued by pupils as a source of information on sexuality, based on national survey results. The availability of CSE programmes coincides with more effective contraceptive use and lower teenage fertility rates. However, more rigorous research is needed to establish a causal relationship between CSE and adolescent sexual and reproductive health indicators.

This paper presents an analysis of trends in sexual activity by marital status and age, and their associations with contraceptive use. Understanding levels of, and trends in, sexual activity is important for assessing the needs for family planning services and for analysing commonly used family planning indicators. Data were taken from 220 Demographic and Health Surveys (DHSs) and 62 Multiple Indicator Cluster Surveys (MICSs) to provide insights into sexual activity by marital status and age in a total of 94 countries in different regions of the world. The results show the sensitivity of the indicator with respect to the definition of currently sexually active, based on the timing of last sexual intercourse (during the last 4 weeks, 3 months, or 1 year). Substantial diversity in sexual activity by marital status and age was demonstrated across countries. The proportion of married women reporting recent sexual activity (sexual intercourse during the last 4 weeks) ranged from 50% to 90%. The proportion of unmarried women reporting recent sexual activity did not exceed 50% in any of the 94 countries with available data, but showed substantial regional differences: it appeared to be rare in Asia and extremely varied within Africa, Europe and Latin America and the Caribbean. Among married women, sexual activity did not vary much by age group, while for unmarried women, there was an inverted U-pattern by age, with the youngest age group (15-19 years old) having the lowest proportion sexually active. The proportion of women who reported currently using contraception and reported not being sexually active varied by the contraceptive method used and was overall much greater among unmarried women. The evidence presented in this paper can be used to improve family planning policies and programmes to serve the diverse needs, for example regarding method choice and service provision, of unmarried women.

Contraception is an essential element of high-quality abortion care. However, women seeking abortion often leave health facilities without receiving contraceptive counselling or methods, increasing their risk of unintended pregnancy. This paper describes contraceptive uptake in 319,385 women seeking abortion in 2326 public-sector health facilities in eight African and Asian countries from 2011 to 2013. Ministries of Health integrated contraceptive and abortion services, with technical assistance from Ipas, an international non-governmental organisation. Interventions included updating national guidelines, upgrading facilities, supplying contraceptive methods, and training providers. We conducted unadjusted and adjusted associations between facility level, client age, and gestational age and receipt of contraception at the time of abortion. Overall, postabortion contraceptive uptake was 73%. Factors contributing to uptake included care at a primary-level facility, having an induced abortion, first-trimester gestation, age ≥25, and use of vacuum aspiration for uterine evacuation. Uptake of long-acting, reversible contraception was low in most countries. These findings demonstrate high contraceptive uptake when it is delivered at the time of the abortion, a wide range of contraceptive commodities is available, and ongoing monitoring of services occurs. Improving availability of long-acting contraception, strengthening services in hospitals, and increasing access for young women are areas for improvement. [ABSTRACT FROM PUBLISHER]

Objective: A brief review of status of sexual and reproductive health and rights of women living with human immunodeficiency virus (HIV) in Asia with a focus on their access to related services. Subject(s) and methods: The content has primarily emerged from several meetings, workshops and research studies that regional networks of women living with HIV have conducted in the region. We used published and unpublished literature in English after the year 2000. Results: We found many hindrances to realization of sexual and reproductive rights by HIV‐positive women and their access to related health services. Rampant stigma and discrimination by service providers take the form of denial of contraceptive and maternal health services, forced sterilization, breach of confidentiality and disclosure of status to others without the consent of the woman. Families blaming women for bringing HIV and male partners objecting to using condoms affect the well‐being of HIV‐positive women. Sexual rights specifically aspects of positive sexuality such as sexual pleasure have not received attention. Conclusion: Findings suggest the need to enhance capacities of HIV‐positive women's organizations to meaningfully participate in decisions on positive women's sexual, reproductive health and rights and sensitize service providers to adequately address HIV‐positive women's concerns. [ABSTRACT FROM AUTHOR]

This paper explores sexual and reproductive health and rights (SRHR) among young people, identifying intersecting factors that create inequities in access to services, health-seeking behaviour, and ultimately health outcomes. Based on qualitative interviews with young people in the Maldives, it demonstrates how these intersectional experiences are contrary to what is often assumed in official data, policies, and services. Three factors were found to shape young people's experiences: marital status, gender, and urban/rural differences. Non-marital sexual activity is illegal in the Maldives, but it is somewhat expected of unmarried men, while unmarried women are stigmatised for being sexually active. Although access to SRH services is restricted for all unmarried people, young women face additional difficulties, as the risk of being exposed is much greater in small island communities. Maldivian island communities are extremely small and characterised by an inward-looking culture that exerts considerable social pressure, particularly on unmarried women. For an unmarried woman, being known to be sexually active, or worse, pregnant outside of marriage, has severe social consequences including stigma and isolation from the community, and their own family. This concern is more prevalent among rural young women, as they live in smaller communities where stigma is inescapable. The need to avoid public scrutiny and humiliation contributes to making unsafe abortion a common solution for many unintended pregnancies. Failure to acknowledge these intersecting factors in SRHR experience and access has led to inequities among an already overlooked population, shaping their experiences, knowledge, health-seeking behaviour, and health outcomes. [ABSTRACT FROM AUTHOR]

"This paper presents a new data collection method, called the Neighborhood History Calendar, designed to collect event histories of community-level changes over time. We discuss the need for and the uses of this method. We describe issues related to the design of instruments, collection of data, and data entry. We provide detailed examples from an application of this method to the study of marriage, contraception, and fertility in rural Nepal. The paper addresses applications of this same technique to other settings and research problems. We also extend the technique to collection of other forms of contextual-history data, including school histories and health service histories. Finally, we discuss how Geographic Information System (GIS) technology can be used to link together multiple sources of contextual-history data.", (excerpt)

"This paper analyses the impact of three credit programmes--the Bangladesh Rural Advancement Committee (BRAC), the Bangladesh Rural Development Board's Rural Development-12 (BRDB RD-12), and the Grameen Bank (GB), on current rate of contraception. These programmes are targeted to alleviate poverty by providing group-based credit to the rural poor in creating self employment opportunities. With small credits, these programmes combine family planning activities in terms of consciousness raising, awareness building and motivation. Sample survey data are used to analyse the problem of impact evaluation. The analyses show that the BRAC and the GB programmes have [a] significantly positive impact on the current rate of contraception, while the BRDB RD-12 programme does not have any such impact. It is also found that education, both of female[s] and male[s] separately, and child survivorship have independently positive impact[s] on current contraception.", (excerpt)

"The objective of this paper is to examine continuation and effectiveness of contraception based on a 1986 survey of more than 3,200 women in rural Sri Lanka. Data on both programme and non-programme methods of contraception are analyzed. Programme methods are defined as including all those methods that are provided through the public or private family planning programmes (namely, oral pills, IUDs, injectables, condoms, female barrier methods and sterilization). Non-programme methods refer to those that are not provided through any structured programme; these methods include calendar rhythm (commonly referred to as 'safe period' in Sri Lanka), withdrawal, abstinence and other traditional methods.", (excerpt)

"The purpose of this paper is to examine the effects of selected socioeconomic and demographic factors on fertility in a rural area of Bangladesh. It has been revealed that age at first marriage and coital frequency have direct significant effects while ever use of contraception and duration of breast-feeding have direct positive significant effects on total parity. Total effects of wife's education and age at first marriage on fertility are found to be negative while those of religion and household income on fertility are found to be positive.", (excerpt)

"This paper examined the relationship between locus of control and such variables as unmarried woman's sexual activity, wife's experience of premarital conception, female marriage probability, post marital contraception and first-conception probability in present-day Japan...[using data from the 1987] Ninth Japanese National Fertility Survey....[The findings] contradict the general prediction that the internal locus of control is associated with well-planned behaviours...." (SUMMARY IN JPN), (excerpt)

The author reports on China's 1988 Two per Thousand Survey, using information from papers presented at an international seminar in Beijing that focused on fertility and contraception. "Seminar papers confirmed the high quality of the survey and its potential for research on topics ranging from rates of sterility to the demography of Tibet. They also suggested that family planning in China is moving on to a wider agenda. The interest of family planners is turning to issues of health, motivation for family planning, and contraception prior to a couple's first birth.", (excerpt)

"Trends and correlates of dramatic fertility declines in the NIES [newly industrialized economies of Asia] from the 1960s to the 1980s are examined in this paper. Specifically, we first look at changes in the fertility effects of such demographic factors as age structure of fertility, age pattern of marriage, and marital fertility. Next, as major proximate determinants of fertility, we examine changes in contraception and induced abortion. We then examine the fertility effects of changes in infant mortality and family planning programs. Finally, by examining changes in such socioeconomic factors as educational attainment and female labor force participation as well as attitudinal changes toward marriage and the family, we seek to infer their effects on fertility declines in the NIES." The data primarily concern Hong Kong, the Republic of Korea, Singapore, and Taiwan. (SUMMARY IN ENG), (excerpt)

"This paper explores the reasons for the not-so-impressive performance of [the] IUD in Northern Karnataka, and more generally that of non-terminal methods of family planning in India." Methods are proposed for improving acceptance rates and length-of-use times., (excerpt)

This paper reviews the literature examining the relationship between women's empowerment and contraceptive use, unmet need for contraception and related family planning topics in developing countries. Searches were conducted using PubMed, Popline and Web of Science search engines in May 2013 to examine literature published between January 1990 and December 2012. Among the 46 articles included in the review, the majority were conducted in South Asia (n=24). Household decision-making (n=21) and mobility (n=17) were the most commonly examined domains of women's empowerment. Findings show that the relationship between empowerment and family planning is complex, with mixed positive and null associations. Consistently positive associations between empowerment and family planning outcomes were found for most family planning outcomes but those investigations represented fewer than two-fifths of the analyses. Current use of contraception was the most commonly studied family planning outcome, examined in more than half the analyses, but reviewed articles showed inconsistent findings. This review provides the first critical synthesis of the literature and assesses existing evidence between women's empowerment and family planning use. [ABSTRACT FROM AUTHOR]

Context: The contribution of copper-bearing intrauterine devices (IUDs) to overall contraceptive protection has declined in many countries, despite their well-known advantages. In response, initiatives to promote this method have been undertaken.Objective: To review and interpret the experience of interventions to promote use of IUDs in low- and middle-income countries in order to provide strategic guidance for policies and programs.Methods: We conducted a systematic search of Medline, Popline, Embase and Global Health electronic databases for relevant journal papers, reports and gray literature since 2010. Telephone interviews were held with two donors and six international family planning organizations.Results: We identified a total of 31 publications. Four reported the results of randomized control trials and three were derived from quasi-experiments. The majority were based on service statistics. Eight publications concerned interventions for HIV-positive women or couples, nine for postpartum or postabortion cases and 14 for general populations. Intervention approaches included vouchers, franchising of private practitioners, mobile outreach services, placement of dedicated staff in high-volume facilities and demand creation. Most publications adduced evidence of a positive impact and some reported impressively large numbers of IUD insertions. Results to date on the uptake of IUDs in postpartum interventions are modest. There is also almost no evidence of effects on IUD use at national levels. Implant uptake generally exceeded IUD uptake when both were offered.Conclusion: The evidence base is weak and offers few lessons on what strategies are most effective. The overall impression is that IUD use can be increased in a variety of ways but that progress is hampered by persistent adverse perceptions by both providers and potential clients. Provider enthusiasm is a key to success. The lack of a population impact stems in part from the fact that nearly all interventions are initiated by international organizations, with limited national reach except in small countries, rather than by government agencies. [ABSTRACT FROM AUTHOR]

"This paper investigates the effect of female education on fertility in Bangladesh...through three proximate determinants of fertility: marriage, postpartum non-susceptibility to conception, and contraception.... The analysis found that a small amount of education tends to increase fertility.... The effect of education on proximate determinants shows that it is positive for postpartum non-susceptibility to conception, [while] in contrast it is negative for marriage and contraception. Therefore, [the] contribution of the duration of postpartum non-susceptibility is stronger for less educated women, while marriage and contraception have important effects when education is high at the individual level.", (excerpt)

"This paper investigates variation in birth control knowledge and practices in Iraq as reported in the 1974 National Fertility Sample Survey. The descriptive and inferential statistical analysis indicated the existence of significant rural-urban differentials in knowledge and use of contraceptive methods by ever-married women. With the continuation of the war with Iran, the Iraqi government has adopted pro-natal policy to spur population growth. Whether such a policy achieves its goals is a matter deserving further investigation.", (excerpt)

A social franchise in health is a network of for-profit private health practitioners linked through contracts to provide socially beneficial services under a common brand. The early 21st century has seen considerable donor enthusiasm for promoting social franchises for the provision of reproductive health services. Based on a compendium of descriptive information on 45 clinical social franchises, located in 27 countries of Africa, Asia and Latin America, this paper examines their contribution to universal access to comprehensive reproductive health services. It finds that these franchises have not widened the range of reproductive health services, but have mainly focused on contraceptive services, and to a lesser extent, maternal health care and abortion. In many instances, coverage had not been extended to new areas. Measures taken to ensure sustainability ran counter to the objective of access for low-income groups. In almost two-thirds of the franchises, the full cost of all services had to be paid out of pocket and was unaffordable for low-income women. While standards and protocols for quality assurance were in place in all franchises, evidence on adherence to these was limited. Informal interviews with patients indicated satisfaction with services. However, factors such as difficulties in recruiting franchisees and significant attrition, franchisees' inability to attend training programmes, use of lay health workers to deliver services without support or supervision, and logistical problems with applying quality assurance tools, all raise concerns. The contribution of social franchises to universal access to reproductive health services appears to be uncertain. Continued investment in them for the provision of reproductive health services does not appear to be justified until and unless further evidence of their value is forthcoming. Dans la santé, une franchise sociale est un réseau de praticiens privés à but lucratif tenus par contrat d'assurer des services socialement bénéfiques sous une même marque. Au début du XXIe siècle, les donateurs ont encouragé avec beaucoup d'enthousiasme les franchises sociales pour les services de santé génésique. Se fondant sur un recueil d'informations descriptives relatives à 45 franchises sociales cliniques, situées dans 27 pays d'Afrique, d'Asie et d'Amérique latine, cet article examine leur contribution à l'accès universel à des services globaux de santé génésique. Il révèle que ces franchises n'ont pas élargi l'éventail de services de santé génésique, mais se sont principalement centrées sur la contraception et, dans une moindre mesure, les soins maternels et l'avortement. Dans de nombreux cas, la couverture n'avait pas été étendue à de nouvelles zones. Les mesures prises pour garantir la viabilité vont à l'encontre de l'objectif d'accès des groupes à faible revenu. Dans près des deux tiers des franchises, le coût total de l'ensemble des services devait être payé par les patients et était inabordable pour les femmes à faible revenu. Les normes et les protocoles d'assurance qualité étaient en place dans toutes les franchises, mais on dispose de données limitées sur leur observance. Des entretiens informels avec des patients ont indiqué qu'ils étaient satisfaits des services. Néanmoins, les difficultés pour recruter des franchisés et une certaine usure, l'incapacité des franchisés de suivre des programmes de formation, l'utilisation d'agents de santé profanes pour assurer des services sans soutien ni supervision et des problèmes logistiques pour appliquer les outils d'assurance qualité sont autant de facteurs préoccupants. La contribution des franchises sociales à l'accès universel aux services de santé génésique paraît incertaine. Il ne semble pas justifié de continuer d'investir en leur faveur pour la prestation de services de santé génésique, à moins que de nouvelles données ne prouvent leur utilité. Una franquicia social en salud es una red de profesionales de la salud particulares con fines de lucro, vinculados mediante contratos para ofrecer servicios de beneficio social bajo una marca en común. A principios del siglo XXI se ha visto un considerable entusiasmo por parte de donantes para promover las franquicias sociales para la prestación de servicios de salud reproductiva. Basado en un compendio de información descriptiva sobre 45 franquicias sociales clínicas, situadas en 27 países de Ãfrica, Asia y Latinoamérica, este artículo examina su contribución al acceso universal a los servicios integrales de salud reproductiva. Se encontró que estas franquicias no han ampliado la gama de servicios de salud reproductiva, sino que se han centrado principalmente en servicios de anticoncepción y, a menor grado, en servicios de salud materna y de aborto. En muchos casos, no se había extendido la cobertura a nuevas áreas. Las medidas tomadas para garantizar sostenibilidad eran contrarias al objetivo de acceso para grupos de bajos ingresos. En casi dos terceras partes de las franquicias, las pacientes tuvieron que pagar el costo total de todos los servicios, inasequible para mujeres de bajos ingresos. Aunque todas las franquicias habían establecido normas y protocolos para garantizar la calidad, había limitada evidencia de su cumplimiento. Las entrevistas informales con pacientes indicaron satisfacción con los servicios. No obstante, preocupan factores como las dificultades en reclutar franquiciados y una considerable amortización de puestos de trabajo, la imposibilidad de los franquiciados de asistir a programas de capacitación, el uso de trabajadores de la salud laicos para proporcionar servicios sin apoyo o supervisión, y los problemas logísticos aplicando las herramientas de garantía de la calidad. La contribución de franquicias sociales al acceso universal a los servicios de salud reproductiva parece ser incierta. A menos que surja más evidencia de su valor, no se justifica continuar invirtiendo en ellas para la prestación de servicios de salud reproductiva. [ABSTRACT FROM AUTHOR]

Emergency contraception (EC) has been around for decades, but the first serious introduction and scale-up efforts started in the mid 1990's. This paper reviews programmatic experiences that sought to expand access to emergency contraceptive pills (ECP) in Africa, Asia and Latin America over the last decade. This multiregional review identifies the individual phases of the introductory processes as well as facilitators and barriers to successful scale-up of ECP service provision. Characteristics of successful projects included conduction of multi-sector diagnostic assessments; careful consideration of legal and policy issues; collaborative advocacy and technical assistance for inclusion in public family planning programs by national and international institutions; as well as attention to programmatic areas such as capacity-building, supply-chain and awareness-raising. Lessons learned from varied developing country experiences are discussed as is the need for increased attention to evaluating and disseminating project results. [ABSTRACT FROM AUTHOR]

Background: In the Philippines, one in four pregnancies are unintended and 610 000 unsafe abortions are performed each year. This study explored the association between missed opportunities to provide family planning counseling, quality of counseling and its impact on utilization of effective contraception in the Philippines. Methods: One-hundred-one nationally representative health facilities were randomly selected from five levels of the health system. Sexually-active women 18–49 years old, wanting to delay or limit childbearing, attending primary care clinics between April 24 and August 8, 2017 were included. Data on contraceptive use, counseling and availability were collected using interviews and facility assessments. Effective contraceptive methods were defined as those with rates of unintended pregnancy of less than 10 per 100 women in first year of typical use. Findings: 849 women were recruited of whom 51.1% currently used effective contraceptive methods, 20.6% were former effective method users and 28.3% had never used an effective method. Of 1664 cumulative clinic visits reported by women in the previous year, 72.6% had a missed opportunity to receive family planning counseling at any visit regardless of level of facility, with 83.7% having a missed counseling opportunity on the day of the interview. Most women (55.9%) reported health concerns about modern contraception, with 2.9% receiving counseling addressing their concerns. Only 0.6% of former users and 2.1% never-users said they would consider starting a modern contraceptive in the future. Short and long acting reversible contraceptive methods were available in 93% and 68% of facilities respectively. Conclusions: Missed opportunities to provide family planning counseling are widespread in the Philippines. Delivery of effective contraceptive methods requires that wider legal, policy, social, cultural, and structural barriers are addressed, coupled with systems approaches for improving availability and quality of counseling at all primary health care contacts. [ABSTRACT FROM AUTHOR]

Anemia is a condition in which the number of red blood cells is not sufficient to meet the physiological need of the body. Women of reproductive age and pregnant women are at a high risk of anemia, which in turn may contribute to maternal morbidity and mortality. We aimed to describe the prevalence of anemia and the factors associated with the risk of developing anemia in women of reproductive age in Nepal. Additionally, we examined the association of women’s decision-making autonomy regarding healthcare and experience of intimate partner violence (IPV) with anemia. Data from the 2016 Nepal Demographic and Health Survey (NDHS) were used in this study. The data were adjusted for sampling weight, stratification, and cluster sampling design. A battery-operated portable HemoCue was used to measure hemoglobin and detect anemia. Using complex sample logistic regression, the association between dependent and independent variables were examined; crude and adjusted odds ratio were reported. The mean (± SD) hemoglobin concentration was 12.13 g/dL (± 1.48). Overall, about 41% (95% CI 38.6–43.0%) of women aged 15–49 years were anemic. Women in households with wells as the source of drinking water (aOR 1.93; 95% CI 1.58–2.37) were significantly associated with an increased risk of developing anemia. While women who were currently using hormonal contraceptives (aOR 0.63, 95% CI 0.52–0.76) were significantly less likely to be anemic. After adjusting for background characteristics among women who were married at the time of the survey, decision-making autonomy regarding healthcare, and experience of IPV did not have a significant association with anemia. The high prevalence of anemia suggests the need for substantial improvement in the nutritional status of women. The increased disease burden compared with the past survey highlights the needs to reconsider the existing nutritional policy in Nepal. [ABSTRACT FROM AUTHOR]

Objective: Family planning service delivery has been neglected; rigorous analyses of the patterns of contraceptive provision are needed to inform strategies to address this neglect.Methods: We used 57 nationally representative Demographic and Health Surveys in low- and middle-income countries (2000-2013) in four geographic regions to estimate need for contraceptive services, and examined the sector of provision, by women's socio-economic position. We also assessed method mix and whether women were informed of side effects.Results: Modern contraceptive use among women in need was lowest in sub-Saharan Africa (39%), with other regions ranging from 64% to 72%. The private sector share of the family planning market was 37-39% of users across the regions and 37% overall (median across countries: 41%). Private sector users accessed medical providers (range across regions: 30-60%, overall mean: 54% and median across countries 23%), specialised drug sellers (range across regions: 31-52%, overall mean: 36% and median across countries: 43%) and retailers (range across regions: 3-14%, overall mean: 6% and median across countries: 6%). Private retailers played a more important role in sub-Saharan Africa (14%) than in other regions (3-5%). NGOs and FBOs served a small percentage. Privileged women (richest wealth quintile, urban residents or secondary-/tertiary-level education) used private sector services more than the less privileged. Contraceptive method types with higher requirements (medical skills) for provision were less likely to be acquired from the private sector, while short-acting methods/injectables were more likely. The percentages of women informed of side effects varied by method and provider subtype, but within subtypes were higher among public than private medical providers for four of five methods assessed.Conclusion: Given the importance of private sector providers, we need to understand why women choose their services, what quality services the private sector provides, and how it can be improved. However, when prioritising one of the two sectors (public vs. private), it is critical to consider the potential impact on contraceptive prevalence and equity of met need. [ABSTRACT FROM AUTHOR]

Using World Fertility Survey data for 15 developing countries, we estimate an equation in which the dependent variable-whether the respondent has ever used an efficient contraceptive method depends on the respondent's education and location of childhood residence. All of the coefficients of this equation, including the intercept, vary over countries. Analysis based on new methodology shows that the intercept and education effects vary as a function of national family planning program efforts and that none of the parameters of the equation depend on gross national product per capita. The results demonstrate the efficacy of multilevel analysis, provide a partial test of the theory underlying the analysis, and refocus discussion of the contributions of development and policy variables to fertility reduction. [ABSTRACT FROM AUTHOR]