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Summary Background Drug therapy for people with AIDS is a humanitarian priority but prevention of HIV infection remains essential. Focusing on young single African women, we aimed to assess trends in a set of behaviours-sexual abstinence, contraceptive use, and condom use-that are known to affect the rates of HIV transmission. Methods We did a secondary analysis of public-access data sets in 18 African countries (132 800 women), and calculated changes in a set of behavioural indicators over time. We standardised these trends from nationally representative surveys to adjust for within-country changes in age, education, and type of residential location. Findings Between about 1993 and 2001, the percentage of women reporting no sexual experience changed little. During the same period, the percentage of sexually experienced women who reported no sexual intercourse in the previous 3 months (secondary abstinence) rose significantly in seven of 18 countries and the median for all 18 countries increased from 43·8% to 49·2%. Use of condoms for pregnancy prevention rose significantly in 13 of 18 countries and the median proportion increased from 5·3% to 18·8%. The median rate of annual increase of condom use was 1·41 percentage points (95% CI 1·12-2·25). In the 13 countries with available data, condom use at most recent coitus rose from a median of 19·3% to 28·4%. Over half (58·5%) of condom users were motivated, at least in part, by a wish to avoid pregnancy. Interpretation Condom promotion campaigns in sub-Saharan Africa have affected the behaviour of young single women; the pace of change has matched the rise in contraceptive use by married couples in developing countries over recent decades. Thus continuing efforts to promote condom use with emphasis on pregnancy prevention are justified. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To ascertain the contribution of contraceptive failure to unintended births and fetal loss in developing countries. METHODS: Nationally representative survey data from married women in 19 developing countries were analyzed. All surveys contained retrospective monthly calendars of contraceptive use and pregnancies for a 5-year period preceding each survey. Information on the intendedness of live births, ascertained earlier in the interview, were linked to the calendar data. Single-decrement life table analysis was applied to episodes of use to estimate failure probabilities. The reproductive consequences of failure were established by simple tabulation. Logistic regression was used to explore the determinants of fetal loss. RESULTS: Refitted contraceptive failure rates were similar to those derived from studies conducted mainly in the United States. About three fourths of pregnancies resulting from contraceptive failure were carried to term, and all but 16% of those were classified by the mother as unwanted or mistimed. Just over one tenth ended in fetal loss, either induced or spontaneous. Analysis of determinants of fetal loss suggested that a large proportion were induced. The median contribution of failure to all unintended births for all 19 surveys was about 15%, and the contribution to fetal loss was 12%. CONCLUSION: The contribution of contraceptive failure in developing countries is much lower than the estimate of 50% in the United States. Despite the substantial increases in contraceptive practice that have occurred in Asia, Latin America, the Middle East, and to a lesser extent, Africa, the level of use is still below the 75% mark achieved in most industrialized countries. Nonuse of contraception remains the dominant direct cause of unintended births, and family planning promotion should remain a public health priority. [ABSTRACT FROM AUTHOR]

Objectives. In 1993, the government of Pakistan started a new approach to the delivery of contraceptive services by training literate married women to provide doorstep advice and supplies in their own and neighboring communities. This report assesses whether this community-based approach is starting to have an impact on contraceptive use in rural areas. Methods. A clustered nationally representative survey was used to collect data on contraceptive use and access to services in each cluster. Two-level logistic regression was applied to assess the effects of service access, after potential confounders were taken into account. Results. Married women living within 5 km of 2 community-based workers were significantly more likely to be using a modern, reversible method of contraception than those with no access (odds ratio= 1.74; 95% confidence interval = 1.11, 2.71). Conclusions. After decades of failure, the managers of the family planning program have designed a way of presenting modern contraceptives that is appropriate to the conditions of rural Pakistan. The new community-based approach should be steadily expanded. (Am J Public Health. 2002;92:1168-1172) [ABSTRACT FROM AUTHOR]

It is estimated that 27 million couples, representing 2.6% of all couples in the reproductive span, use periodic abstinence (PA). Using data from 15 national surveys in low and middle-income countries, this article assesses characteristics of PA users, knowledge of the fertile period, accidental conceptions while using PA and the reproductive consequences of these conceptions. Current users of PA (predominantly the simple calendar variant) tend to be more educated and urban than users of other methods. The method is preferred by young single women and older married women. The proportion of users with correct knowledge of the timing of ovulation ranges from 8% to 91%, with a median value of 62%. The median 12-month gross failure rate was 24 per 100 episodes. Net of other predictors of failure, correct knowledge of the timing of ovulation was associated with a 12% decrease in failure probabilities. Couples who experienced PA failure were more likely than couples who experienced failure with another method to carry the pregnancy to term. Nevertheless, PA still contributes to one-sixth of all abortions (or miscarriages) following contraceptive failure. [Copyright &y& Elsevier]