Do Population Policies Matter? Fertility and Politics in Egypt, India, Kenya, and Mexico

How are effective population policies articulated and implemented? Have international agencies played a strong role in prompting developing-country governments to adopt and implement strong population policies? How has the international debate influenced deliberations on population issues in developing countries? The impetus for the four country studies presented in this book was provided by a desire to better understand some of these issues within specific contexts. Egypt, India, Kenya, and Mexico were selected because of their demographic weight, a long history of population policies and programs, and evidence of fertility decline. The four country studies examine the influence of many forces on the design and implementation of population policies. The authors extrapolate from their findings to speculate on the future of population policy within the countries under consideration

Challenges in impact evaluation

These notes are for a presentation given at the Consultation on Social and Behavioral Change Interventions for Enhancing Child Survival in South Asia organized by UNICEF, USAID, and Population Council in New Delhi, India. The slides identify challenges for conducting impact evaluations by describing the anticipated process for behavior change communication using women’s support groups, issues encountered in the process, and evaluation designs. Examples from the Population PAIMAN project are used to illustrate ways to address these challenges

Quality of care in the context of rights-based family planning

Over the past two decades, the quality-of-care framework has become a cornerstone of family planning (FP) programming. FP programs have been concerned about improving access and reducing the cost to the client but at the same time making services sustainable and improving their effectiveness and efficiency. Nevertheless, access to FP services is not equitable: educated, wealthier, or urban women have better access to the available services from a range of sources than their more vulnerable counterparts, who are less educated, poor, or live in rural areas. This policy brief suggests five modifications to the QoC framework, based on the comparison of quality across frameworks, past experiences, and issues faced in measuring quality. The anticipated outcome of improved services is likely to be an improvement in the effectiveness and duration of contraceptive use and an improvement in women’s and men’s ability to achieve their own reproductive intentions in a healthful manner

Proposed metrics to measure quality: Overview

The first quality-of-care framework in family planning was articulated over 25 years ago and a considerable amount of work has been done since then to measure quality in the context of routine service delivery, yet, we do not have agreed-upon indicators to measure quality that can be applied uniformly across different health systems and social contexts. This paper takes a slightly different approach and uses a common definition of quality from the outset. Indicators of quality are required for describing the nature of family planning services and quality of care offered by a health service delivery program, and for improving clients’ experience and health outcomes. Additionally, indicators are needed for monitoring quality of care over time in a single country (e.g., for quality improvement) as well as for comparing quality across countries (e.g., for understanding contraceptive discontinuation and unintended pregnancies). Different types of indicators are needed to serve these different needs for policy and program development. Keeping these needs in mind, we propose a new set of measures to assess quality across different levels and settings

Do Indian women receive adequate information about contraception?

This study analysed the recent changes and patterns of information received about contraceptive methods by contraceptive users in India – an important indicator of quality of care in family planning services. Data were taken from the third and fourth rounds of National Family and Health Surveys (NFHS) conducted in India during 2005–06 and 2015–16. The Method Information Index (MII) was used to capture the information received by respondents on three aspects of contraceptive method use: information about the side-effects of the method, what to do if they experienced any complication from using the method and information received about other methods of contraception. A separate analysis of information received by users about the permanency of sterilization was also carried out. Logistic regression models were applied to assess the independent effects of users’ background characteristics and their states and union territories of residence on method information received by them. The value of the MII nearly doubled from about 16% in 2004–05 to 31% in 2015–16, indicating a marked increase in the information received by contraceptive users in India over the period between 2005–06 and 2015–16. In addition, the percentage of sterilized women who received information about the permanency of the method also increased, from 67% to 80%, over the period. While considerable progress has been made in the last decade, there is still plenty of scope for improvement in the information received by contraceptive users to advance a voluntary approach to family planning

Male migration and risky sexual behavior in rural India: is the place of origin critical for HIV prevention programs?

<p>Abstract</p> <p>Background</p> <p>Recent studies of male migrants in India indicate that those who are infected with HIV are spreading the epidemic from high risk populations in high prevalence areas to populations in low prevalence areas. In this context, migrant men are believed to initiate and have risky sexual behaviors in places of destination and not in places of origin. The paucity of information on men's risky sexual behaviors in places of origin limits the decision to initiate HIV prevention interventions among populations in high out-migration areas in India.</p> <p>Methods</p> <p>A cross-sectional behavioral survey was conducted among non-migrants, returned migrants (with a history of migration), and active (current) migrants in rural areas across two districts with high levels of male out-migration: Prakasam district in Andhra Pradesh and Azamgarh district in Uttar Pradesh. Surveys assessed participant demographics, migration status, migration history, and sexual behavior along the migration routes, place of initiation of sex. District-stratified regression models were used to understand the associations between migration and risky sexual behaviors (number of partners, condom use at last sex) and descriptive analyses of migrants' place of sexual initiation and continuation along migration routes.</p> <p>Results</p> <p>The average age at migration of our study sample was 19 years. Adjusted regression analyses revealed that active migrants were more likely to engage in sex with sex workers in the past 12 months (Prakasam: 15 percent vs. 8 percent; adjusted odds ratio (aOR)=2.1, 95% CI 1.2-3.4; Azamgarh: 19 percent vs.7 percent; aOR=4.0, 95% CI 2.4-6.6) as well as have multiple (3+) sex partners (Prakasam: 18 percent vs. 9 percent; aOR=2.0, 95% CI 1.3-3.2; Azamgarh: 28 percent vs. 21 percent; aOR=1.9, 95% CI 1.2-3.0) than non-migrants. Contrary to popular belief, a high proportion of active and returned migrants (almost 75 percent of those who had sex) initiated sex at the place of origin before migrating, which is equivalent to the proportion of non-migrants who engaged in sex with sex workers as well as with casual unpaid partners. Moreover, non-migrants were more likely than migrants to engage in unprotected sex.</p> <p>Conclusion</p> <p>Findings of this study document that returned migrants and active migrants have higher sexual risk behaviors than the non-migrants. Most migrants initiate non-marital sex in the place of origin and many continue these behaviors in places of destination. Migrants’ destination area behaviors are linked to sex with sex workers and they continue to practice such behaviors in the place of origin as well. Unprotected sex in places of destination with high HIV prevalence settings poses a risk of transmission from high risk population groups to migrants, and in turn to their married and other sexual partners in places of origin. These findings suggest the need for controlling the spread of HIV among both men and women resulting from unsafe sex in places of origin that have high vulnerability due to the frequent migratory nature of populations.</p

Patterns and implications of male migration for HIV prevention strategies in Karnataka, India

Karnataka is one of the high HIV prevalence states in India. Results from the National Family Health Survey indicate that 0.69 percent of adults aged 15–49 were infected with HIV in 2005–06. According to sentinel surveillance system data, HIV prevalence among pregnant women receiving antenatal care (ANC) in Karnataka was 1.3 percent. Further, 18 of the state\u27s 27 districts have recorded HIV prevalence of more than 1 percent among pregnant women receiving ANC in sentinel sites. Strong male migration patterns are evident in some of the state’s high HIV prevalence districts. According to the 2001 census, Karnataka ranks fourth in terms of total in-migration, with 2.2 million men on the move from 1991 to 2001. These northern districts are particularly vulnerable to HIV infection. To inform HIV prevention efforts, the Population Council studied patterns and motivations related to migration of male laborers and their links with HIV risk. As part of this study, the Council conducted a systematic analysis of 2001 census data on migration and district-level sentinel surveillance data on HIV prevalence. The purpose of the research was to document patterns of male migration and determine whether there was a relationship between migration and HIV prevalence

Relationship between reported prior condom use and current self-perceived risk of acquiring HIV among mobile female sex workers in southern India

<p>Abstract</p> <p>Background</p> <p>With the evolution of Health Belief Model, risk perception has been identified as one of several core components of public health interventions. While female sex workers (FSWs) in India continue to be at most risk of acquiring and transmitting HIV, little is known about their perception towards risk of acquiring HIV and how this perception depends upon their history of consistent condom use behavior with different type of partners. The objective of this study is to fill this gap in the literature by examining this relationship among mobile FSWs in southern India.</p> <p>Methods</p> <p>We analyzed data for 5,413 mobile FSWs from a cross-sectional behavioral survey conducted in 22 districts from four states in southern India. This survey assessed participants’ demographics, condom use in sex with different types of partners, continuation of sex while experiencing STI symptoms, alcohol use before having sex, and self-perceived risk of acquiring HIV. Descriptive analyses and multilevel logistic regression models were used to examine the associations between risky sexual behaviors and self-perceived risk of acquiring HIV; and to understand the geographical differences in HIV risk perception.</p> <p>Results</p> <p>Of the total mobile FSWs, only two-fifths (40%) perceived themselves to be at high risk of acquiring HIV; more so in the state of Andhra Pradesh (56%) and less in Maharashtra (17%). FSWs seem to assess their current risk of acquiring HIV primarily on the basis of their past condom use behavior with occasional clients and less on the basis of their past condom use behaviors with regular clients and non-paying partners. Prior inconsistent condom use with occasional clients was independently associated with current perception of high HIV risk (adjusted odds ratio [aOR)] = 2.1, 95% confidence interval [CI]: 1.7-2.6). In contrast, prior inconsistent condom use with non-paying partners was associated with current perception of low HIV risk (aOR= 0.7, 95% CI: 0.5-0.9). The congruence between HIV risk perception and condom use with occasional clients was high: only 12% of FSWs reported inconsistent condom use with occasional clients but perceived themselves to be at low risk of acquiring HIV.</p> <p>Conclusion</p> <p>The association between high risk perception of acquiring HIV and inconsistent condom use, especially with regular clients and non-paying partners, has not been completely internalized by this high risk group of mobile FSWs in India. Motivational efforts to prevent HIV should emphasize the importance of accurately assessing an individual’s risk of acquiring HIV based on condom use behavior with all types of partners: occasional and regular clients as well as non-paying partners; and encourage behavior change based on an accurate self-assessment of HIV risk.</p

Patterns of migration/mobility and HIV risk among female sex workers: Andhra Pradesh 2007-08

This report presents the findings from the female sex workers study in Andhra Pradesh, India implemented by TNS India Private Limited and the Population Council in New Delhi. Specifically the study was undertaken to assess the volume and patterns of mobility of female sex workers; to describe the characteristics of mobile female sex workers; and too examine the determinants of HIV risk among female sex workers, with particular emphasis on mobility-related characteristics. The report concludes that targeting such highly mobile female sex workers in intervention programs requires a comprehensive understanding of their places of solicitation and sex. Female sex workers who move frequently to different places and who visit other areas for a short time are at greater risk of HIV, and special efforts are needed in HIV-prevention programs to address the needs of such workers

Patterns and implications of male migration for HIV prevention strategies in Maharashtra, India

Maharashtra was one of the first states to be affected by HIV in India. Results from the National Family Health Survey (NFHS-3) in 2005–06 indicate that 0.62 percent of men and women aged 15–49 years were infected with HIV, as compared to the national average of 0.28 percent. HIV sentinel surveillance data from sites across Maharashtra indicate that 1.3 percent of pregnant women receiving antenatal care (ANC) and 10.4 percent of patients receiving treatment for sexually transmitted infections in 2005 were infected with HIV. At the same time, Maharashtra ranks first nationally in the proportion of total migrants, and there is a growing consensus among policymakers and program managers that migration could be a major contributor in the spread of HIV in the state. However, empirical evidence to support or refute this conjecture is limited. To address this research gap, the Population Council studied the patterns and motivations related to the migration of male laborers and their linkages with HIV risk. The purpose of the research, as stated in this brief, was to document patterns of male migration and determine whether there was a relationship between migration and HIV prevalence