Perceived social approval and condom use with casual partners among youth in urban Cameroon

Background: HIV prevention programs targeting youth often emphasize the role of peers, and assume that youths will model their behavior after their peers'. We challenge this view; we argue that adopting a given behavior requires social approval, and that youths do not necessarily turn to peers for such approval. This study analyzes survey data on youths in urban Cameroon to 1) identify which type of persons youths look to for social approval, and 2) establish how important social approval by these persons is for condom use among youths. Methods: We analyzed data from three survey waves (2000, 2002, and 2003) of a reproductive health survey conducted among urban Cameroonian youth (aged 15-24). Only respondents who reported having at least one casual partner in the past year were retained for the analysis. Bivariate analyses and structural equation modeling were used to examine relationships among perceived social approval, attitudes towards condoms and condom use. Results: The data show that only 3% of youths named their friends as people whose opinion they valued, while 93% mentioned family members. The perceived approval of condom use by these persons had a significant positive effect on the frequency of condom use among youths. The frequency of condom use was also affected by the respondents' attitudes toward condom use, the range of persons with whom they discussed reproductive health matters, whether they were enrolled in school, socioeconomic status, their self-efficacy, perceived severity of AIDS, risk perception and sexual risk behavior. The perceived social approval of condom use and the respondents' own condom attitudes were correlated. Conclusions: Our analysis demonstrates that perceived social approval facilitates the adoption of condom use among urban Cameroonian youth. However, youths tend to value the opinions of family members much more than the opinions of their peers. These results suggest that interventions targeting youths should not focus exclusively on peers but should also include other groups, such as parents and community leaders

Women's position and attitudes towards female genital mutilation in Egypt : a secondary analysis of the Egypt demographic and health surveys, 1995-2014

Background: Female genital mutilation (FGM) is still widespread in Egyptian society. It is strongly entrenched in local tradition and culture and has a strong link to the position of women. To eradicate the practice a major attitudinal change is a required for which an improvement in the social position of women is a prerequisite. This study examines the relationship between Egyptian women's social positions and their attitudes towards FGM, and investigates whether the spread of anti-FGM attitudes is related to the observed improvements in the position of women over time. Methods: Changes in attitudes towards FGM are tracked using data from the Egypt Demographic and Health Surveys from 1995 to 2014. Multilevel logistic regressions are used to estimate 1) the effects of indicators of a woman's social position on her attitude towards FGM, and 2) whether these effects change over time. Results: Literate, better educated and employed women are more likely to oppose FGM. Initially growing opposition to FGM was related to the expansion of women's education, but lately opposition to FGM also seems to have spread to other segments of Egyptian society. Conclusions: The improvement of women's social position has certainly contributed to the spread of anti-FGM attitudes in Egyptian society. Better educated and less traditional women were at the heart of this change, and formed the basis from where anti-FGM sentiment has spread over wider segments of Egyptian society

'Main' girlfriends, girlfriends, marriage, and money: the social context of HIV risk behaviour in sub-Saharan Africa

Research on African societies documents the magnitude of the AIDS epidemic, and shows that at younger ages women are more likely to be affected than men. Young African women are particularly vulnerable to HIV infection because sexual relations with men are an important means to achieve social and economic status, and for some women they are necessary for survival. Many African adolescents and young adults engage in premarital sexual relationships, either sequentially or simultaneously. Unmarried African males commonly have a ‘main’ girlfriend whom they expect to marry, and one or more other girlfriends, for whom there are no such expectations; some females have similar strategies. This study uses focus-group data from Cameroun to describe popular types of premarital sexual relationships, and to examine gender differentials in the motivations for engaging in such relationships and in perceptions of the factors that affect the marriage prospects of these premarital relationships. Economic need leads many young women to use premarital sexual relations for economic support, despite high levels of HIV infection. These findings help inform policy-makers and program managers in Africa about gender differentials in the motivations for engaging in premarital sexual unions, which in turn can help improve the design and implementation of social and health policies and programs

Trends in attitudes towards female genital mutilation among ever-married Egyptian women, evidence from the Demographic and Health Surveys, 1995–2014: paths of change

Background: Over the past few decades Egypt has attempted to limit and control female genital mutilation (FGM). However, these efforts have not succeeded in curbing the practice, which maintains wide popular support and is firmly embedded in local traditions and structures. An attitudinal change is therefore a prerequisite for any successful campaign against FGM. This paper charts the evolution of beliefs that the practice of FGM in Egypt should be stopped. Method: This paper examines trends in opposition to FGM among ever-married women in Egypt between 1995 and 2014, using six waves of the Egypt Demographic and Health Surveys. Results: The results show that the percentage of ever-married women who think the practice of FGM should be stopped rose from 13.9 % in 1995 to 31.3 % in 2014. The central question here is whether this trend exists because new cohorts of young married women are more modern and more opposed to the practice, or because opposition to FGM has spread through multiple segments of society. Our results show that back in 1995 opposition to FGM was concentrated in two groups: non-circumcised women, and wealthy, highly educated urban women. Between 1995 and 2014 opposition to FGM increased considerably among other groups of women. Conclusion: Our results show that the observed increases in opposition to FGM are not caused by younger cohorts of married women who oppose FGM, nor by the expansion of the groups most likely to oppose FGM. Rather, the results imply that the belief that FGM should be stopped spread to all walks of life, although poorly educated rural women remain least likely to oppose FGM

Guide for assessing the impact of a Total Market Approach to family planning programs

PATH has drawn on its global experience from our total market approach (TMA) work in the Democratic Republic of Congo, Myanmar, Nicaragua, Uganda, and Vietnam to produce a TMA planning guide to increase access to family planning. The guide (Planning Guide for a Total Market Approach to Increase Access to Family Planning—Module 1: Landscape Assessment) and toolkit, produced by The Evidence Project, contain practical information and specific tools to help organizations and other planners conduct a landscape assessment, the first phase in developing a TMA. These resources are part of a larger toolkit, which also includes an in-depth market analysis and two-volume handbook produced by MEASURE Evaluation, and this joint publication by all three projects

Handbook for Research on the Family Planning Market—Volume 1: Using Data to Inform a Total Market Approach to Family Planning

A “total market approach” (TMA) to family planning promotes access to family planning for individuals and couples through coordination and collaboration among government health care services, nonprofit health care services, and the business/commercial sector for family planning products. While many countries are interested in the TMA approach to family planning policies and strategies, it’s difficult to know what steps to take first to inform plans and programs. MEASURE Evaluation, in collaboration with the Evidence Project (both funded by USAID), has developed several resources, including a planning tool (Planning Guide for a Total Market Approach to Increase Access to Family Planning—Module 2: In-depth Analyses of the Family Planning Market) and a two-volume handbook (in addition to this one, Handbook for Research on the Family Planning Market—Volume 2: Tool and Resources for an In-depth Analysis of the Family Planning Market), to standardize a best-practice guide for countries to assess their particular need and readiness for TMA. These resources are part of a larger toolkit, which also includes a Landscape Assessment (Planning Guide for a Total Market Approach to Increase Access to Family Planning—Module 1: Landscape Assessment) and Toolkit (Planning Guide for a Total Market Approach to Increase Access to Family Planning: Toolkit and Glossary) produced by PATH, and a joint publication by all three projects (Guide for Assessing the Impact of a Total Market Approach to Family Planning Programs)

Handbook for Research on the Family Planning Market—Volume 2: Tool and Resources for an In-depth Analysis of the Family Planning Market

A “total market approach” (TMA) to family planning promotes access to family planning for individuals and couples through coordination and collaboration among government health care services, nonprofit health care services, and the business/commercial sector for family planning products. While many countries are interested in the TMA approach to family planning policies and strategies, it’s difficult to know what steps to take first to inform plans and programs. MEASURE Evaluation, in collaboration with the Evidence Project (both funded by USAID), has developed several resources, including a planning tool (Planning Guide for a Total Market Approach to Increase Access to Family Planning—Module 2: In-depth Analyses of the Family Planning Market) and a two-volume handbook (in addition to this one, Handbook for Research on the Family Planning Market. Volume 1: Using Data to Inform a Total Market Approach to Family Planning), to standardize a best-practice guide for countries to assess their particular need and readiness for TMA. These resources are part of a larger toolkit, which also includes a Landscape Assessment (Planning Guide for a Total Market Approach to Increase Access to Family Planning—Module 1: Landscape Assessment) and Toolkit (Planning Guide for a Total Market Approach to Increase Access to Family Planning: Toolkit and Glossary) produced by PATH, and a joint publication by all three projects (Guide for Assessing the Impact of a Total Market Approach to Family Planning Programs)

Planning Guide for a Total Market Approach to Increase Access to Family Planning—Module 2: In-depth Analyses of the Family Planning Market

A “total market approach” (TMA) to family planning promotes access to family planning for individuals and couples through coordination and collaboration among government health care services, nonprofit health care services, and the business/commercial sector for family planning products. While many countries are interested in the TMA approach to family planning policies and strategies, it’s difficult to know what steps to take first to inform plans and programs. MEASURE Evaluation, in collaboration with the Evidence Project (both funded by USAID), has developed several resources, including this planning tool and a two-volume handbook (Handbook for Research on the Family Planning Market. Volume 1: Using Data to Inform a Total Market Approach to Family Planning and Handbook for Research on the Family Planning Market Volume 2: Tool and Resources for an In-depth Analysis of the Family Planning Market), to standardize a best-practice guide for countries to assess their particular need and readiness for TMA. These resources are part of a larger toolkit, which also includes a Landscape Assessment (Planning Guide for a Total Market Approach to Increase Access to Family Planning—Module 1: Landscape Assessment) and Toolkit (Planning Guide for a Total Market Approach to Increase Access to Family Planning: Toolkit and Glossary) produced by PATH, and a joint publication by all three projects (Guide for Assessing the Impact of a Total Market Approach to Family Planning Programs)

Evaluation of the reach and impact of the 100% Jeune youth social marketing program in Cameroon: findings from three cross-sectional surveys

BACKGROUND: The 100% Jeune youth social marketing program in Cameroon aims to address the high STI/HIV prevalence rates and the high levels of unwanted pregnancy. This study evaluates the 100% Jeune program, analyzing its reach and impact on condom use, level of sexual activity, and predictors of condom use. METHODS: This analysis uses data from three waves of the Cameroon Adolescent Reproductive Health Survey, implemented at 18-month intervals between 2000 and 2003. The sample is restricted to unmarried youth aged 15–24; sample sizes are 1,956 youth in 2000, 3,237 in 2002, and 3,370 in 2003. Logistic regression analyses determine trends in reproductive health behavior and their predictors, as well as estimate the effect of program exposure on these variables. All regression analyses control for differences in sample characteristics. RESULTS: A comparison of trends over the 36-month study period shows that substantial positive changes occurred among youth. Results of dose response analyses indicate that some of these positive changes in condom use and predictors of use can be attributed to the 100% Jeune youth social marketing program. The program contributed to substantial increases in condom use, including consistent use with regular partners among youth of both sexes. Among males, it also contributed to consistent use with casual partners. While condom use increased with both regular and casual partners, levels of use are higher with the latter. Observed secular trends indicate that factors besides the 100% Jeune program also contributed to the observed improvements. Despite efforts to promote abstinence, the 100% Jeune program had no effect on levels of sexual activity or number of sexual partners. Likewise, there is no evidence that reproductive health programs for youth lead to increased sexual activity. CONCLUSION: Results show that 100% Jeune successfully used a variety of mass media and interpersonal communication channels to reach a high proportion of youth throughout the intervention period. In a context in which a variety of governmental and nongovernmental partners are increasing youth-focused reproductive health programming, the 100% Jeune program reached a higher proportion of youth than did other programs. Collective efforts of multiple organizations over time can lead to improvements in adolescent reproductive health. Resources should be allocated to identify and understand predictors of abstinence and partner reduction to inform future programming decisions