Women’s Empowerment and Modern Contraceptive Use: Evidence from Four Southeast Asian Countries

Modern contraceptive prevalence rates differ across Southeast Asian countries due to the different levels of socio-economic development, cultural practices, and women’s empowerment. This study investigates the relationship between women’s empowerment and modern contraceptive use in Cambodia, Indonesia, Myanmar, and the Philippines, where Demographic and Health Surveys data are available. The main study variables include modern contraceptive use (as measured by the percentage of married women aged 15-49 currently using a modern contraceptive method) and women’s empowerment measures, which include asset ownership, household decision-making, and attitudes towards spousal violence. Binary logistic regression is used to assess the association between modern contraceptive use and women’s empowerment, controlling for the effects of women’s age, education, work status, exposure to mass media, exposure to family planning via media, place of residence, wealth index, age at marriage, and number of living children. Results show that pills and injections were commonly used across the countries under study. Multivariate analysis reveals that women with greater empowerment were more likely to use a modern contraceptive method, but the effect varied across women’s empowerment indicators. It is important to empower women in the household as disempowered women tend to neglect their rights to access primary health care, which could jeopardize their health. Hence, empowering women remains an important agenda for improving modern contraceptive use within Southeast Asian countries

Alcohol-related liver disease is rarely detected at early stages compared with liver diseases of other etiologies worldwide

© 2019 by the AGA InstituteBackground & aims: Despite recent advances in treatment of viral hepatitis, liver-related mortality is high, possibly owing to the large burden of advanced alcohol-related liver disease (ALD). We investigated whether patients with ALD are initially seen at later stages of disease development than patients with hepatitis C virus (HCV) infection or other etiologies. Methods: We performed a cross-sectional study of 3453 consecutive patients with either early or advanced liver disease (1699 patients with early and 1754 with advanced liver disease) seen at 17 tertiary care liver or gastrointestinal units worldwide, from August 2015 through March 2017. We collected anthropometric, etiology, and clinical information, as well as and model for end-stage liver disease scores. We used unconditional logistic regression to estimate the odds ratios for evaluation at late stages of the disease progression. Results: Of the patients analyzed, 81% had 1 etiology of liver disease and 17% had 2 etiologies of liver disease. Of patients seen at early stages for a single etiology, 31% had HCV infection, 21% had hepatitis B virus infection, and 17% had nonalcoholic fatty liver disease, whereas only 3.8% had ALD. In contrast, 29% of patients seen for advanced disease had ALD. Patients with ALD were more likely to be seen at specialized centers, with advanced-stage disease, compared with patients with HCV-associated liver disease (odds ratio, 14.1; 95% CI, 10.5-18.9; P < .001). Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. These patients had significantly more visits to health care providers, with more advanced disease, compared with patients without excess alcohol use. The mean model for end-stage liver disease score for patients with advanced ALD (score, 16) was higher than for patients with advanced liver disease not associated with excess alcohol use (score, 13) (P < .01). Conclusions: In a cross-sectional analysis of patients with liver disease worldwide, we found that patients with ALD are seen with more advanced-stage disease than patients with HCV-associated liver disease. Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. Early detection and referral programs are needed for patients with ALD worldwide.This study was funded by the National Institute of Alcohol Abuse and Alcoholism grants U01AA021908 and U01AA020821, a scholarship grant from the Spanish Association for the Study of the Liver (M.V.-C.), and a grants NSFC 81570530 and 81370550 from the National Natural Science Foundation of China (L.Y.).info:eu-repo/semantics/publishedVersio