Intimate Partner Violence Attitudes and Experience Among Women and Men in Uganda

This study examines intimate partner violence (IPV) attitudes and experience among women and men in Uganda to inform IPV prevention programs in the region. Nationally representative population-based data from women ages 15–49 and from men ages 15–54 were collected between May and October, 2006 as part of the Uganda Demographic and Health Survey. The survey included questions on women’s and men’s attitudes toward wife beating and information on IPV victimization (women) and perpetration (men). More than half of men and nearly three-quarters of women have attitudes supportive of wife beating in Uganda. More than half of married women report IPV victimization and 40% of married men report perpetration. Women and men who reported witnessing their fathers beating their mothers were more likely to report IPV victimization (perpetration for men). Witnessing violence was also associated with positive attitudes towards wife beating among men. IPV prevention programs need to address the important role of having witnessed wife beating between the mother and the father on men’s subsequent attitudes and behaviors. Women who witnessed wife beating are also the most likely to have supportive attitudes and IPV experience, possibly indicating that their relationship expectations are different than women who did not witness violence. Community-based prevention programs targeting men and women are needed in Uganda and elsewhere in sub-Saharan Africa where gender norms that justify intimate partner violence prevail

Community-level intimate partner violence and the circumstances of first sex among young women from five African countries

<p>Abstract</p> <p>Background</p> <p>Gender-based violence is an important risk factor for adverse reproductive health (RH). Community-level violence may inhibit young women's ability to engage in safer sexual behaviors due to a lack of control over sexual encounters. Few studies examine violence as a contextual risk factor.</p> <p>Methods</p> <p>Using nationally representative data from five African countries, the association between community-level physical or sexual intimate partner violence (IPV) and the circumstances of first sex (premarital or marital) among young women (ages 20-29) was examined.</p> <p>Results</p> <p>In Mali, and Kenya bivariate analyses showed that young women who had premarital first sex were from communities where a significantly higher percentage of women reported IPV experience compared to young women who had marital first sex. Multivariate analyses confirmed the findings for these two countries; young women from communities with higher IPV were significantly more likely to have had premarital first sex compared to first sex in union. In Liberia, community-level IPV was associated with a lower risk of premarital sex as compared to first sex in union at a marginal significance level. There was no significant relationship between community-level IPV and the circumstances of first sex in the Democratic Republic of Congo or Zimbabwe.</p> <p>Conclusion</p> <p>These findings indicate that context matters for RH. Individualized efforts to improve RH may be limited in their effectiveness if they do not acknowledge the context of young women's lives. Programs should target prevention of violence to improve RH outcomes of youth.</p

Can family planning outreach bridge the urban-rural divide in Zambia?

Abstract: Background: Zambia experienced declining aggregate fertility and increasing aggregate contraceptive use from 1990 to 2000. Yet, in rural Zambia, progress in family planning has lagged far behind the advances made in Zambia's urban areas. The contraceptive prevalence rate in Lusaka and other urban areas outstripped the rate in rural Zambia by nearly 25 percentage points (41.2 percent versus 16.6 percent) in 2001. The total fertility rate varied between urban and rural areas by 2.5 children (4.3 versus 6.9 children). This paper considers the urban-rural differentials in Zambia and assesses family planning outreach as a tool to narrow this divide. Methods: This study uses the Zambia Demographic and Health Survey (DHS) data, collected between 2001 and 2002. Logistic regression techniques were employed to examine factors associated with contraceptive use. The first analysis tested modern contraceptive use versus traditional method use and no use. In addition, separate models were run for samples stratified by type of residence (rural or urban) to determine if different factors were associated with use by residence. A simulation determined the effect of all women receiving at least one household visit from a health worker if all other variables were held constant. Results: Differences in modern contraceptive use between urban and rural areas persist (OR: 1.56, 95 percent CI: 1.24–1.96) even after adjusting for a number of demographic, socioeconomic, cognitive, and attitudinal factors. Household visits by a community health worker significantly increased the likelihood of modern contraceptive use among rural women (OR: 1.83; 95 percent CI: 1.29–2.58). If all rural women received at least one outreach visit per year, the prevalence rate for modern contraceptive methods would be expected to increase for this group by 5.9 percentage points, a marked increase but less than one-quarter of the total urban-rural differential. Conclusion: Outreach in the form of health worker visits can improve access to family planning services, but it does not eliminate barriers to access or address continued high-fertility desires in Zambia. Until policymakers consider strategies that address both family planning demand creation and supply of services, progress in Zambia and the rest of sub-Saharan Africa will continue to lag behind the rest of the world

Reaching urban female adolescents at key points of sexual and reproductive health transitions: evidence from a longitudinal study from Kenya

Urban areas include large numbers of adolescents (ages 15-19) and young adults (ages 20-24) who may have unmet sexual and reproductive health (SRH) needs. Worldwide, adolescents contribute 11% of births, many of which are in low and middle-income countries. This study uses recently collected longitudinal data from urban Kenyan women to examine the association between targeted intervention activities and adolescents‘ SRH transitions. The focus was on a female adolescent (15-19) sample and their transition to first sex and first pregnancy/birth. Multinomial logistic regression methods were used to examine whether exposure to program activities was associated with delays in transitions. Overall, a high percentage of adolescents were exposed to television activities with family planning messages. About a third were exposed to community events, program posters, or the Shujaaz comic book that included themes related to relationships and positive health outcomes using recognizable characters. Multivariate analyses found that exposure to the Shujaaz comic book was associated with remaining sexually inexperienced and never pregnant at end line. Future programs for urban adolescents should implement interventions that test novel media strategies, like the Shujaaz comic book, that may be more interesting for young people. Innovative strategies are needed to reach female adolescents in urban settings.Keywords: Urban; Kenya; Sexual Initiation; Pregnancy; Adolescent

Adolescent Sexual Behavior and Reproductive Outcomes In Central America: Trends over the Past Two Decades

Compared with the Latin American average,adolescent fertility is high in El Salvador,Guatemala, Honduras and Nicaragua,countries that also have high poverty levels and poor access to reproductive health care

Association between Early Marriage and Intimate Partner Violence in India: A Focus on Youth from Bihar and Rajasthan

The relationship between intimate partner violence (IPV) and early marriage is explored using the 2005-2006 India National Family Health Survey (NFHS-3). The NFHS-3 collected data from a representative sample of women and men in India with a large enough sample size to have a representative sample at the state level. The focus is on youth from Bihar and Rajasthan, two states with high IPV and early marriage. Multivariate logistic regression analyses demonstrate that women ages 20-24 who married before age eighteen, the legal age at marriage in India, are more likely to have ever experienced IPV in their lifetime and recently experienced IPV (in the last 12 months) than their counterparts who married later. The results were significant in Rajasthan but not in Bihar. To reduce IPV, targeted efforts must be made to decrease the proportion of India’s girls who are married under the legal age of marriage

The direct and indirect effects of community beliefs and attitudes on postpartum contraceptive method choice among young women ages 15–24 in Nigeria

Understanding what factors influence postpartum contraceptive use among young people (ages 15–24 years) is important since this group often has closely spaced and unintended births. Using secondary data gathered for an evaluation of a Bill & Melinda Gates Foundation funded initiative designed to increase modern contraceptive use in select urban areas of Nigeria, we determine the direct and indirect effects of community beliefs and attitudes on adolescent and youth postpartum contraceptive method choice. Our statistical methods control for the endogenous timing of the initiation of sexual activity and the timing and number of births to each respondent by simultaneous estimation of equations for these choices with the choice of postpartum contraceptive method. We find that community beliefs and attitudes have important effects on our primary outcome of postpartum contraceptive use and we quantify the size of both direct and indirect effects on postpartum contraceptive method choice using simulations. The findings from this study can be used to inform programs seeking to increase young women’s postpartum contraceptive use for healthy spacing and timing of births

Exposure to family planning messages and modern contraceptive use among men in urban Kenya, Nigeria, and Senegal: a cross-sectional study

Abstract Background Family planning (FP) researchers and policy makers have often overlooked the importance of involving men in couples’ fertility choices and contraception, despite the fact that male involvement is a vital factor in sexual and reproductive health programming. This study aimed to assess whether men’s exposure to FP demand-generation activities is associated with their reported use of modern contraceptive methods. Methods We used evaluation data from the Measurement, Learning & Evaluation project for the Urban Reproductive Health Initiative (URHI) in select cities of three African countries (Kenya, Nigeria, and Senegal) collected in 2012/2013. A two-stage cluster sampling design was used to select a representative sample of men in the study sites. The sample for this study includes men aged 15–59 years who had no missing data on any of the key variables: 696 men in Kenya, 2311 in Nigeria, and 1613 in Senegal. We conducted descriptive analyses and multivariate logistic regression analyses to assess the associations of interest. All analyses were weighted to account for the study design and non-response rates using Stata version 13. Results The proportion of men who reported use of modern contraceptive methods was 58 % in Kenya, 43 % in Nigeria, and 27 % in Senegal. About 80 % were exposed to at least one URHI demand-generation activity in each country. Certain URHI demand-generation activities were significantly associated with men’s reported use of modern contraception. In Kenya, those who participated in URHI-led community events had four times higher odds of reporting use of modern methods (aOR: 3.70; p < 0.05) while in Senegal, exposure to URHI-television programs (aOR: 1.40; p < 0.05) and having heard a religious leader speak favorably about FP (aOR: 1.72; p < 0.05) were associated with modern contraceptive method use. No such associations were observed in Nigeria. Conclusion Study findings are important for informing future FP program activities that seek to engage men. Program activities should be tailored by geographic context as results from this study indicate city and country-level variations. These types of gender-comprehensive and context-specific programs are likely to be the most successful at reducing unmet need for FP

A Multilevel Logit Estimation of Factors Associated With Modern Contraception in Urban Nigeria

This study aimed to estimate the multilevel determinants of modern contraceptive use among reproductive-age women living in six cities in Nigeria (Abuja, Benin, Ibadan, Ilorin, Kaduna, and Zaria). Data from cross-sectional surveys conducted between 2010 and 2011 were linked to provide information on five hierarchical levels of the Socioecological Framework. Multilevel logit models estimated the odds of modern contraceptive use among 9,473 non-pregnant married/cohabiting women aged 15–49 years living in 488 clusters. About 25 percent of the women reported using modern contraceptive methods at the time of survey. Individual-level factors found to have a positive association with modern contraceptive use were parity, family planning self-efficacy, and partner discussion about fertility desires while perception of negative attitudes from community member about contraceptive use was negatively associated with modern contraceptive use (p < 0.05). At the community level, media exposure to family planning messages and city of residence were significantly associated with modern contraceptive use in the studied sample (p < 0.05). The positive association between parity and modern contraceptive use was modified by the community’s ideal family size. The results of this study support the evidence for multilevel interventions as a way to improve the prevalence of modern contraceptive use in urban Nigeria

Counseling During Maternal and Infant Health Visits and Postpartum Contraceptive Use in Uttar Pradesh, India

Postpartum family planning is a compelling concern of global significance due to its salience to unplanned pregnancies, and to maternal and infant health in developing countries. Yet, women face the highest level of unmet need for contraception in the year following a birth. A cost-effective way to inform women about their risk of becoming pregnant after the birth of a child is to integrate family planning counseling and services with maternal and infant health services