Correlation between an early sexual debut,and reproductive health and behavioral factors: a multinational European study

Objective To investigate whether women who made an early sexual debut differ from those with a later debut regarding genital signs and symptoms.

Methods The study included women who considered themselves gynecologically healthy and who attended 17 family planning centers in 13 European countries for contraceptive advice. There were 629 women who made their sexual debut at the age of 16 years or earlier (study population) and 927 women who had their first sexual intercourse at the age of 19 years or later (comparison group). Genital symptoms and signs, contraceptive use, smoking, and genital hygiene habits and previous genital infections were recorded on a structured patient record form. Detection of Chlamydia trachomatis was made by means of a polymerase chain reaction on first-void urine. The study was made, on average, 7–10 years after the women's sexual debut.

Results The mean age of first intercourse was 15.3 years for the study group versus 20.7 years for the control group (p < 0.001). The study population had significantly more symptoms, such as vaginal discharge and pruritus, and signs, such as abnormal discharge, erythema of the vaginal mucosa and lower genital tract infections, than the comparison group. Twice as many women in the study group were smokers and there was a ten-fold increase among these subjects of using low-pH solutions for genital hygiene. The prevalence of C. trachomatis infection did not differ between the two groups (p = 0.22).

Conclusion Age at first intercourse is not only a predictor of sexual risk behavior, but also a predictor, regarding both signs and symptoms, of future gynecological problems.     

Coerced sexual intercourse within marriage: a clinic-based study of pregnant Palestinian refugees in Lebanon

This study examines the correlates of forced sexual intercourse among pregnant refugee women attending an antenatal clinic in Sidon, Lebanon. A total of 349 pregnant women were interviewed during a clinic visit for a prenatal check-up during the months of June and July 2005. The Abuse Assessment Screen was used to identify cases of abuse. The outcome variable was whether the woman was forced to have sexual intercourse during the past year. One-quarter of women (26.2%) reported having forced sexual intercourse. Associations between forced sexual intercourse and sociodemographic risk factors were assessed using odds ratios from logistic regression models. Low educational levels and reported fear of husband were significant risk factors for sexual abuse, adjusting for other relevant variables. Age, parity, length of marriage, place of residence, undesired pregnancy, gestational age, consanguinity, and physical violence during last year were not associated with forced sexual intercourse.     

Knowledge,attitudes, and practice of abortion among women and doctors in Armenia

Objective?To assess knowledge and attitudes towards abortion among women and obstetricians/gynaecologists in Armenia, in order to facilitate the introduction of medical abortion.

Methods?Ninety-nine doctors and 400 women in three cities in Armenia were purposively selected to participate in face-to-face interviews using structured survey instruments.

Results?Most women knew that abortion is legal under any (31%) or certain (50%) circumstances. The majority of women had heard of medical abortion, but had superficial or incorrect knowledge of the method. Thirty percent of women expressed a preference for medical abortion over surgical abortion. Despite the fact that the medications are not readily available in Armenia, nearly one out of three doctors reported having experience in using misoprostol or mifepristone?+?misoprostol to terminate pregnancies. Doctors not providing medical abortion cited concerns about the method's efficacy and safety, or felt that they did not have enough information. One-third of doctors were very interested in receiving training on medical abortion methods.

Conclusions?Both doctors and women in Armenia are interested in medical abortion as an alternative to surgical abortion. Efforts should focus on informing women about the legality of abortion and the details of the medical abortion procedure, and on training doctors in this new method.     

Protection of sexual and reproductive health rights: Addressing violence against women

Violence against women is recognized as a global public health and human rights problem in need of urgent attention. It affects women's health, including their sexual and reproductive health, and their human rights. While progress has been made in the last 15 years, there is still a long way to go. International human rights law and public health provide tools to governments and non-governmental actors to ensure women a life free from violence and its consequences. Health policies and services need to address violence more systematically and health providers must take action. At a minimum, they should be informed and able to respond appropriately to violence, providing appropriate care and referral to other services. Equally, if not more important, is to provide support to interventions that prevent violence against women from happening in the first place.     

Contraceptive behavior among women after abortion in Nepal

Objective

To investigate the timing of contraceptive use and estimate the discontinuation rates of temporary methods among women after abortion, or a live birth or stillbirth.

Methods

A sample of married women with detailed pregnancy and contraceptive histories was analyzed in a population-based cross-sectional study based on calendar data extracted from the 2011 Nepal Demographic and Health Survey. Kaplan–Meier cumulative and discrete-time hazard models were used to estimate the timing of contraceptive use and discontinuation rates among users of temporary methods.

Results

The final analysis sample included 3190 women. Of 684 women who had had an abortion, 298 (43.6%) had not initiated any contraceptive use in the 12 months afterwards. Women initiated contraceptive use significantly earlier after abortion (hazard ratio [HR] 2.25; 95% CI, 1.96–2.59; P < 0.001). The rate of discontinuation among contraceptive users was significantly higher in the postabortion group (HR 1.32; 95% CI, 1.05–1.65; P < 0.05). Women who were educated, wealthier, had used contraceptives before the index pregnancy, had two sons and had autonomy initiated contraceptive use significantly earlier in the post-abortion period than their counterparts.

Conclusion

Postabortion contraceptive use is low in Nepal. Postabortion family-planning counseling and related services should be strengthened with systematic monitoring and follow-up interventions.     

Urologic complications among women with advanced cervical cancer at a tertiary referral hospital in Uganda

Objective

To determine the prevalence of and factors associated with urologic complications among women with advanced cervical cancer before treatment in Uganda.

Methods

In total, 283 women with histologically confirmed stage IIB–IVB cervical cancer who were admitted to Mulago Hospital over a 6-month period were studied. Abdominopelvic scan was carried out to check for hydronephrosis and hydroureter and to measure the tumor volume. Serum creatinine and urea levels were measured, and the presence of anuria and vesicovaginal fistula (VVF) was ascertained from self-reporting and clinical records.

Results

Urologic complications were present in 138 (48.8%) women. Hydronephrosis, VVF, hydroureter, and anuria were present in 112 (39.6%), 21 (7.4%), 11 (3.9%), and 9 (3.2%) women, respectively; serum creatinine and urea levels were elevated in 48 (17.0%) women. Stage of disease was significantly associated with urologic complications: stage IIIB odds ratio (OR) 3.36 (95% confidence interval [CI], 1.57–7.20); stage IVA OR 17.10 (95% CI, 6.07–48.16); P < 0.001.

Conclusion

There is a high prevalence of urologic complications among women with advanced cervical cancer; these complications are significantly associated with the stage of cervical cancer.     

Posttraumatic stress disorder, depression, and hopelessness in women who are victims of sexual violence

Objective

To evaluate posttraumatic stress disorder (PTSD), depression, and hopelessness in women 1 and 6 months after they experienced sexual violence.

Methods

This prospective study, in which the clinician-administered PTSD scale, the Beck depression inventory, and the Beck hopelessness scale were used, included 67 women at 1 month and 52 women at 6 months after they experienced sexual violence.

Results

Overall, 77.6% of the women were ≤ 24 years of age, and 52% were adolescents; 15% had a history of drug abuse, and 13.5% had a history of previous sexual violence. The aggressor was unknown in 76% of cases, and there was more than 1 aggressor in 9% of cases. In the first month, 43% of the women had moderate or very severe PTSD; 52.2% had moderate or severe depression; and 22.4% had moderate or severe hopelessness, which decreased to 21%, 20% and 10%, respectively, at 6 months. In the first month, severity of PTSD was associated with moderate or severe depression, and at 6 months severity of PTSD was associated with multiple aggressors and previous psychiatric disorders. All scores decreased in the sixth month.

Conclusion

Severe mental health disorders were still present 6 months after women had experienced sexual violence.     

Mental health impacts of reproductive coercion among women in Côte d’Ivoire

Objective

To assess the independent associations of partner-perpetrated reproductive coercion, intimate partner violence (IPV), in-law reproductive coercion, and in-law abuse with recent probable post-traumatic stress disorder (PTSD), and to test their relationship with PTSD symptoms when controlling for the other types of abuse among partnered women in rural Côte d’Ivoire.

Methods

Cross-sectional analyses were conducted using logistic generalized estimating equations, which accounted for village-level clustering. Data were drawn from baseline data from a randomized controlled trial among 24 villages in rural Côte d’Ivoire (n = 953 partnered women). Three adjusted models were used to test associations of reproductive coercion and abuse with probable PTSD.

Results

Partner-perpetrated reproductive coercion was experienced by 176 (18.5%) women. In model 3, which accounted for the co-occurrence of abuses, partner-perpetrated reproductive coercion (odds ratio [OR] 2.3; 95% confidence interval [CI], 1.4–3.9) and partner-perpetrated IPV (OR 1.7; 95% CI, 1.1–2.7) were the most significant predictors of past-week probable PTSD (P < 0.05).

Conclusion

Reproductive coercion may be a significant contributor to poor mental health. The mental health impacts of reproductive coercion and IPV should be considered within psychosocial programming for rural Ivorian communities to address the full range of traumatic experiences that may have been experienced by women.     

Abuse of women and children in a Philippine community.

This retrospective study describes the demographic profiles, types of injuries and characteristics of abusers of 1354 women and children survivors of domestic violence who sought medical care from the obstetrics and gynecology resident and attending staff in the Women and Children Protection Unit in Vicente Sotto Memorial Medical Center from 1 January 1997 to 31 December 1998. Thirty-nine percent of these patients were sexually abused; their peak age was 11-20 years. Almost 75% of sexual abusers were from outside of the household. The highest incidence of physical abuse occurred in ages 26-35 years. Seventy-five percent of this form of abuse was in the home and perpetrated by husbands and live-in partners. Our data add to the expanding literature demonstrating the existence of family violence throughout the world. The role of our Protection Unit in responding to the victims of family violence is in keeping with the responsibilities and the ethical obligations all obstetrician-gynecologists have to the safety, physical and psychological needs of the women they serve.     

Risk factors for induced abortions in St Petersburg,Estonia and Finland. Results from surveys among women of reproductive age

Objectives?To compare the risk factors of self-reported abortion in St Petersburg, Estonia and Finland, which are neighbouring areas having different abortion rates.

Methods?Data from four population-based questionnaire surveys (Finland 1992 and 1999; St Petersburg 2003; Estonia 2004) were used. With the exception of the 1992 Finnish survey (based on interviews) all were postal surveys. There were 1070 respondents in Finland (78% and 52% response rates), 1147 (68%) in St Petersburg, and 5190 (54%) in Estonia.

Results?The prevalence of self-reported abortions was highest among women in St Petersburg and among the two oldest age groups of Russian-speaking Estonians. In all areas women with a history of abortion were more likely to have low education, children, a history of multiple partners and to have had their first intercourse when younger than 18 years. Insufficient use of reliable contraception, both at first and last intercourse, was the only risk factor that was more common in St Petersburg and in Estonia than in Finland. In Estonia, more Estonian than Russian-speaking women used reliable contraceptives.

Conclusion?The comparison of three areas suggests that high abortion rates are related to low contraceptive use and not to other risky sexual behaviour.     

Sexual abuse and reproductive health among unmarried young women seeking abortion in China.

OBJECTIVE: To investigate sexual violence and its impact on reproductive health in unmarried young women seeking abortion in China. METHODS: A total of 2002 participants were surveyed by questionnaire, gynecologic examination, and laboratory tests for sexually transmitted disease (STD). RESULTS: Overall, 14% of participants had experienced sexual violence and 43.4% were diagnosed with STD. Among victims of sexual abuse, 8.6% had their first sexual encounter when they were younger than 18 years; 42.7% had had 2 or more sexual partners; and 21.6% never used contraception. Multivariate analysis revealed that sexual abuse, multiple sexual partners, sexual activity before the age of 18 years, and not using contraception were important indicators of the presence of STD. CONCLUSION: The prevalence of sexual abuse is high in China; and among unmarried young women seeking abortion, those who experience sexual abuse are at significantly increased risk for STD.     

Psychiatric evaluation of women who were assisted at a university referral center in Campinas,Brazil, following an experience of sexual violence

Objective

To present the sociodemographic characteristics and psychiatric symptoms of women who have been raped.

Methods

Between 2006 and 2010, a retrospective study was conducted of 468 women who underwent psychiatric evaluation at a university referral center in Brazil after an experience of sexual violence.

Results

The women had a mean age of 24.1 years; were predominantly white, unmarried, childless, and employed; had 9–11 years of education; and had a religion. Rape was the first sexual intercourse for 124 (26.8%) of 462 for whom data were available; 53 (13.6%) of 389 had a personal history of sexual violence and 29 (8.0%) of 361 had a family history. No psychiatric symptoms were reported in 146 (32.9%) of 444 women, mild/short-term symptoms were reported in 107 (24.1%), and a psychiatric diagnosis was made for 191 (43.0%). Psychiatric comorbidity was seen in 59 (12.6%) women, and 174 (38.0%) received pharmacologic treatment. All follow-up consultations were attended by 215 (45.9%) of 468 women; 166 (35.5%) attended some, and 87 (18.6%) attended only one during the 6-month follow-up period.

Conclusion

The frequency and severity of psychiatric symptoms and mental disorders among women who have been raped highlights the importance of mental health monitoring.     

A qualitative study of condom use among married couples in Kampala, Uganda

Twenty-five years into the HIV/AIDS epidemic, condom use among married/stable couples remains low and under-researched in developing countries, even countries with high HIV prevalence. Introducing condoms into a long-standing relationship, in spite of HIV risk, is likely to be awkward. We conducted a qualitative study in Kampala, Uganda, with 39 couples reporting 100% condom use in the previous three months. The women were recruited from among women in a clinical trial who were using condoms and whose partners also agreed to participate. Twenty-two of the women and six of the men reported having taken the initiative to suggest condom use; the remaining couples disagreed who raised the subject first. Women used insistence, refusal to have sex, persuasion, and condoms for family planning or to protect children, which helped to deflect distrust and get their partner to agree. Some men resisted initially but their reactions were often more positive than expected. Men's reasons for accepting condoms were to please their partner, protect her from HIV, protect their children, protect themselves and, in some cases, continue having other partners. Although condom use is a couple behaviour, an encouraging environment and condom availability are all crucial to increasing condom use by couples in settings like Uganda.     

Child labor and sexual assault among girls in Maiduguri, Nigeria

Objective

To determine the relationship between child labor and sexual assault among girls in Maiduguri, Nigeria.

Methods

Face-to-face interview using a validated questionnaire of a randomly selected sample of employed girls.

Results

Out of 350 girls, 316 were successfully interviewed for a response rate of 90.3%. Mean age of the girls was 14.9 ± 2.3 years and mean workday was 8.5 ± 3.8 hours/day. In 33.4% of cases the girls had no formal education, and 78.5% were not currently going to school. The sexual assault rate was 77.7%, and in 38.6% of cases the assailant was a customer. Sexual assault was more likely in girls who were younger than 12 years (OR 3.54; 95% CI, 1.38-9.14), had no formal education (OR 4.80; 95% CI, 1.63-14.16), worked for more than 8 hours/day (OR 4.43; 95% CI, 1.60-12.30), or had 2 or more jobs (OR 16.09; 95% CI, 1.20-61.70).

Conclusion

To reduce the risk of sexual assault, if girls are employed they should be older, work for limited hours, and not have more than one job at a time.     

Physical and sexual abuse of women before, during, and after pregnancy.

OBJECTIVES: To examine patterns of physical and sexual abuse before, during, and after pregnancy. METHODS: A community-based interview survey of a representative group of women with children aged 6-18 months was carried out between November 1, 2001, and February 28, 2002, in 32 communities of the Tianjing, Liaoning, Henan, and Shannxi provinces. RESULTS: The overall prevalence of physical and sexual abuse (occurring before, during, and after pregnancy) was 11.7%. The prevalence of physical and sexual abuse before pregnancy was 8.5%, compared with 3.6% during pregnancy and 7.4% during an average postpartum period of 11 months. Abuse before pregnancy was a strong indicator of abuse during pregnancy and after delivery, and abuse during a previous period was a strong indicator of subsequent abuse. Most abuse was recurrent and not severe. CONCLUSIONS: Routine screening for abuse in the maternity services setting is advocated to decrease the effect of abuse on women and their children.     

Toxoplasmosis-associated abortion and stillbirth in Tehran,Iran

Objectives: This study was aimed to evaluate the role of toxoplasmosis in etiology of abortion and stillbirth based on molecular and serological techniques.

Material and methods: A total of 110 pregnant women with abortion and stillbirth were enrolled as the case group, and 110 pregnant women with normal delivery were enrolled as the control group. Serological and molecular detections of Toxoplasma gondii were assessed by ELISA and PCR methods.

Results: The seroprevalence of IgG was 25.5% in the case group (26.8% in abortion and 21.4% in stillbirth) and 26.4% in the control group. IgM seropositivity was detected in 2.7% of the case group (3.6% in abortion and 0% in stillbirth) and 0.9% of the control group (p?=?0.37). Toxoplasma gondii DNA was detected in 6.4% of the case group (7.3% in abortion and 3.6% in stillbirth) and 1.8% of the control group by PCR (p?=?0.17). The major risk factor of congenital toxoplasmosis was the history of eating undercooked meat (p?=?0.06).

Conclusion: Results of this study revealed that the rate of PCR positive in women with abortion and stillbirth was 3.7 times higher than that in normal delivery, but the difference was not statistically significant. These findings suggest that toxoplasmosis can be involved in etiology of abortion and stillbirth.