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Sitruk-Ware R.,Rockefeller University | Nath A.,Population Council
Best Practice and Research: Clinical Endocrinology and Metabolism | Year: 2013

Estrogen and progestins have been used by millions of women as effective combined oral contraceptives. Oral contraceptives (OCs) modify surrogate markers such as lipoproteins, insulin response to glucose, and coagulation factors, that have been associated with cardiovascular and venous risk. Ethinyl-Estradiol (EE) exerts a stronger effect that natural estradiol (E2) on hepatic metabolism. New progestins with high specificity have been designed to avoid interaction with other receptors and prevent androgenic, estrogenic or glucocorticoid related side-effects. The risks and benefits of new progestins used in contraception depend upon their molecular structure, the type and dose of associated estrogen, and the delivery route. The lower impact of E2-based combinations on metabolic surrogate markers may result in an improved safety profile, but only clinical outcomes are relevant to assess the risk. Large surveillance studies are warranted to confirm this hypothesis. © 2012 Elsevier Ltd. All rights reserved.


Haberland N.A.,Population Council
International Perspectives on Sexual and Reproductive Health | Year: 2015

CONTEXT: Curriculum-based sexuality and HIV education is a mainstay of interventions to prevent STIs, HIV and unintended pregnancy among young people. Evidence links traditional gender norms, unequal power in sexual relationships and intimate partner violence with negative sexual and reproductive health outcomes. However, little attention has been paid to analyzing whether addressing gender and power in sexuality education curricula is associated with better outcomes. METHODS: To explore whether the inclusion of content on gender and power matters for program efficacy, electronic and hand searches were conducted to identify rigorous sexuality and HIV education evaluations from developed and developing countries published between 1990 and 2012. Intervention and study design characteristics of the included interventions were disaggregated by whether they addressed issues of gender and power. RESULTS: Of the 22 interventions that met the inclusion criteria, 10 addressed gender or power, and 12 did not. The programs that addressed gender or power were five times as likely to be effective as those that did not; fully 80% of them were associated with a significantly lower rate of STIs or unintended pregnancy. In contrast, among the programs that did not address gender or power, only 17% had such an association. CONCLUSIONS: Addressing gender and power should be considered a key characteristic of effective sexuality and HIV education programs. © 2015, Guttmacher Institute. All rights reserved.


Bongaarts J.,Population Council
Seminars in Reproductive Medicine | Year: 2015

Over the past several decades, the world and most countries have undergone unprecedented demographic change. The most obvious example of this change is the rise in human numbers, and there are also important trends in fertility, family structure, mortality, migration, urbanization, and population aging. This paper summarizes past trends and projections in fertility and population. After reaching 2.5 billion in 1950, the world population grew rapidly to 7.2 billion in 2013 and the projections expect this total to be 10.9 billion by 2100. World regions differ widely in their demographic trends, with rapid population growth and high fertility continuing in the poorest countries, particularly in sub-Saharan Africa, while population decline, population aging, and very low fertility are now a key concern in many developed countries. These trends have important implications for human welfare and are of interest to policy makers. The conclusion comments briefly on policy options to address these adverse trends. © 2015 by Thieme Medical Publishers, Inc.


Erulkar A.,Population Council
International Perspectives on Sexual and Reproductive Health | Year: 2013

Context: A considerable proportion of women worldwide are married during childhood. Although many studies have examined early marriage (before age 18), few have compared outcomes or correlates among girls married during different stages of adolescence or have focused on girls married very early (before age 15). Methods: Data from a population-based survey conducted in 2009-2010 in seven Ethiopian regions were used to examine early marriage among 1,671 women aged 20-24. Cross-tabulations and logistic regression were used to compare characteristics and contextual factors among girls married before age 15, at ages 15-17 or at ages 18-19 and to identify factors associated with selected marital outcomes. Results: Seventeen percent of respondents had married before age 15 and 30% had married at ages 15-17. Most of those who married before age 18 had never been to school. Compared with young women who had married at ages 18-19, those married before age 15 were less likely to have known about the marriage beforehand (odds ratio, 0.2) and more likely to have experienced forced first marital sex (3.8). Educational attainment was positively associated with foreknowledge and wantedness of marriage and with high levels of marital discussions about fertility and reproductive health issues. Conclusions: Initiatives addressing the earliest child marriages should focus on girls who have left or never attended school. Given the vulnerability of girls married before age 15, programs should pay special attention to delaying very early marriages.


Haberland N.,Population Council | Rogow D.,Independent Consultant
Journal of Adolescent Health | Year: 2015

The International Conference on Population and Development and related resolutions have repeatedly called on governments to provide adolescents and young people with comprehensive sexuality education (CSE). Drawing from these documents, reviews and meta-analyses of program evaluations, and situation analyses, this article summarizes the elements, effectiveness, quality, and country-level coverage of CSE. Throughout, it highlights the matter of a gender and rights perspective in CSE. It presents the policy and evidence-based rationales for emphasizing gender, power, and rights within programs - including citing an analysis finding that such an approach has a greater likelihood of reducing rates of sexually transmitted infections and unintended pregnancy - and notes a recent shift toward this approach. It discusses the logic of an "empowerment approach to CSE" that seeks to empower young people - especially girls and other marginalized young people - to see themselves and others as equal members in their relationships, able to protect their own health, and as individuals capable of engaging as active participants in society. © 2015 Society for Adolescent Health and Medicine.


Background: A recent observational study among HIV-1 serodiscordant couples (uninfected women living with an infected partner) raised concerns about the safety of injectable contraceptives, especially depot medroxyprogesterone acetate (DMPA). The purpose of this paper is to assess the implications of potentially elevated risk of Human Immunodeficiency Virus (HIV) acquisition with the use of hormonal contraceptives for individual users and public policies. Study Design: Two indicators expressing costs (additional unwanted births and additional maternal deaths) in terms of the same unit of benefit (per 100 HIV infections averted) are estimated by using data on competing risks of unwanted birth and HIV acquisition associated with the use of various contraceptive methods. Elevated HIV acquisition risks associated with hormonal contraception observed in the observational studies of family planning users, sex workers and HIV-1 serodiscordant couples are used. Other relevant data for Kenya, South Africa and Zimbabwe are used to illustrate the potential effect of withdrawal of DMPA at the population level. Results: Both the risks of unwanted birth and HIV acquisition with sterilization, intrauterine devices (IUDs) and implants at the individual level are lower than those with DMPA. A shift from DMPA to an oral contraceptive (OC) or male condom by an individual could result in about 600 and a shift to no method in about 5400 additional unwanted births per 100 HIV infections averted. At the population level, the withdrawal of DMPA from Kenya, for example, could result in 7600 annual additional unwanted births and 40 annual additional maternal deaths per 100 HIV infections averted. Conclusion: Individual DMPA users may be advised to shift to sterilization, IUD or implant depending upon their reproductive needs and circumstances, but not to no method, OC or even condom alone. At the macro level, the decision to withdraw DMPA from family planning programs in sub-Saharan Africa is not warranted. © 2012 Elsevier Inc.


Sabarwal S.,Population Council
International Journal of Gynecology and Obstetrics | Year: 2013

Objective: To estimate the prevalence of sex trafficking as a mode of entry into sex work and to examine associations between sex trafficking and HIV vulnerability, recent violence experience, and symptoms of sexual ill health among young female sex workers (FSWs). Methods: A cross-sectional survey of 1137 FSWS aged 18-25 years residing in Andhra Pradesh, India, was conducted. Results: In total, 574 (50.5%) FSWs entered sex work via trafficking. Trafficked FSWs had an increased risk of experiencing sexual violence (adjusted odds ratio [AOR] 2.09; 95% confidence interval [CI], 1.42-3.06) and physical/sexual violence (AOR 1.93; 95% CI, 1.24-3.01), and reporting more clients (AOR 2.25; 95% CI, 1.56-3.22) and more work days per week (AOR 1.48; 95% CI, 1.09-2.02). Symptoms of sexual ill health were not associated with mode of entry into sex work. Conclusion: There is a high prevalence of entry into sex work via trafficking among young FSWs. A history of sex trafficking is associated with greater risk of recent physical and sexual violence and of HIV. Public health interventions must focus attention on young FSWs. © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.


Ezeh A.C.,African Population and Health Research Center | Bongaarts J.,Population Council | Mberu B.,African Population and Health Research Center
The Lancet | Year: 2012

Rapid population growth is a threat to wellbeing in the poorest countries, whereas very low fertility increasingly threatens the future welfare of many developed countries. The mapping of global trends in population growth from 2005-10 shows four distinct patterns. Most of the poorest countries, especially in sub-Saharan Africa, are characterised by rapid growth of more than 2% per year. Moderate annual growth of 1-2% is concentrated in large countries, such as India and Indonesia, and across north Africa and western Latin America. Whereas most advanced-economy countries and large middle-income countries, such as China and Brazil, are characterised by low or no growth (0-1% per year), most of eastern Europe, Japan, and a few western European countries are characterised by population decline. Countries with rapid growth face adverse social, economic, and environmental pressures, whereas those with low or negative growth face rapid population ageing, unsustainable burdens on public pensions and health-care systems, and slow economic growth. Countries with rapid growth should consider the implementation of voluntary family planning programmes as their main policy option to reduce the high unmet need for contraception, unwanted pregnancies, and probirth reproductive norms. In countries with low or negative growth, policies to address ageing and very low fertility are still evolving. Further research into the potential eff ect of demographic policies on other social systems, social groups, and fertility decisions and trends is therefore recommended.


Despite the increasing number of population-based surveys in sub-Saharan Africa that provide testing and counseling for HIV over the past decade, understanding the nature of nonresponse in these surveys, especially panel HIV surveys, is still limited. This article uses longitudinal HIV data collected from rural Malawi in 2004 and 2006 to examine nonresponse in repeat population-based testing. It shows that nonresponse in repeat testing led to significant bias in the estimates of HIV prevalence and to inconsistent conclusions about the predictors of HIV status. In contrast, previous cross-sectional analyses found that nonresponse does not significantly bias the estimates of HIV prevalence. The difference in conclusions from cross-sectional and longitudinal analyses of nonresponse can be attributed to two factors: the different definitions of what constitutes nonresponse in both contexts, and the risk profiles of the missed populations. In particular, although refusal and temporary absence are the major sources of nonresponse in the cross-sectional contexts, attrition attributable to mortality and out-migration are additional sources of nonresponse in repeat testing. Evidence shows that outmigrants have higher HIV prevalence than nonmigrants, which could account for significant bias in the estimates of prevalence among participants in both tests observed in this study.


Geibel S.,Population Council
Journal of the International AIDS Society | Year: 2013

Previous research on the use of personal lubricants for sexual intercourse is limited and has primarily focused on condom compatibility and breakage, with only recent limited assessment of lubricant safety and possible epidemiologic implications. This article discusses the global evidence of lubricant compatibility with latex condoms and biological safety of lubricants, as well as documentation of lubricant use and current guidelines for HIV prevention programming in Africa. Data on lubricant compatibility with condoms are less available than commonly realized, and many lubricant products may not have been thoroughly tested for safety due to flexible regulatory environments. Recent laboratory and study findings from microbicides research also suggest that some water-based lubricants may have safety issues. Some African populations are using several types of lubricants, especially oil-based petroleum jellies, and receive little evidence-based guidance. More research is needed from the medical community to guide prevention programming. © 2013 Geibel S; licensee International AIDS Society.

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