1.   Peer Reviewed Title: Trends in primary and secondary abstinence among Kenyan youth. Author: Chiao C; Mishra V Source: AIDS Care. 2009 Jul;Calverton, Maryland, Macro International, Demographic and Health Research Division, MEASURE DHS, 2007 Nov. 21(7):881-892. 15 p. (DHS Working Papers No. 36USAID Contract No. GPO-C-00-03-00002-00) Abstract: The authors used data from Kenya Demographic and Health Surveys in 1993, 1998, and 2003 to examine 10-year trends in primary and secondary abstinence among never-married youth ages 15–24 and to explore the role of HIV prevention knowledge, schooling, and contextual factors in affecting their abstinence behaviors. Their analysis shows that both primary and secondary abstinence levels have risen in the past 10 years, with the abstinence levels higher among females than among males. Logistic regression models indicate that knowledge that abstinence can prevent HIV infection was positively associated with the likelihood of practicing abstinence. However, knowledge that condom use can prevent HIV infection was associated with lower abstinence practice. In-school youth were more likely to abstain from sex than those working. Effects of the contextual variables were only significant on the likelihood of primary abstinence among female youth. Language: English Keywords: KENYA | TECHNICAL REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | DATA ANALYSIS | YOUTH | ADOLESCENTS | STUDENTS | PRIMARY SCHOOLS | SECONDARY SCHOOLS | ABSTINENCE | HIV INFECTIONS | TRANSMISSION | HIV PREVENTION | KNOWLEDGE | CONDOM USE | BEHAVIOR | SEX EDUCATION | PROGRAM EFFECTIVENESS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Research Methodology | Age Factors | Population Characteristics | Education | Schools | Family Planning, Behavioral Methods | Family Planning | Viral Diseases | Diseases | Infections | Sociocultural Factors | Risk Reduction Behavior | Program Evaluation | Programs | Organization and Administration Document Number: 322987 |
| 2. Peer Reviewed Title: Gender factors associated with sexual abstinent behaviour of rural South African high school going youth in KwaZulu-Natal, South Africa. Author: Dlamini S; Taylor M; Mkhize N; Huver R; Sathiparsad R; de Vries H; Naidoo K; Jinabhai C Source: Health Education Research. 2009 Jun;24(3):450-60. Abstract: The cross-sectional study investigated South African rural high school learners' choice of sexual abstinence in order to be able to develop tailored health education messages. All Grade 9 learners from one class at each of 10 randomly selected rural high schools participated. The Integrated Model for Motivational and Behavioural Change was used to elicit attitudes, social influences, self-efficacy and intentions towards sexual abstinence. Chi-square and t-tests were used for bivariate analysis. In total, 454 learners, mean age 16.7 years (standard deviation 1.41) range 14-20 years, participated, of whom 246 (54.2%) were female. When comparing learners reporting abstinence (n = 252) with those not abstinent (n = 202), abstinent learners were significantly more often females (P < 0.005), younger (16.5 years versus 17.1 years, P < 0.005) and drank less alcohol (P < 0.005). Abstaining girls believed that their friends and parents think that they should abstain from sex, that their friends abstained from sex and that abstinence helped them to mature emotionally. Abstinent boys expressed intentions to abstain from sex until marriage. Targeted intervention research is required to encourage South African rural high school learners to delay their sexual initiation to reduce their risk of human immunodeficiency virus infection. Different abstinent messages are needed for boys and girls to address the different patterns of behaviour observed. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | SAMPLING STUDIES | RURAL POPULATION | STUDENTS | ABSTINENCE | PREVALENCE | ATTITUDES | SEX FACTORS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Education | Family Planning, Behavioral Methods | Family Planning | Measurement | Psychological Factors | Behavior Document Number: 341430 |
| 3. Peer Reviewed Title: Cohort comparison of two fertility awareness methods of family planning. Author: Fehring RJ; Schneider M; Barron ML; Raviele K Source: Journal of Reproductive Medicine. 2009 Mar;54(3):165-70. Abstract: OBJECTIVE: To determine if an electronic hormonal fertility monitor aided method (EHFM) of family planning is more effective than a cervical mucus only method (CMM) in helping couples to avoid pregnancy. STUDY DESIGN: Six hundred twenty-eight women were taught how to avoid pregnancy with either the EHFM (n=313) or the CMM (n = 315). Both methods involved standardized group teaching and individual follow-up. All pregnancies were reviewed and classified by health professionals. Correct use and total unintended pregnancy rates over 12 months of use were determined by survival analysis. Comparisons of unintended pregnancies between the 2 methods were made by use of the Fisher exact test. RESULTS: There were a total of 28 unintended pregnancies with the EFHM and 41 with the CMM. The 12-month correct use pregnancy rate of the monitor-aided method was 2.0%, and the total pregnancy rate was 12.0%. In comparison, the 12-month correct use pregnancy rate of the CMM was 3.0%, and the total pregnancy rate was 23.0%. There was a significant difference in total pregnancies between the 2 groups (p<0.05). CONCLUSION: EFHM is more effective than CMM. Further research is needed to verify the results. Language: English Keywords: DEVELOPING COUNTRIES | UNITED STATES OF AMERICA | RESEARCH REPORT | FAMILY PLANNING | FERTILITY | NATURAL FAMILY PLANNING | PREGNANCY, UNPLANNED | PREVENTION AND CONTROL | PROGRAM EFFECTIVENESS | Developed Countries | North America | Americas | Population Dynamics | Demographic Factors | Population | Family Planning, Behavioral Methods | Reproductive Behavior | Diseases | Program Evaluation | Programs | Organization and Administration Document Number: 331019 |
| 4. Peer Reviewed Title: Adapting a multifaceted U.S. HIV prevention education program for girls in Ghana. Author: Fiscian VS; Obeng EK; Goldstein K; Shea JA; Turner BJ Source: AIDS Education and Prevention. 2009 Feb;21(1):67-79. Abstract: We adapted a U.S. HIV prevention program to address knowledge gaps and cultural pressures that increase the risk of infection in adolescent Ghanaian girls. The theory-based nine-module HIV prevention program combines didactics and games, an interactive computer program about sugar daddies, and tie-and-dye training to demonstrate an economic alternative to transactional sex. The abstinence-based study was conducted in a church-affiliated junior secondary school in Nsawam, Ghana. Of 61 subjects aged 10-14 in the prevention program, over two thirds were very worried about becoming HIV infected. A pre-post evaluation of the intervention showed significant gains in three domains: HIV knowledge (p = .001) and self efficacy to discuss HIV and sex with men (p < .001) and with boys (p < .001). Responses to items about social norms of HIV risk behavior were also somewhat improved (p = .09). Subjects rated most program features highly. Although short-term knowledge and self-efficacy to address HIV improved significantly, longer term research is needed to address cultural and economic factors placing young women at risk of HIV infection. Language: English Keywords: UNITED STATES OF AMERICA | GHANA | EVALUATION REPORT | THEORETICAL MODELS | ADOLESCENTS, FEMALE | SUGAR DADDIES | SEX WORKERS | FAITH-BASED ORGANIZATION | HEALTH EDUCATION | SEX EDUCATION | HIV PREVENTION | CULTURE | COMPUTER PROGRAMS AND PROGRAMMING | ABSTINENCE | BEHAVIOR CHANGE COMMUNICATION | Developed Countries | North America | Americas | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Evaluation | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Sex Behavior | Behavior | Organizations | Political Factors | Sociocultural Factors | Education | HIV Infections | Viral Diseases | Diseases | Information Processing | Information | Family Planning, Behavioral Methods | Family Planning | Communication Programs | Communication | Behavior Change Document Number: 331081 |
| 5. Title: Traditional postpartum practices of women and infants and the factors influencing such practices in South Eastern Turkey. Author: Geckil E; Sahin T; Ege E Source: Midwifery. 2009 Feb;25(1):62-71. Abstract: OBJECTIVE: to gain an understanding of traditional postpartum practices for women and babies, and to investigate the factors influencing such practices. DESIGN: descriptive study. SETTING: Maternity and Children's Hospital in Adiyaman city, Turkey. PARTICIPANTS: 273 women who gave birth at the Maternity and Children's Hospital in Adiyaman city from March to June 2004. FINDINGS: more than half of the 273 women (55.7%) were aged between 25 and 32 years (mean 27.85, standard deviation [SD] 5.45). A total of 22.3% of women were illiterate, and most were unemployed. The most popular practices among new mothers were eating a kind of dessert, called 'Bulamac' (82.8%). A number of women (69.6%) drank a mixture of grape molasses and butter, 64.5% had their abdomen tightly wrapped, 62.6% were not left alone at home, and more than half of the women (57.9%) avoided sexual intercourse for 40 days after giving birth. Nearly, half of the women (45.4%) fed their babies with water containing sugar just after the birth, and 77.1% of women kept their babies' umbilical cord in a special place. Afterwards, the mothers threw the cords into a river or they buried them in the grounds of a mosque or a school. Most of the mothers (89%) reported that they covered their babies with a yellow cloth in order to protect them from jaundice. A relationship between traditional postpartum practices and demographic characteristics of women was observed. The women's mothers and mothers-in-law (66.7%) usually encouraged such practices. KEY CONCLUSIONS: postpartum care of women and their babies are important cultural practices. Some of these practices may have harmful effects on women and their babies. IMPLICATIONS FOR PRACTICE: it is important to gain an understanding of cultural beliefs and traditional practices relating to the postpartum care of women and their babies. Midwives and nurses should discuss these findings and their implications when they educate new mothers and their families about contemporary methods of postnatal maternal and infant care. Language: English Keywords: TURKEY | RESEARCH REPORT | KAP SURVEYS | POSTPARTUM WOMEN | WOMEN IN DEVELOPMENT | INFANT | POSTPARTUM | DIET | MATERNAL NUTRITION | BEHAVIOR | POSTPARTUM ABSTINENCE | TIME FACTORS | SUPPLEMENTARY FEEDING | TRADITIONAL HEALTH PRACTICES | DEMOGRAPHIC FACTORS | Europe, Southeastern | Europe | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Puerperium | Reproduction | Economic Development | Economic Factors | Youth | Age Factors | Population Characteristics | Population | Nutrition | Health | Abstinence | Family Planning, Behavioral Methods | Family Planning | Population Dynamics | Infant Nutrition | Culture | Sociocultural Factors Document Number: 331293 |
| 6. Title: Postpartum contraception. Author: Hughes H Source: Journal of Family Health Care. 2009;19(1):9-10, 12. Abstract: Mothers and their partners have a range of options to consider for use postnatally. Clinicians may help couples to make a decision by describing the options available and discussing the advantages and disadvantages of each, taking into account the particular demands of the post-delivery period. The options they may consider include: lactational amenorrhoea, combined oral contraception, the progesterone-only pill, injectable methods, implants, intrauterine devices and systems, barrier methods and sterilisation. Emergency contraception may also be needed. Language: English Keywords: UNITED KINGDOM | SUMMARY REPORT | MOTHERS | POSTPARTUM | ANTENATAL CARE | CONTRACEPTION | BREASTFEEDING | LACTATIONAL AMENORRHEA METHOD | CONTRACEPTIVE USAGE | ORAL CONTRACEPTIVES, COMBINED | BARRIER METHODS | EMERGENCY CONTRACEPTION | Developed Countries | Europe, Western | Europe | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Puerperium | Reproduction | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Family Planning | Infant Nutrition | Nutrition | Family Planning, Behavioral Methods | Oral Contraceptives | Contraceptive Methods Document Number: 331020 |
| 7. Peer Reviewed Title: Contraceptive use in women enrolled into preventive HIV vaccine trials: experience from a phase I/II trial in East Africa. Author: Kibuuka H; Guwatudde D; Kimutai R; Maganga L; Maboko L; Watyema C; Sawe F; Shaffer D; Matsiko D; Millard M; Michael N; Wabwire-Mangen F; Robb M Source: PLoS One. 2009;4(4):e5164. Abstract: BACKGROUND: HIV vaccine trials generally require that pregnant women are excluded from participation, and contraceptive methods must be used to prevent pregnancy during the trial. However, access to quality services and misconceptions associated with contraceptive methods may impact on their effective use in developing countries. We describe the pattern of contraceptive use in a multi-site phase I/IIa HIV Vaccine trial in East Africa (Uganda, Kenya and Tanzania) and factors that may have influenced their use during the trial. METHODS: Pregnancy prevention counseling was provided to female participants during informed consent process and at each study visit. Participants' methods of contraception used were documented. Methods of contraceptives were provided on site. Pregnancy testing was done at designated visits during the trial. Obstacles to contraceptive use were identified and addressed at each visit. RESULTS: Overall, 103 (31.8%) of a total of 324 enrolled volunteers were females. Female participants were generally young with a mean age of 29(+/-7.2), married (49.5%) and had less than high school education (62.1%). Hormonal contraceptives were the most common method of contraception (58.3%) followed by condom use (22.3%). The distribution of methods of contraception among the three sites was similar except for more condom use and less abstinence in Uganda. The majority of women (85.4%) reported to contraceptive use prior to screening. The reasons for not using contraception included access to quality services, insufficient knowledge of certain methods, and misconceptions. CONCLUSION: Although hormonal contraceptives were frequently used by females participating in the vaccine trial, misconceptions and their incorrect use might have led to inconsistent use resulting in undesired pregnancies. The study underscores the need for an integrated approach to pregnancy prevention counseling during HIV vaccine trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT00123968. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | CLINICAL TRIALS | CONTRACEPTIVE PREVALENCE SURVEYS | WOMEN IN DEVELOPMENT | VACCINES | CONTRACEPTIVE USAGE | HIV PREVENTION | CONTRACEPTIVE AGENTS, FEMALE | CONDOM USE | CONTRACEPTIVE PREVALENCE | ABSTINENCE | KNOWLEDGE | PROGRAM ACCESSIBILITY | Africa | Developing Countries | Clinical Research | Research Methodology | Family Planning Surveys | Family Planning | Economic Development | Economic Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraception | HIV Infections | Viral Diseases | Diseases | Contraceptive Agents | Risk Reduction Behavior | Behavior | Family Planning, Behavioral Methods | Sociocultural Factors | Program Evaluation | Programs | Organization and Administration Document Number: 330944 |
| 8. Title: High contraceptive failure rate of rhythm method: Possible involvement of pheromones [letter] Author: Kumar RS; Narayanan SN; Paval J Source: Medical Hypotheses. 2009 Jun 2; Abstract: The rhythm method of birth control is a type of natural family planning and one of the practiced methods of contraception used by many couples through out the world. Couples who opt for contraception abstain from sex during the fertile period of women. The principle of this method is based on the knowledge of the life span of sperm, ovum and the time of ovulation. Though the approximate time of ovulation can be calculated based on the duration of women's last menstrual cycle, it is still subjected to individual variations. Hence the failure rates reported on this contraceptive method is comparatively higher than other methods available. Pheromones are airborne chemical signals released by an organism into the environment which can affect the physiological and behavioral responses of other organisms of the same species. Researchers have identified the presence of pheromones in human sweat, urine and mucous secretions from the genitals. McClintock effect is a classical example which once again proves the presence of human pheromones and its influence. Olfactory mucosa is considered to be the major receptive area through which pheromones mediates their actions in humans. Altered behavioral responses were studied in women who are exposed to male pheromones. Pheromones also have strong influence in the modulation of ovulation in women. Considering the above findings, we hypothesize that the presence of male pheromones, which will be released from the bodily secretions of male partner at the time of sexual intercourse might be a cause for reducing the ovulation time in the female partner their by causing an early ovulation in her. This might result in high chances of fertilization. This pheromone interplay which alters the ovulation time in females could be one of the possible reasons of high failure rate observed in rhythm method of contraception. Just by knowing the time of ovulation, it may not be sufficient enough to prevent pregnancy. It must be always coupled with other tests for the detection of ovulation. How much or to what extend pheromones influence the human nervous system functioning is of considerable interest. (full-text) Language: English Keywords: INDIA | CRITIQUE | COUPLES | RHYTHM METHOD, CALENDAR | CONTRACEPTION FAILURE | Asia, Southern | Asia | Developing Countries | Family Characteristics | Family and Household | Sociocultural Factors | Family Planning, Behavioral Methods | Family Planning | Contraceptive Usage | Contraception Document Number: 341566 |
| 9. Title: Update in adolescent contraception. Author: Lara-Torre E Source: Obstetrics and Gynecology Clinics of North America. 2009 Mar;36(1):119-28. Abstract: Pregnancy rates in the United States seem to have stabilized in the past decade but continue to be higher than those in other industrialized nations. Although abstinence and barrier methods are available and efficient in preventing pregnancy, a comprehensive approach is a better choice when counseling patients on available options. The new approach to old contraceptive methods provides new alternatives to adolescents seeking safe and reliable methods. The availability and proved safety with longterm reversible contraceptive methods, such as the intrauterine system and subdermal implant, may allow adolescents to make better choices in preventing pregnancy. Future efforts in research should concentrate on finding the reasons why adolescents are at increased risk for unplanned pregnancy and solutions for this problem. Future contraceptive technology continues to focus on safety and convenience to facilitate the use of contraceptives in adolescents. Language: English Keywords: UNITED STATES OF AMERICA | CRITIQUE | KAP SURVEYS | ADOLESCENTS | SEX BEHAVIOR | RISK BEHAVIOR | CONTRACEPTIVE USAGE | ABSTINENCE | BARRIER METHODS | ORAL CONTRACEPTIVES, COMBINED | CONTRACEPTIVE METHODS | ORAL CONTRACEPTIVES | CONTRACEPTIVE AGENTS, PROGESTIN | EMERGENCY CONTRACEPTION | IUD | Developed Countries | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | Contraception | Family Planning | Family Planning, Behavioral Methods | Contraceptive Agents, Female | Contraceptive Agents Document Number: 330954 |
| 10. Peer Reviewed Title: Kenyan in-School Youths' Level of Understanding of Abstinence, Being Faithful, and Consistent Condom Use Terms: Implications for HIV-Prevention Programs. Author: Lillie T; Pulerwitz J; Curbow B Source: Journal of Health Communication. 2009 Apr-May;14(3):276-92. Abstract: Kenyan in-school youth ages 13-19 years (N = 1,375) were surveyed before an HIV-prevention intervention was implemented. As part of the survey, students wrote their definitions of the terms "abstinence," "being faithful," and "consistent condom use." These definitions were qualitatively analyzed by determining recurrent themes, developing a codebook, and having two coders code the responses. The entire definition was assigned an overall code of fully comprehended, partly comprehended, did not comprehend, or no response in comparison to the conventional definition of the term. Overall, 48% fully comprehended abstinence, 20% fully comprehended being faithful, and 7% fully comprehended consistent condom use. Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | ADOLESCENTS | STUDENTS | ABSTINENCE, BE FAITHFUL, CONDOM USE | HIV PREVENTION | KNOWLEDGE | ABSTINENCE | CONDOM USE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Education | Sex Behavior | Behavior | HIV Infections | Viral Diseases | Diseases | Sociocultural Factors | Family Planning, Behavioral Methods | Family Planning | Risk Reduction Behavior Document Number: 341107 |
| 11. Peer Reviewed Title: Emerging discourse: Islamic teaching in HIV prevention in Kenya. Author: Maulana AO; Krumeich A; Van Den Borne B Source: Culture, Health and Sexuality. 2009 May 12;:1. Abstract: Islamic values portraying sex outside of marriage as sinful are often believed to contribute to HIV transmission as they reject safe-sex practices. Moreover, stigma associated with sinful behaviour is frequently assumed to interfere with access to care for those infected. In contrast, adherence to religious values such as abstinence is viewed as an explanation for the relatively low incidence of HIV infection in Islamic populations. Inspired by this debate, a study was conducted into the possibilities of using Islamic texts as a starting point for health promotion addressing HIV infection and HIV/AIDS-related stigma in Lamu, a Muslim community in Kenya. The study also explored the potential role of Lamu's Islamic leaders in the delivery of that health promotion. In collaboration with Islamic leaders, texts were identified that applied to sexual conduct, health, stigma and the responsibilities of Islamic leaders towards their congregations. In spite of the association of HIV with improper sexual behaviour, Islamic texts offer a starting point for tackling HIV transmission and HIV/AIDS-related stigma. Under particular conditions, the identified Islamic texts may even justify the promotion of safer-sex methods, including condom use. Language: English Keywords: KENYA | RESEARCH REPORT | EVALUATION | COMMUNITY | HIV PREVENTION | ISLAM | EXTRAMARITAL SEX BEHAVIOR | STIGMA | UTILIZATION OF HEALTH CARE | VALUE ORIENTATION | ABSTINENCE | LEADERSHIP | SEX BEHAVIOR | RISK BEHAVIOR | SAFER SEX | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Residence Characteristics | Population Distribution | Geographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Religion | Sociocultural Factors | Behavior | Social Problems | Health Services | Delivery of Health Care | Health | Psychological Factors | Family Planning, Behavioral Methods | Family Planning | Organization and Administration Document Number: 341496 |
| 12. Title: The role of sexually abstained groups in two-sex demographic and epidemic logistic models with non-linear mortality. Author: Maxin D; Milner FA Source: Journal of Theoretical Biology. 2009 Jun 7;258(3):389-402. Abstract: We describe several gender structured population models governed by logistic growth with non-linear death rate. We extend these models to include groups of people isolated from sexual activity and individuals exposed to a mild and long-lasting sexually transmitted disease, i.e. without disease-induced mortality and recovery. The transmission of the disease is modeled through formation/separation of heterosexual couples assuming that one infected individual automatically infects his/her partner. We are interested in how the non-reproductive class may change the demographic tendencies in the general population and whether they can curb the growth of the infected group while keeping the healthy one at acceptable levels. A comparison of the equilibrium total population size in the presence and the absence of the isolated class is also provided. Language: English Keywords: GLOBAL | THEORETICAL STUDIES | MATHEMATICAL MODEL | EPIDEMIOLOGY | SEXUALLY TRANSMITTED DISEASES | TRANSMISSION | ABSTINENCE | REPRODUCTIVE BEHAVIOR | MARRIAGE | POPULATION DYNAMICS | Studies | Research Methodology | Theoretical Models | Public Health | Health | Reproductive Tract Infections | Infections | Diseases | Family Planning, Behavioral Methods | Family Planning | Fertility | Demographic Factors | Population | Nuptiality Document Number: 342385 |
| 13. Title: Correlates of the intention to remain sexually inactive among male adolescents in an Islamic country: case of the Republic of Iran. Author: Mohtasham G; Shamsaddin N; Bazargan M; Anosheravan K; Elaheh M; Fazlolah G Source: Journal of School Health. 2009 Mar;79(3):123-9. Abstract: BACKGROUND: There are very few studies that have examined sexual intentions and behaviors of adolescents in Islamic countries. This study employs the Health Belief Model to assess the correlates of the intention to remain sexually inactive among male adolescents in the Republic of Iran. METHODS: This cross-sectional study was performed with a sample of 314 adolescents recruited from 3 high schools from Tehran, Iran. RESULTS: Fifty-seven percent of this sample planned to remain abstinent until marriage. Another 23% rejected the notion of remaining abstinent and 20% were uncertain. Multinomial logistic regression revealed that students whose mothers were employed and who received a higher daily allowance were more likely to report that they would not remain abstinent. No significant independent relationship between human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome-related knowledge and an intention to remain abstinent was detected. However, consistent with previous studies conducted in Asia, Africa, and in Western countries, we documented that (1) perceived subjective norms, (2) self-efficacy, (3) and perceived susceptibility to contracting the HIV virus all are associated with the intention to remain sexually inactive among adolescents. CONCLUSIONS: It seems abstinence until marriage is more likely to be practiced in traditional families. However, Iranian society is changing rapidly and traditional family structures, values, and norms may not sufficiently protect adolescents from HIV infection. The data from this study support previous studies conducted in Western countries, which found that intervention programs that focus on knowledge alone are ineffective in their ability to alter adolescents' intentions to postpone sexual activity. Language: English Keywords: IRAN | RESEARCH REPORT | KAP SURVEYS | THEORETICAL MODELS | CROSS SECTIONAL ANALYSIS | MULTIVARIATE ANALYSIS | ADOLESCENTS, MALE | STUDENTS | ABSTINENCE | ISLAM | SECONDARY SCHOOLS | PREVALENCE | INCOME | EMPLOYMENT | VALUE ORIENTATION | Middle East | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Education | Family Planning, Behavioral Methods | Family Planning | Religion | Sociocultural Factors | Schools | Measurement | Socioeconomic Factors | Economic Factors | Macroeconomic Factors | Psychological Factors | Behavior Document Number: 341162 |
| 14. Title: Gender differences in intention to remain a virgin until marriage among school pupils in rural northern Tanzania. Author: Njau B; Mtweve S; Manongi R; Jalipa H Source: African Journal of AIDS Research. 2009;8(2):157-166. Abstract: This study was conducted in 10 districts in northern Tanzania in July 2005. Out of 65 villages, four were randomly selected. In total, 953 primary school pupils, ages 10 to 14 years, participated in an interview and questionnaire: about 54% were girls and 41% were ages 12 to 13. Thirty-four percent of boys and 28.5% of girls said they had the intention to remain a virgin until marriage. Among the male respondents, having the intention to remain a virgin until marriage was associated with sharing a bedroom with a brother under age 18 years and with saying that girls have the right to say no to sex. Among the female respondents, having the intention to remain a virgin until marriage was associated with living with both parents and saying that they had the confidence to refuse sex with someone who has authority or power. Language: English Keywords: TANZANIA | RURAL AREAS | RESEARCH REPORT | SAMPLING STUDIES | STUDENTS | ABSTINENCE | VIRGINITY | ATTITUDES | SEX FACTORS | PRIMARY SCHOOLS | INTERVIEWS | LIVING ARRANGEMENTS | PSYCHOSOCIAL FACTORS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Geographic Factors | Population | Studies | Research Methodology | Education | Family Planning, Behavioral Methods | Family Planning | Sex Behavior | Behavior | Psychological Factors | Population Characteristics | Demographic Factors | Schools | Data Collection | Residence Characteristics | Population Distribution Document Number: 339890 |
| 15. Peer Reviewed Title: "If you don't abstain, you will die of AIDS": AIDS education in Kenyan public schools. Author: Njue C; Nzioka C; Ahlberg BM; Pertet AM; Voeten HA Source: AIDS Education and Prevention. 2009 Apr;21(2):169-79. Abstract: This article explores the constraints of implementing AIDS education in public schools in Kenya. The authors conducted 60 interviews with teachers and 60 focus group discussions with students in 21 primary and nine secondary schools. System and school-level constraints included lack of time in the curriculum, limited reach of secondary-school students (because AIDS education is embedded in biology, which is not compulsory), and disapproval of openness about sex and condoms by the Ministry of Education and parents. Alternative strategies to teach about AIDS had their own constraints. Teachers lacked training and support and felt uncomfortable with the topic. They were not used to interactive teaching methods and sometimes breached confidentiality. Teachers' negative attitudes constrained students from seeking information. The authors conclude that training interventions should be provided to teachers to increase their self-confidence, foster more positive attitudes, and stimulate interactive teaching methods. The Ministry of Education needs to have a clear policy toward the promotion of condoms. Language: English Keywords: KENYA | RESEARCH REPORT | TEACHERS | STUDENTS | HEALTH EDUCATION | AIDS PREVENTION | ATTITUDES | ABSTINENCE | CURRICULUM | PRIMARY SCHOOLS | SECONDARY SCHOOLS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Education | AIDS | HIV Infections | Viral Diseases | Diseases | Psychological Factors | Behavior | Family Planning, Behavioral Methods | Family Planning | Schools Document Number: 341679 |
| 16. Title: Introducing a natural family planning method in Albania. Author: Ram S; Doracaj D Source: [Tirana], Albania, Macro International, [2009]. [8] p. Abstract: The Albanian Child Survival Program (ACSP) worked to increase contraception use in particular. Their network facilitated women's family planning support groups, offered household-level counseling, and referred women for MOH-approved contraceptives either at the nearest commune-level health center or in their own village if it contained a pilot delivery point. The project promoted all MOH-approved methods: oral contraceptives, condoms, injectables, the IUD, and natural contraception, including the lactational amenorrhea method. Included in the category of natural contraception -- and the topic of the present case study -- was the Standard Days Method (SDM). The ACSP introduced this method to Albania in 2006. SDM is a fertility awareness method that offers couples an accessible, inexpensive, and effective family planning option. Researchers at the Institute of Reproductive Health at Georgetown University School of Medicine developed the method. SDM is more than 95 percent effective with correct use, and more than 88 percent effective with typical use among women who reported regular cycles of 26 to 32 days. SDM is especially attractive to couples who fear the side effects of other modern methods and/or in cultures where barrier and hormonal methods are viewed negatively and have common reproductive health goals. As such, SDM appeared ideally suited to the Albanian context. (Excerpt) Language: English Keywords: ALBANIA | RESEARCH REPORT | CASE STUDIES | FAMILY PLANNING ACCEPTORS, NEW | FAMILY PLANNING PERSONNEL | NATURAL FAMILY PLANNING | FAMILY PLANNING TRAINING | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTION CONTINUATION | CONTRACEPTION TERMINATION | CONTRACEPTIVE METHOD SWITCHING | CONDOM USE | Developing Countries | Europe, Southeastern | Europe | Studies | Research Methodology | Family Planning Acceptors | Family Planning Programs | Family Planning | Family Planning, Behavioral Methods | Training Programs | Education | Contraceptive Usage | Contraception | Risk Reduction Behavior | Behavior Document Number: 331622 |
| 17. Title: [HIV infection prophylaxis in Uganda] Zapobieganie zakazeniom HIV w Ugandzie. Author: Rogowska-Szadkowska D Source: Przeglad Epidemiologiczny. 2009;63(1):45-8. Abstract: Uganda is one of the few countries where rates of HIV infection decreased, from about 18 percent in the early 1990s to about five percent in 2001. Although at the end of 2005, UNAIDS estimated that 6.7 percent of adults were HIV-infected, in recent years the number of infections has started to rise again. Uganda receives funds from the Unites States President's Emergency Plan for AIDS Relief (PEPFAR), which promotes the ABC approach focusing on sexual abstinence. Many experts argue that by emphasizing abstinence over condom use, the approach leaves women at risk of infection, because currently in Uganda marital sex continues to pose a particular risk for women. Language: Polish Keywords: UGANDA | RESEARCH REPORT | HIV INFECTIONS | AIDS PREVENTION | ABSTINENCE | RISK FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Viral Diseases | Diseases | AIDS | Family Planning, Behavioral Methods | Family Planning | Health Document Number: 341922 |
| 18. Peer Reviewed Title: Patient teenagers? A comparison of the sexual behavior of virginity pledgers and matched nonpledgers. Author: Rosenbaum JE Source: Pediatrics. 2009 Jan;123(1):e110-e120. Abstract: The US government spends more than $200 million annually on abstinencepromotion programs, including virginity pledges. This study compares the sexual activity of adolescent virginity pledgers with matched nonpledgers by using more robust methods than past research. The subjects for this study were National Longitudinal Study of Adolescent Health respondents, a nationally representative sample of middle and high school students who, when surveyed in 1995, had never had sex or taken a virginity pledge and who were >15 years of age (n = 3440). Adolescents who reported taking a virginity pledge on the 1996 survey (n = 289) were matched with nonpledgers (n = 645) by using exact and nearest-neighbor matching within propensity score calipers on factors including prepledge religiosity and attitudes toward sex and birth control. Pledgers and matched nonpledgers were compared 5 years after the pledge on self-reported sexual behaviors and positive test results for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, and safe sex outside of marriage by use of birth control and condoms in the past year and at last sex. Five years after the pledge, 82% of pledgers denied having ever pledged. Pledgers and matched nonpledgers did not differ in premarital sex, sexually transmitted diseases, and anal and oral sex variables. Pledgers had 0.1 fewer past-year partners but did not differ in lifetime sexual partners and age of first sex. Fewer pledgers than matched nonpledgers used birth control and condoms in the past year and birth control at last sex. The sexual behavior of virginity pledgers does not differ from that of closely matched nonpledgers, and pledgers are less likely to protect themselves from pregnancy and disease before marriage. Virginity pledges may not affect sexual behavior but may decrease the likelihood of taking precautions during sex. Clinicians should provide birth control information to all adolescents, especially virginity pledgers. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | KAP SURVEYS | HEALTH SURVEYS | COMPARATIVE STUDIES | ADOLESCENTS | VIRGINITY | ABSTINENCE | ATTITUDES | RELIGION | CONTRACEPTION | SEX BEHAVIOR | RISK BEHAVIOR | SEXUALLY TRANSMITTED DISEASES | EXTRAMARITAL SEX BEHAVIOR | Developed Countries | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | Family Planning, Behavioral Methods | Family Planning | Psychological Factors | Sociocultural Factors | Reproductive Tract Infections | Infections | Diseases Document Number: 328034 |
| 19. Peer Reviewed Title: Prevalence, correlates, and sexually transmitted infection risk related to coitus interruptus among African-American adolescents. Author: Sznitman SR; Romer D; Brown LK; DiClemente RJ; Valois RF; Vanable PA; Carey MP; Stanton B Source: Sexually Transmitted Diseases. 2009 Apr;36(4):218-20. Abstract: "Coitus interruptus" or withdrawal that involves the male partner "pulling out" before ejaculation, has received relatively little research attention, particularly in adolescents. The limited data that exist suggest that it is practiced among adolescents, yet its prevalence remains unclear. In a research trial developed to test the efficacy of a sexually transmitted infection (STI)/HIV prevention program among black adolescents, we were surprised to see extensive use of withdrawal (60% prevalence). Because black adolescents are disproportionately affected by the intersecting epidemics of HIV and other STIs, the practice of withdrawal may pose a particular risk practice for this population. Therefore, we examined 3 questions: (1) what are the correlates of withdrawal use among black adolescents, (2) how widespread is the combined use of withdrawal and condoms, and (3) what is the contribution of withdrawal to STI acquisition? (excerpt) Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | BLACKS | ADOLESCENTS | MULTIPLE PARTNERS | PREVALENCE | SEXUALLY TRANSMITTED DISEASES | WITHDRAWAL | SEX FACTORS | CONDOM USE | Developed Countries | North America | Americas | Research Methodology | Ethnic Groups | Cultural Background | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Sexual Partners | Sex Behavior | Behavior | Measurement | Reproductive Tract Infections | Infections | Diseases | Family Planning, Behavioral Methods | Family Planning | Risk Reduction Behavior Document Number: 341120 |
| 20. Title: Breastfeeding and contraception use among women with unplanned pregnancies less than 2 years after delivery. Author: Tilley IB; Shaaban OM; Wilson M; Glasier A; Mishell DR Jr Source: International Journal of Gynaecology and Obstetrics. 2009;105:127-130. Abstract: OBJECTIVE: To examine breastfeeding and contraceptive use after the lactational amenorrhea method (LAM) criteria were no longer met. METHODS: Two hundred and thirty-three parous Egyptian women with unplanned pregnancies less than 2 years after delivery completed a questionnaire examining breastfeeding practice and contraceptive use. RESULTS: The majority of women (81.5%) with unplanned pregnancies within 2 years of delivery were breastfeeding at conception. Of these women, 36.3% had used a method of contraception other than LAM compared with 60.5% of women who had weaned (P<0.05). Among the breastfeeding women, 61.2% failed to use contraception because they believed breastfeeding would prevent pregnancy. CONCLUSION: Breastfeeding women with unplanned pregnancies were less likely to have used contraception than women who had weaned, suggesting that prolonged breastfeeding contributes to unmet contraceptive need. Language: English Keywords: EGYPT | RESEARCH REPORT | KAP SURVEYS | CONTRACEPTIVE PREVALENCE SURVEYS | WOMEN IN DEVELOPMENT | MOTHERS | BREASTFEEDING | CONTRACEPTIVE USAGE | PREGNANCY, UNPLANNED | LACTATIONAL AMENORRHEA METHOD | CONTRACEPTIVE PREVALENCE | WEANING | BELIEFS | Developing Countries | Africa, North | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Family Planning Surveys | Family Planning | Economic Development | Economic Factors | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Infant Nutrition | Nutrition | Health | Contraception | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Family Planning, Behavioral Methods | Culture Document Number: 330421 |
| 21. Title: Contraceptive withdrawal in adolescents: a complex picture of usage. Author: Woods JL; Hensel DJ; Fortenberry JD Source: Journal of Pediatric and Adolescent Gynecology. 2009 Aug;22(4):233-7. Abstract: STUDY OBJECTIVE: Contraceptive withdrawal, or coitus interruptus, is a widespread method in adolescents, but factors affecting usage have not been longitudinally investigated. Study objectives were to examine usage numbers of withdrawal among a group of sexually active adolescent females and to investigate the influence of personal, partner, and family factors on usage patterns. DESIGN/SETTING/PARTICIPANTS: Subjects (N=387; 14 to 17 years at enrollment; 92% African American) were recruited from primary care adolescent health clinics in areas with high rates of pregnancy and sexually transmitted infection. As part of a larger longitudinal study, subjects contributed face-to-face quarterly and annual questionnaires assessing contraceptive behavior, recent sexual behaviors, as well as partner- and family-based attitudes/beliefs. INTERVENTIONS, MAIN OUTCOME MEASURES: The outcome variable was: withdrawal use during the previous 12 weeks (no/yes); predictor variables included 19 individual, family and partner variables. All models additionally controlled for any current hormonal use (no/yes; any method), current condom use (no/yes) and past withdrawal use (past 30 days; no/yes). Logistic regression, with GEE estimation to adjust for repeated within-subject observations, was performed in SUDAAN, 9.0. RESULTS: Subjects supplied 1632 quarterly interviews; withdrawal was mentioned in about 25% of the interviews (392/1632). Controlling for primary contraceptive method, withdrawal was mentioned in 13.2% (51/307) of interviews with hormonal methods, in 32.4% (255/787) of the interviews with condoms and in 4.7% (78/1632) of interviews with no method. Current hormonal use was associated with a decreased likelihood of also using withdrawal (OR=0.34), whereas past withdrawal use increased the likelihood of current withdrawal by about 4-fold (OR=4.18). Condom use was not associated with withdrawal use. Current withdrawal use was more likely with a more diverse sexual repertoire (OR=1.65), more sexual partners in the past 3 months (OR=1.46), higher sexual control (OR=1.15), lower perceived STI risk (OR=0.46), higher sexual self-efficacy (OR=1.24), lower sexual coercion (OR=0.56) higher condom negativity (OR=1.16), living with a boyfriend (OR=2.17) and lower family sexual health support (OR=0.88). CONCLUSION: Contraceptive withdrawal in adolescents should not be considered 'rare.' Careful clinical consideration of usage within the context of other contraceptive behaviors, sexual behaviors/attitudes, and relationship issues could better inform effective contraceptive counseling efforts. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | STATISTICAL REGRESSION | ADOLESCENTS, FEMALE | FAMILY AND HOUSEHOLD | SEXUAL PARTNERS | WITHDRAWAL | INTERVIEWS | SEX BEHAVIOR | ATTITUDES | CONDOM USE | CONTRACEPTIVE USAGE | Developed Countries | North America | Americas | Data Analysis | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Sociocultural Factors | Behavior | Family Planning, Behavioral Methods | Family Planning | Data Collection | Psychological Factors | Risk Reduction Behavior | Contraception Document Number: 342400 |
| 22. Title: Potential market for CycleBeads: a basic model for estimating demand. Author: Georgetown University. Institute for Reproductive Health Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008. [13] p. (USAID Cooperative Agreement No. GPO-A-00-07-0003-00) Abstract: The purpose of this tool kit is to provide programs with guidelines for establishing an initial supply of CycleBeads in their country or region. CycleBeads are a string of teardrop-shaped, colored beads that represent each day of a woman's menstrual cycle. They help a women know if she is on a day when pregnancy is likely or on a day when pregnancy is very unlikely. CycleBeads are based on the Standard Days Method (SDM) of family planning. This model is a tool to help program managers use generally available statistics and data to define the potential market for CycleBeads in their area. It is intended to help guide estimations for overall CycleBeads demand in a country for which there is no or little historical data on CycleBeads use. (Excerpts) Language: English Keywords: GLOBAL | TEACHING MATERIALS | ESTIMATION TECHNIQUES | MATHEMATICAL MODEL | MENSTRUAL CYCLE | RHYTHM METHOD, CALENDAR | NEEDS | AWARENESS | IEC | FAMILY PLANNING, TRADITIONAL METHODS | Research Methodology | Theoretical Models | Menstruation | Reproduction | Family Planning, Behavioral Methods | Family Planning | Economic Factors | Knowledge | Sociocultural Factors | Program Activities | Programs | Organization and Administration Document Number: 331671 |
| 23. Title: Assessing the impact of scaling-up the Standard Days Method in India, Peru, and Rwanda. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Feb. [225] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: This study was designed to assess the impact of integrating the Standard Days Method® (SDM) into existing services in India, Peru, and Rwanda. The method was introduced on a large scale and information was collected for two years through simulated clients, survey statistics, and household surveys in the intervention and control areas. Results of this study will help shape efforts to scale-up the SDM in various countries. The specific objectives of the study were to test the effect of SDM integration on provider behavior, client behavior and community perceptions, attitudes, and practices. The study spanned three years, beginning in the second half of 2004 and ending in early 2007. It was implemented in each country by local research organizations with supervision from the IRH local office and IRH-Washington. The intervention was tailored to each country and involved integrating the SDM into existing public health and family planning services in all facilities in the intervention areas, so that it became one of the family planning options available to couples. Integration included advocating at the national, regional, and local level, making CycleBeads® available in all area facilities, training providers and supervisors to provide the SDM, monitoring and supervising services, and extensive information, education and communication (IEC) activities. In some areas the SDM was also made available in selected non-governmental organizations and private facilities. (excerpt) Language: English Keywords: INDIA | PERU | RWANDA | TECHNICAL REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | INTEGRATED PROGRAMS | HEALTH SERVICES | NEEDS | PROVIDERS WITH CLIENTS | CLIENT-STAFF RELATIONS | QUESTIONNAIRES | Asia, Southern | Asia | Developing Countries | South America, Western | South America | Latin America | Americas | Africa, Central | Africa, Sub Saharan | Africa | Family Planning | Family Planning, Behavioral Methods | Programs | Organization and Administration | Delivery of Health Care | Health | Economic Factors | Interpersonal Relations | Behavior Document Number: 327613 |
| 24. Title: AWARENESS Project. Benin country report, 2002-2007. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Jan. [16] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: Benin became the first African country to introduce the SDM when the Ministry of Health (MOH) and IRH agreed in December 2000 to conduct a pilot introduction study in two urban centers, Cotonou and Parakou. The study determined that strong demand for the method existed; that the SDM could be offered effectively through existing service delivery channels; that there was a high degree of acceptability and continuation of use; and that the SDM could be used correctly and consistently. The government requested IRH?s help to expand delivery of the method nationwide, an effort that began in December 2004. As service sites multiplied, Benin participated in other international, multisite studies, including a long-term (up to two-year) follow up of users and a study to determine the impact of social marketing campaigns on SDM use, particularly comparing pharmacy and clinic-based services. There was no significant difference in correct use between clients who obtained the SDM through clinics and those who obtained it in pharmacies. The government has included the SDM in national reproductive health norms, policies, and training protocols and materials. The AWARENESS Project, in collaboration with local partners, trained more than 600 providers countrywide, recording more than 12,000 SDM acceptors between 2004 and 2007. The SDM is currently offered in more than 150 public, community, and commercial sites in all 12 departments of the country. An evaluation of the integration process after three years showed that the SDM is well integrated into the health system, and was offered in all visited clinics, where 57% of providers had been trained on the SDM. The Benin program serves as a demonstration site for neighboring francophone countries. (excerpt) Language: English Keywords: BENIN | TECHNICAL REPORT | FERTILITY AWARENESS | PILOT PROJECTS | INTEGRATED PROGRAMS | NONGOVERNMENTAL ORGANIZATIONS | FAITH-BASED ORGANIZATION | CLINICAL DISTRIBUTION | PHARMACY DISTRIBUTION | COMMUNITY-BASED DISTRIBUTION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Family Planning, Behavioral Methods | Family Planning | Studies | Research Methodology | Programs | Organization and Administration | Organizations | Political Factors | Sociocultural Factors | Distributional Activities | Program Activities | Nonclinical Distribution Document Number: 327616 |
| 25. Title: AWARENESS Project. Bolivia country report, 2001-2006. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Jan. [12] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: IRH collaborated with the MOH and the PROCOSI (Programa de Coordinación en Salud Integral) network of nongovernmental organizations (NGOs) to integrate the SDM into public- and private sector services. As a result, in 2001, the MOH included the SDM in its national family planning (FP) norms and in 2004 added it to services covered by its public health insurance policy, thereby requiring that the method be provided free of charge to qualifying women at all MOH clinics. The MOH, key NGOs, and EngenderHealth (the USAID cooperating agency [CA] now responsible for TA to the MOH on family planning), all have integrated the SDM into their pre-service curricula, as have two auxiliary nursing programs in Trinidad and Beni departments. Efforts continue to integrate the SDM into the Cochabamba school of public health?s auxiliary nursing curriculum, as this school is responsible for certifying curriculum changes for all public-sector auxiliary nursing programs nationally. USAID/Bolivia discontinued field support to IRH after FY05, and IRH phased out activities in Bolivia by September 2006. By then the SDM was available in 270 MOH networks in six departments, and seven NGOs; over 2,100 providers had been trained; and over 14,000 couples were registered as SDM users. With a grant from EngenderHealth, IRH has continued to transfer capacity for further consolidation of SDM integration. (excerpt) Language: English Keywords: BOLIVIA | TECHNICAL REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | IEC | NONGOVERNMENTAL ORGANIZATIONS | CAPACITY BUILDING | PROGRAM ACCESSIBILITY | QUALITY OF HEALTH CARE | NEEDS | South America, Central | South America | Latin America | Americas | Developing Countries | Family Planning | Family Planning, Behavioral Methods | Program Activities | Programs | Organization and Administration | Organizations | Political Factors | Sociocultural Factors | Program Sustainability | Program Evaluation | Health Services Evaluation | Economic Factors Document Number: 327617 |
| 26. Title: AWARENESS Project. Burkina Faso country report, 2002-2007. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Jan. [14] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: In 2002, the MOH invited IRH to conduct a pilot study of the acceptability and feasibility of introducing the SDM through public and private-sector services. Results showed high acceptability with clients and providers. The SDM appeared to be an acceptable family planning method because, similar to traditional methods familiar to approximately half of Burkinabé women and men, the method does not have any effect on women?s health and has no side effects. The study also showed the feasibility of providing the SDM though the public-sector family planning program. The MOH therefore decided to expand SDM availability throughout the country and include it in national reproductive health norms. Scale-up efforts began in June 2005 when the MOH included the SDM on the list of methods to promote and CycleBeads on its essential family planning commodities procurement list. To expand coverage, IRH and JHPIEGO developed alliances across a broad network of faith-based and secular organizations. Strong endorsement from top Catholic clerics, the MOH, and community leaders (both Muslim and Christian) has been key to making SDM an integral part of the family planning program in Burkina Faso. IRH and JHPIEGO have trained 17 master trainers on the SDM and 13 on LAM. These trainers have trained over 120 SDM providers and more than 150 LAM providers. The SDM is available in 57 sites and LAM in nine. Eight other partners have started providing the SDM and/or LAM and together these organizations have registered more than 5,000 SDM users and more than 300 LAM users (under-reporting is significant). IRH and JHPIEGO are seeking options for continued support for LAM and SDM in Burkina Faso. (excerpt) Language: English Keywords: BURKINA FASO | TECHNICAL REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | IEC | COMMUNITY-BASED DISTRIBUTION | LACTATIONAL AMENORRHEA METHOD | CONTRACEPTIVE METHOD ACCEPTABILITY | INTEGRATED PROGRAMS | TRAINING PROGRAMS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Family Planning | Family Planning, Behavioral Methods | Program Activities | Programs | Organization and Administration | Nonclinical Distribution | Distributional Activities | Contraceptive Usage | Contraception | Education Document Number: 327618 |
| 27. Title: AWARENESS Project. Democratic Republic of Congo country report, 2003-2007. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Jan. [17] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: In 2003, the USAID Mission and the National Reproductive Health Program (PNSR) invited IRH to introduce the SDM in the Democratic Republic of Congo (DRC). The strategy focused on training providers and integrating the SDM into existing clinic, community, and pharmacy services in Kinshasa, Lubumbashi, and Bukavu, and the rural area of Katako Kombe. By 2004, 14 organizations were able to offer the SDM. CycleBeads are included in the national list of essential medicines and the five-year contraceptive security plan. The SDM is part of in-service family planning training curricula. The PNSR is developing national norms and protocols and intends to include the SDM. IRH also worked with the MOH to incorporate the SDM into national policies and logistics and reporting systems. However, the lack of overall government norms and functioning distribution and reporting systems is an obstacle requiring more comprehensive attention than the AWARENESS Project could offer. The program leveraged significant resources, as most partners paid for their own training programs and CycleBeads. The Congolese program participated in a study to determine the impact of the social marketing campaign, a general evaluation of SDM integration in the DRC. Major findings from the simulated client study showed that 89% of clinic providers gave spontaneous information on the SDM as opposed to only 38% of pharmacists; confidentiality was observed in over 70% of both clinics and pharmacies; 96% of providers in clinics told clients that CycleBeads represent a woman?s cycle while only 35% of pharmacists did so; and 7% of clinic providers attempted to convince clients to use other methods of family planning as opposed to 23% of pharmacists. The success of recent initiatives in DRC to introduce the TDM through services of an faith-based organization (FBO) suggest that this method may also be an appropriate addition to family planning services. (excerpt) Language: English Keywords: DEMOCRATIC REPUBLIC OF THE CONGO | TECHNICAL REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | CONTRACEPTIVE METHOD ACCEPTABILITY | INTEGRATED PROGRAMS | FAMILY PLANNING TRAINING | FAMILY PLANNING PROGRAMS | GOVERNMENT PROGRAMS | SOCIAL MARKETING | CLINICAL DISTRIBUTION | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Family Planning | Family Planning, Behavioral Methods | Contraceptive Usage | Contraception | Programs | Organization and Administration | Training Programs | Education | Marketing | Economic Factors | Distributional Activities | Program Activities Document Number: 327619 |
| 28. Title: AWARENESS Project. Ecuador country report, 2001-2007. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Jan. [13] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: CEMOPLAF (the Centro Médico de Orientación y Planificación) wanted to include SDM in its services in an effort to address unmet need. A pilot study showed a strong potential for the SDM to address this need and demonstrated feasibility of service provision in clinics and in the community. It also showed that clients were able to use the SDM correctly with a single counseling session. The longterm follow-up of pilot study participants continuing with the SDM demonstrated that while the majority of discontinuation during the first quarter of year one was due to cycles out of range; discontinuation during the second and third year had more to do with birth spacing and other life circumstances. Based on these results, CEMOPLAF provided training and technical input to its close partner, the MOH, and executed a social marketing program that introduced the SDM into pharmacies with mass media support. A study of the social marketing approach, conducted with the Population Council, showed awareness of the SDM increased from 4% to 34%, intention to use increased from 27% to 32%, demand for the SDM increased five-fold in pharmacies and clinics in one month during the mass media campaign, and both clinic-based providers and pharmacists provided correct information. CEMOPLAF used research results to advocate successfully for integrating the SDM into MOH norms and training curricula. Currently, the SDM is available in all CEMOPLAF and 11 MOH clinics in 11 of 22 departments. A number of local NGOs have also adopted the SDM. By including the SDM in national norms and the maternity program, the MOH committed to expanding the SDM to all its clinics by purchasing materials in exchange for training and technical assistance from CEMOPLAF. (excerpt) Language: English Keywords: ECUADOR | TECHNICAL REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTION CONTINUATION | INTEGRATED PROGRAMS | FAMILY PLANNING TRAINING | FAMILY PLANNING PROGRAMS | GOVERNMENT PROGRAMS | SOCIAL MARKETING | CLINICAL DISTRIBUTION | Developing Countries | South America, Western | South America | Latin America | Americas | Family Planning | Family Planning, Behavioral Methods | Contraceptive Usage | Contraception | Programs | Organization and Administration | Training Programs | Education | Marketing | Economic Factors | Distributional Activities | Program Activities Document Number: 327620 |
| 29. Title: AWARENESS Project. Guatemala country report, 2002-2007. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Jan. [21] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: With a population of 12 million, Guatemala is the largest country in Central America. Contraceptive prevalence in 2002 was relatively low, at 43% for women aged 15-49, and was even lower among rural (under 35%) and indigenous women (24%). In 2002, the Ministry of Health (MOH) and the Social Security Institute (IGGS) requested assistance from the AWARENESS Project to expand contraceptive choice through the integration of fertility awareness-based methods (FAM) into the method mix. The program functioned in USAID priority zones including the largely indigenous departments of the Altiplano (Quetzaltenango, Solola, and Huehuetenango), Santa Rosa, Chimaltenango, and Alta Verapaz. It focused primarily on building evidence for the future scale-up of the Standard Days Method® (SDM), while also assessing the effectiveness and feasibility of the TwoDay Method ® (TDM). IRH used a diversified strategy to build the evidence base for FAM and subsequently establish the necessary support and conditions for scale up. With approximately 200 trainers and 2000 trained SDM providers, Guatemala has substantial capacity for offering SDM services. In the last three years, more than 13,000 women began using the SDM, most of whom previously had not used family planning. The SDM also is supported in norms and gradually is being included in management information and logistics systems, pre- and in-service training, and communication strategies. (excerpt) Language: English Keywords: GUATEMALA | TECHNICAL REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | CONTRACEPTIVE METHOD ACCEPTABILITY | INTEGRATED PROGRAMS | FAMILY PLANNING TRAINING | FAMILY PLANNING PROGRAMS | GOVERNMENT PROGRAMS | SOCIAL MARKETING | CLINICAL DISTRIBUTION | Central America | Latin America | Americas | Developing Countries | Family Planning | Family Planning, Behavioral Methods | Contraceptive Usage | Contraception | Programs | Organization and Administration | Training Programs | Education | Marketing | Economic Factors | Distributional Activities | Program Activities Document Number: 327621 |
| 30. Title: AWARENESS Project. Lactational amenorrhea method (LAM) projects in India. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Feb. [90] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: In 2006, the U.S. Agency for International Development (USAID) asked the Institute for Reproductive Health, Georgetown University (IRH) to resume the role of providing technical assistance for the Lactational Amenorrhea Method (LAM), which IRH had developed under a previous project. In light of the weak state of LAM programs worldwide, IRH developed and pilot tested strategies to reinvigorate LAM. This included emphasizing LAM's potential to serve as a gateway to other family planning methods, simplifying messages to clients, and streamlining training and counseling for LAM. To pilot IRH's approach to LAM, IRH engaged in programs to integrate LAM in three countries: Mali, Burkina Faso, and India. This report focuses on the experience in India. IRH worked with three non-governmental organizations (NGOs) in rural areas of India to incorporate LAM into their programs. These organizations were World Vision in Uttar Pradesh, URMUL Seemant in Rajasthan, and People's Rural Education Movement (PREM) in Orissa. All three organizations offered LAM through community level workers as part of a basket of family planning methods. (excerpt) Language: English Keywords: INDIA | TECHNICAL REPORT | LACTATIONAL AMENORRHEA METHOD | TRAINING OF TRAINERS | FAMILY PLANNING TRAINING | FAMILY PLANNING POLICY | BEHAVIOR CHANGE COMMUNICATION | ADVOCACY | COMMUNICATION STRATEGY | COUNSELING | PROGRAM SUSTAINABILITY | Developing Countries | Asia, Southern | Asia | Family Planning, Behavioral Methods | Family Planning | Training Programs | Education | Population Policy | Social Policy | Policy | Political Factors | Sociocultural Factors | Communication Programs | Communication | Behavior Change | Behavior | Clinic Activities | Program Activities | Programs | Organization and Administration Document Number: 327638 |
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