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We aimed to determine whether current contraceptive use is affected by a history of abortion for women from a country with abortion-restricted laws. This is an analysis of 2006 Brazil Demographic and Health Survey. Nonpregnant women whose first pregnancy occurred in the previous 5 years were selected for this study (n = 2,181). We used propensity score matching to compare current contraceptive use among women with induced or spontaneous abortion and women with no abortion. We found differences in the use, but women with a history of abortion did not report more effective contraceptive than women with no abortion, as we expected.

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BACKGROUND: Although it is well known that post-abortion contraceptive use is high when family planning services are provided following spontaneous or induced abortions, this relationship remains unclear in Brazil and similar settings with restrictive abortion laws. Our study aims to assess whether contraceptive use is associated with access to family planning services in the six-month period post-abortion, in a setting where laws towards abortion are highly restrictive. METHODS: This prospective cohort study recruited 147 women hospitalized for emergency treatment following spontaneous or induced abortion in Brazil. These women were then followed up for six months (761 observations). Women responded to monthly telephone interviews about contraceptive use and the utilization of family planning services (measured by the utilization of medical consultation and receipt of contraceptive counseling). Generalized Estimating Equations were used to analyze the effect of family planning services and other covariates on contraceptive use over the six-month period post-abortion. RESULTS: Women who reported utilization of both medical consultation and contraceptive counseling in the same month had higher odds of reporting contraceptive use during the six-month period post-abortion, when compared with those who did not use these family planning services [adjusted aOR = 1.93, 95 % Confidence Interval: 1.13-3.30]. Accessing either service alone did not contribute to contraceptive use. Age (25-34 vs. 15-24 years) was also statistically associated with contraceptive use. Pregnancy planning status, desire to have more children and education did not contribute to contraceptive use. CONCLUSIONS: In restrictive abortion settings, family planning services offered in the six-month post-abortion period contribute to contraceptive use, if not restricted to simple counseling. Medical consultation, in the absence of contraceptive counseling, makes no difference. Immediate initiation of a contraceptive that suits women's pregnancy intention following an abortion is recommended, as well as a wide range of contraceptive methods, including long-acting reversible methods, even in restrictive abortion laws contexts.

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OBJECTIVES: Networks of franchised health establishments, providing a standardized set of services, are being implemented in developing countries. This article examines associations between franchise membership and family planning and reproductive health outcomes for both the member provider and the client. METHODS: Regression models are fitted examining associations between franchise membership and family planning and reproductive health outcomes at the service provider and client levels in three settings. RESULTS: Franchising has a positive association with both general and family planning client volumes, and the number of family planning brands available. Similar associations with franchise membership are not found for reproductive health service outcomes. In some settings, client satisfaction is higher at franchised than other types of health establishments, although the association between franchise membership and client outcomes varies across the settings. CONCLUSIONS: Franchise membership has apparent benefits for both the provider and the client, providing an opportunity to expand access to reproductive health services, although greater attention is needed to shift the focus from family planning to a broader reproductive health context.

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The paper examines the validity of two indices of sustainability: family planning programme sustainability (PSI) and outcome sustainability (OSI) developed by Tsui and Knight (1997) by applying their original method to recent data. The indices succeed in identifying the directional path of programme and outcome sustainability. Close correlations are found between PSI and OSI predicted values and actual programme and outcome values. The indices provide a repeatable method for measuring sustainability, although they are sensitive to data measurement errors. The indices provide a policy tool for funding decisions but should be used with other data sources to judge sustainability.

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OBJECTIVES: There has been a growing recognition of the importance of contextual influences on health outcomes. This article examines community-level influences on 5 reproductive wellness outcomes in Uttar Pradesh, India. METHODS: Multilevel modeling is used to estimate household and community-level effects on wellness, with hierarchically organized data from a statewide survey of villages, urban blocks, households, women, health providers, and staff. RESULTS: The household and community have a strong contextual influence on wellness, although the models explain more of the variation in outcomes between households than between communities. CONCLUSIONS: Communities influence wellness outcomes through the socioeconomic environment and the characteristics of the health infrastructure. The specific dimensions of the community and health infrastructure varied between the outcomes.

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BACKGROUND: Although one cannot underestimate the importance of macrosystem-level forces (such as cultural and social norms) in the aetiology of gender-based violence within any country, including India, individual-level variables (such as observing violence between one's parents while growing up) may also play important roles in the development of such violence. Therefore, this research studies men residing in northern India to: (1) estimate the prevalence of men's childhood experiences of witnessing parent-to-parent violence within their families of origin; (2) examine whether men raised in violent homes were more likely than men raised in non-violent homes to have attitudes supportive of husbands' control of their wives; (3) examine whether men raised in violent homes were more likely than men raised in non-violent homes to be abusive toward their own wives; and (4) estimate the extent to which wife abuse in this second generation could have been prevented had there not been parent-to-parent violence in the men's natal families. METHODS: Married men (n = 6902) were surveyed concerning: their childhood experiences of witnessing parent-to-parent violence in their families of origin; their attitudes regarding the appropriateness of husbands' control of their wives; their physically and sexually abusive behaviours toward their own wives; and sociodemographic variables. Descriptive statistics, multivariable modelling procedures, and estimation of a population attributable fraction were used to address the study questions. RESULTS: Approximately one-third of the men had witnessed parent-to-parent violence as a child. Compared to men raised in non-violent homes, men from violent homes were significantly more likely to believe in husbands' rights to control their wives, and to be physically/sexually abusive toward their own wives. Non-violence in the earlier generation was strongly predictive of non-violence in the second generation, with about a third of the wife abuse in the second generation being attributable to parent-to-parent violence in the first generation. CONCLUSIONS: These findings from northern India are congruent with those from other geographical/cultural settings in suggesting that witnessing violence between one's parents while growing up is an important risk factor for the perpetration of partner violence in adulthood.

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This study examines the determinants of the use of four types of reproductive health-care services in Uttar Pradesh, India: contraceptive services, antenatal care, delivery in a medical institution, and services dealing with reproductive tract and sexually transmitted infections. The analysis uses a multilevel modeling strategy to assess the presence of household- and community-level variation in service use. The influence of community-level characteristics and reproductive health-care service attributes on service use is examined. The results highlight strong community-level influences on service use, although the type of community effect varies by service type. The role of some individual and household factors in determining a person's use of services is mediated by the characteristics of the community in which the individual lives. The results demonstrate the need to look beyond individual factors when examining health-care-seeking behavior, and illustrate that there is no singular "community" effect on service use.

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