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BACKGROUND: Family planning helps to reduce poverty, increase gender equity, prevent the spread of sexually transmitted infections, and reduce maternal, infant, and childhood mortality. Hence, this study aimed to examine the association between exposure to mass media family planning messages and the utilization of modern contraceptives among urban and rural youth women in Ethiopia. METHODS: A comparative cross-sectional study using the 2016 Ethiopia Demographic and Health Survey (EDHS) data set was applied. The data were analyzed with SPSS version 20. Multivariate logistic regression analysis was performed to assess the association between exposure to mass media family planning messages and the utilization of modern contraceptives by controlling confounders. An adjusted odds ratio with a 95% confidence interval was considered to declare a statistically significant association. RESULTS: The total sample was comprised of 6401 women (4061 from rural and 2340 from the urban area). There was no association between women exposed to mass media family planning messages and the utilization of modern contraceptives in rural areas. Surprisingly, this study showed that women exposed to mass media family planning messages in an urban area were less likely to use modern contraception by 62% (AOR: 0.38; 95% CI: 0.21, 0.68). CONCLUSION: The present study revealed that there was no significant association between women exposed to mass media family planning messages and utilization of modern contraceptives in rural areas. But, women exposed to mass media family planning messages in urban areas were less likely to use modern contraception. The study showed the role of inequalities in modern contraceptive utilization as shaped by structural and intermediary factors including religion, location, household wealth, education, and the number of children. This implies that the use of modern contraceptive use may be more impactful if cultural, geographical, and socioeconomic barriers are addressed.

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Este estudo tem como objetivo analisar os discursos produzi - dos por mulheres jovens no blog "Depois dos Quinze". Trata-se de uma pesquisa qualitativa, do tipo estudo de caso na internet, que utilizou a análise de conteúdo para a categorização dos discursos das jovens. No blog pesquisado observaram-se constantes trocas sobre inúmeras temá- ticas que interpelam as jovens frequentadoras, destacando-se o corpo como tema central nesse cenário. Verificaram-se processos de empode - ramento dos sujeitos construídos a partir de discursos de resistência e ressignificação de padrões corporais hegemônicos. É a partir da identi -ficação de diferenças expressas no corpo que elas vão se constituindo como um grupo identitário, uma cultura de resistência.

This study aims to analyze the discourses produced by young women in the blog "Depois dos Quinze" (After Fifteen). This paper contains a qualitative research, of the case study type which uses content analysis for the categorization of the discourses of the young women. In the blog there have been constant exchanges on numerous themes that challenge the young women who participate in the interactions, and the body stands out as the central theme in this scenario. There were processes of empowerment of the individuals constructed from discourses of resistance and re-signification of hegemonic body patterns. It is from the identification of differences expressed in the body that they are becoming an identity group, a culture of resistance.

El presente estudio tiene como finalidad analizar los discursos producidos por mujeres jóvenes en el blog Después de los Quince. Se trata de una investigación cualitativa, del tipo estudio de caso en Internet que utilizó el análisis de contenido para la categorización de los discursos de las jóvenes. El blog se observaron constantes cambios sobre innumerables temáticas que interpelan las jóvenes frecuentadoras y se destaca el cuerpo como tema central en este escenario. Se verificaron procesos de empoderamiento de los sujetos construidos a partir de discursos de resistencia y resignificación de patrones corporales hegemónicos. Es a partir de la identificación de diferencias expresadas en el cuerpo que ellas se van constituyendo como un grupo identitrio, una cultura de resistencia.

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In this comparative study of the sexual behaviour of 476 Nigerian female students in tertiary institutions comprising of 243 students of the medical discipline of study (MD group) and 233 students of the non-medical discipline of study (NMD group), the overall incidence of sexual intercourse was 56.7 percent. The mean age at first sexual experience was not significantly different at & = 0.05 among the two groups. However, sexual exposure was significantly more prevalent among students of the non-medical discipline of study (NMD group)--69.1 percents compared to those of the medical discipline of study (MD group)--44.9 percent (p < 0.01). In addition, the frequency of sexual exposure was significantly higher among the former group, 5.5 +/- 6.8 times per month, than in the later, 1.7 +/- 3.8 times per month (t = 5.25 with 274 d.f.; p < 0.005). The incidence of pregnancy among the two groups of students 37.1 percent and 31.2 percent respectively for the NMD and MD groups showed no significant difference at & = 0.05. The reasons for the observed difference in the sexual behaviour between the students for the two groups are adduced. The overall implications of sexuality and the relevance of its management among the youth are also discussed.

PIP: Findings are presented from a comparative study of the sexual behavior of 476 Nigerian female students in tertiary institutions in 1991 in Anambra State, Nigeria, 243 medical (MD) students and 233 nonmedical (NMD) students. The women were 10-42 years old, of mean age 22.2 years, with 83.5% of MD students and 73.0% of NMD students aged 20-29. 56.7% of the women had ever experienced sexual intercourse. The mean age at first sexual experience among the MD students was 18.6 years, not significantly different statistically from the 18.1 years mean age of the NMD students at first sexual experience. 44.9% of the MD students and 69.1% of the NMD students had ever had sexual intercourse. MD students had sex 1.7 +or- 3.8 times/month, compared to the NMD students who had sex 5.5 +or- 6.8 times/month. The frequency of pregnancy was 31.2% among the MD students, not significantly different than the 37.9% among NMD students. These findings suggest that study has a tempering effect upon adolescent sexual activity.

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The present study examined the correlates of consistent condom use among African-American women and prospectively evaluated the stability of these significant variables to predict consistent condom use at 3-month follow-up. A sample of 128 African-American women, 18-29 years of age completed a baseline interview and 3 months later completed a similar follow-up interview (n = 100). Compared to women who were inconsistent condom users, women who were consistent condom users were more likely to: have high assertive communication skills (OR=13), desire not becoming pregnant (OR=8.6), have high sexual self-control over condom use (OR=7.6), perceive having control over their partners' use of condoms (OR=6.6), be younger (OR=5.8), and report having a partner that was not committed to the relationship (OR=3.3). Prospective analyses identified baseline level of condom use as the best predictor of condom use at 3-month follow-up. Women who were consistent condom users at baseline were 6.3 times as likely to be consistent condom users at 3-month follow-up. In conclusion, HIV prevention programmes for women need to be gender specific and need to be implemented before high-risk behaviours are established and may be more difficult to modify.

PIP: Consistent condom use represents the primary HIV prevention strategy for US women. Baseline and follow-up interviews conducted in 1993 with 128 African-American women 18-29 years of age recruited from a low-income community in San Francisco, California, sought to identify the predictors of consistent condom use. 90.6% of respondents were unmarried, 71.9% had at least 1 child, and 71.9% received public assistance. Compared with inconsistent condom users, the 36 women (28.1%) who reported condom use on all occasions were significantly more likely to have high assertiveness communication skills (odds ratio (OR), 13.0; 95% confidence interval (CI), 3.9-43.8), not desire pregnancy (OR, 8.6; 95% CI, 2.2-34.5), have high sexual self-control over condom use (OR, 7.6; 95% CI, 2.5-23.0), perceive themselves to have control over their sexual partner's condom use (OR, 6.6; 95% CI, 2.1-20.6), be under 25 years of age (OR, 5.8; 95% CI, 1.8-19.2), and be in a relationship with a partner with a low commitment to the relationship (OR, 3.3; 95% CI, 1.2-9.4). Baseline level of condom use was the best predictor of condom use at the 3-month follow-up interview. Specifically, women who were consistent condom users at baseline were 6.3 times more likely to be consistent users at follow-up. These findings underscore the need to contextualize women's condom use and HIV prevention within the framework of gender relations.

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CONTEXT: While policymakers and researchers alike often seem to believe that young women's decision to initiate sexual intercourse is conscious and free of ambiguity, the actual degree of control that such young women exert over first intercourse has rarely been explicitly examined. METHODS: The 1995 National Survey of Family Growth asked all women who had experienced intercourse to rate, on a 1-10 scale, the wantedness of their first intercourse; they were then asked whether the experience was voluntary. Logistic regression analysis of data for women aged 15-24 who had experienced first premarital intercourse was performed to test the effect of background factors and wantedness scores on contraceptive use at voluntary first intercourse. RESULTS: Twenty-four percent of women aged 13 or younger at the time of their first premarital intercourse report the experience to have been nonvoluntary, compared with 10% of those aged 19-24 at first premarital intercourse. About one-quarter of respondents who reported their first intercourse as voluntary chose a low value (1-4) on the wantedness scale. Women whose first partner was seven or more years older than themselves were more than twice as likely as those whose first partner was the same age or younger to choose a low value (36% vs. 17%). Women whose partner had been seven or more years older were also less likely than other women to have used contraceptives at first intercourse. After the introduction of controls for demographic and background factors, partner age discrepancy and relationship status, wantedness of voluntary first intercourse was not independently related to the odds of contraceptive use at that intercourse. CONCLUSION: Characterizing women's first intercourse as simply voluntary or nonvoluntary is inadequate. Measures that take into account degrees of wantedness may help elucidate relationships between sexual initiation, contraceptive use and teenage pregnancy. The fact that substantial numbers of young women voluntarily participated in a first sexual experience about which they felt ambivalent or negative deserves the attention of program planners and service providers.

PIP: The degree of control that young women exert over first intercourse was investigated through the use of data from the 1995 US National Survey of Family Growth. All 2933 sexually active respondents, 15-24 years of age at the time of the survey, were asked to rate the wantedness of their first coitus on a scale of 1 to 10 and were queried as to whether the experience was voluntary. Overall, 91% of the respondents indicated that their first intercourse was voluntary. 76% of women 13 years or younger at first intercourse, compared with 90% of those 19-24 years old, characterized their first intercourse as voluntary. 24% of women who rated their first intercourse as voluntary selected a low value (1-4) on the wantedness scale, however. 36% of women whose first partner was 7 or more years older, compared with 17% of those with a first partner of the same age or younger, selected a low (1-4) wantedness value. 39% of women who rated the wantedness of first intercourse as 1-2, compared with 22% of women with a wantedness score of 9-10, had not used a contraceptive method for this event. Women with a substantially older partner also were less likely to use contraception at first intercourse. However, after introduction of controls for demographic and background factors, partner age discrepancy, and relationship status, wantedness of voluntary first intercourse was not independently associated with the odds of contraceptive use. The finding that substantial numbers of young women voluntarily participated in a first sexual experience about which they had ambivalent or negative feelings underscores the need for programs to increase the actual degree of control women exert over their sexual encounters.

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BACKGROUND: Genital human papillomavirus (HPV) infection is highly prevalent in sexually active young women. However, precise risk factors for HPV infection and its incidence and duration are not well known. METHODS: We followed 608 college women at six-month intervals for three years. At each visit, we collected information about lifestyle and sexual behavior and obtained cervicovaginal-lavage samples for the detection of HPV DNA by polymerase chain reaction and Southern blot hybridization. Pap smears were obtained annually. RESULTS: The cumulative 36-month incidence of HPV infection was 43 percent (95 percent confidence interval, 36 to 49 percent). An increased risk of HPV infection was significantly associated with younger age, Hispanic ethnicity, black race, an increased number of vaginal-sex partners, high frequencies of vaginal sex and alcohol consumption, anal sex, and certain characteristics of partners (regular partners having an increased number of lifetime partners and not being in school). The median duration of new infections was 8 months (95 percent confidence interval, 7 to 10 months). The persistence of HPV for > or =6 months was related to older age, types of HPV associated with cervical cancer, and infection with multiple types of HPV but not with smoking. The risk of an abnormal Pap smear increased with persistent HPV infection, particularly with high-risk types (relative risk, 37.2; 95 percent confidence interval, 14.6 to 94.8). CONCLUSIONS: The incidence of HPV infection in sexually active young college women is high. The short duration of most HPV infections in these women suggests that the associated cervical dysplasia should be managed conservatively.

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OBJECTIVE: To determine which factors are associated with duration of use of a levonorgestrel implant (Norplant) for contraception in adolescents and young adults. DESIGN: We retrospectively studied 144 young women (14 to 21 years of age) who chose a levonorgestrel contraceptive implant at Mayo Clinic Rochester between April 1990 and December 1993. MATERIAL AND METHODS: The following information was obtained at the time of insertion of the implant and from any follow-up visits: demographics, prior contraceptive experiences, frequency and management of complications, complications noted at removal of the implant, and subsequent contraceptive choice. The duration of use was examined. RESULTS: Of the 144 young women who underwent insertion of a Norplant system, 75 telephoned or made a medical appointment because of implant-related side effects. During the follow-up period, 64 patients had the Norplant system removed. The Kaplan-Meier estimate of the probability of the Norplant system remaining in place for at least 12 months was 83 % and for at least 24 months was 63 %. Duration of Norplant use was not found to differ with respect to age, prior contraceptive use, or timing of insertion, but it was significantly shorter among those with a prior pregnancy than in those who had never been pregnant. CONCLUSION: These findings suggest that a group of young women who are likely to continue use of a contraceptive implant (with or without treatment for side effects) are those who have never been pregnant.

PIP: A retrospective study of 144 US women 14-21 years of age who requested and received the Norplant contraceptive implant system at the Mayo Clinic (Rochester, Minnesota) in 1990-93 analyzed the factors associated with duration of method use. Of the 124 women who reported past use of contraception, 94 (76%) had been pregnant at least once. The method most commonly used before Norplant was oral contraception (57%). The reasons for Norplant selection were its convenience (86%) and problems tolerating the pill (14%). Of the 130 Norplant users who either telephoned or made a clinic appointment after insertion, 60% reported side effects such as breakthrough bleeding, headache, and depression or mood swings. 64 women had the implants removed. The median duration of Norplant use was 29 months. The Kaplan-Meier estimate of the probability of the Norplant system remaining in place for at least 12 months was 83% and 63% for at least 24 months. Age, prior contraceptive use, and timing of insertion had no impact on duration of Norplant use. Multivariate analysis indicated that women with at least 1 prior pregnancy had a two-fold increased risk of Norplant removal compared to those who had never been pregnant. Larger studies are needed to identify additional factors associated with long-term use of injectable contraception among young women and to suggest interventions that would improve compliance with routine follow-up.

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Contracting sexually transmitted diseases is a serious health problem faced by young women, in part, because they may routinely engage in risky sexual behaviors. This study describes the sexual behaviors of eighty-one young adult females who had positive and negative tests for STDs. The STD-negative group consisted of forty-nine African American females and the STD-positive group was thirty African American and two Caucasian females. The women completed the Safe Sex Behavior Questionnaire and the Rosenberg Self Esteem Scale. Demographic factors were also examined. The findings revealed that STD-negative females had higher self esteem and practiced safe sex more frequently. Also, women with higher education and incomes above $10,000 a year, plus a higher self-esteem level scored higher on the SSBQ, indicating the practice of safer sex. Age was not related to self esteem or the practice of safe sexual behavior. Implications for nurse practitioner practice are discussed.

PIP: This study describes the sexual behavior and self-esteem of 81 young adult females who had positive and negative tests for sexually transmitted diseases (STDs). STD-negative respondents consisted of 49 African American females, while STD-positive respondents consisted of 30 African American females and 2 Caucasian females. Findings showed significant positive correlations between the Rosenberg Self Esteem Scale and the total score of the Safe Sex Behavior Questionnaire. The STD-negative group exhibited higher self-esteem and practiced safe sex more frequently. Young adult females with high incomes and high degree of education also showed a high prevalence of self-esteem. Age was not related to self-esteem nor to the practice of safe sexual behavior. The implications of this study in nursing practice include dissemination of information about STDs, discussions with at-risk women related to their susceptibility to infections, and assisting women in understanding the adverse consequences of contracting STDs.

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PIP: This study describes the population characteristics among a hospital-based sample of single women who experienced an abortion in Hanoi, Viet Nam. Data were obtained from topical and in-depth interviews with women in two Hanoi hospitals, a district health center, and a private clinic in Hadong, a Hanoi suburb. The total sample consisted of 279 single women. 75% were residents of Hanoi. In-migrants had lived in Hanoi for an average of 4 years. Over 80% lived with their parents or relatives, of whom 60% lived in privately-owned housing. Nearly 20% lived alone. Nearly 40% had a college education; almost 50% had completed secondary school. The average monthly income was 358,000 dong. Over 95% had a boyfriend at the time of the survey. 33% had engaged in their first sexual intercourse within the prior year. The average duration between first sex and abortion was about 15 months. Among those with the first boyfriend, the interval was shorter (7 months). About 45% waited 6 months before having their first sexual intercourse; 38% waited 1 year. Among first abortion users, under 20% had ever used a contraceptive method. The few that had used contraception used it ineffectively. Almost 50% had never talked about sexuality with anyone. Over 93% believed that the pregnancy could have been avoided. Most desired high-quality printed information and a youth-specific health center. Qualitative findings revealed misconceptions about contraception. Following abortion, most did not want another unwanted pregnancy. The implications for policies and programs are identified.^ieng

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OBJECTIVE: To describe sexual behaviour that may partly explain a decline in HIV seroprevalence in pregnant women in urban settings in Uganda, East Africa. SETTINGS: Two major urban districts in Uganda. METHODS: Repeated population-based behavioural surveys in 1989 and 1995, and repeated HIV serological surveys in consecutive pregnant women attending antenatal clinics from 1989 to 1995. RESULTS: During the study period, a 2-year delay in the onset of sexual intercourse among youths aged 15-24 years and a 9% decrease in casual sex in the past year in male youths aged 15-24 years were reported. Men and women reported a 40% and 30% increase in experience of condom use, respectively. In the same study area, over the same period, there was an overall 40% decline in the rates of HIV seroprevalence among pregnant women attending antenatal clinics. It can be hypothesized that the observed declining trends in HIV correspond to a change in sexual behaviour and condom use, especially among youths. CONCLUSIONS: This is the first report of a change over a period of 6 years in male and female sexual behaviour, assessed at the population level, that may partly explain the observed decline in HIV seroprevalence in young pregnant women in urban Uganda. This result should encourage AIDS control programmes to pursue their prevention activities.

PIP: Repeated serologic surveys conducted in consecutive pregnant women attending antenatal clinics in three urban sites--Nsambya, Rubaga, and Jinja--in Uganda in 1989-95 documented substantial declines (27-47%) in HIV prevalence. Multiple population-based behavioral surveys conducted in urban Uganda in 1989 and 1995 suggest this decline in HIV prevalence among pregnant women may be a result of three key changes in sexual practices: a 2-year delay in the onset of sexual intercourse among young people 15-24 years of age, a 9% decrease in the practice of casual sex among males 15-24 years old, and increases in the experience of condom use of 40% among males and 30% among females. Proportions of male and female youth reporting they had never had sexual intercourse increased from 31% and 26%, respectively, in 1989 to 56% and 46%, respectively, in 1995. The prevalence among men in the past year of sex outside relationships that had lasted more than 12 months declined from 22.6% in 1989 to 18.1% in 1995. The proportion of men and women who reported exchanging sex for money dropped by almost 50%. Finally, the proportion of sexually active respondents who reported ever-use of condoms increased from 15.4% to 55.2% among men and from 5.8% to 38.7% among women from 1989 to 1995. In two of the three urban areas, the decline in HIV prevalence was sharpest among pregnant women in the youngest age group (15-24 years), suggesting a true decrease. The finding of substantial changes in the sexual behavior of urban Ugandan youth confirms the efficacy of AIDS prevention and control interventions.

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A comprehensive model of the determinants of condom use among young women was developed, tested, and replicated, with longitudinal follow-up to assess predictive utility of the model for condom use over time. Participants in Study 1 and Study 2 were 198 female undergraduates (mean age, 18.6 years) and 238 female undergraduates (mean age, 19.1 years), respectively. Acceptance of sexuality and control over the sexual encounter were related to a multidimensional measure of condom use self-efficacy, which predicted condom use intentions. Perceived susceptibility to STDs was both directly related to intentions and indirectly related through perceived benefits and attitudes about condom use. Intentions predicted subsequent reports of condom use. The model suggests foci for condom use interventions for young women.

PIP: A comprehensive model of the determinants of condom use among young women was developed, tested, and replicated, with longitudinal folow-up to assess the predictive utility of the model for condom use over time. Participants in study 1 and study 2 were 198 female undergraduates of mean age 18.6 years and 238 female undergraduates of mean age 19.1 years, respectively. 74-79% of the women were White and approximately 75% in both groups had ever experienced sexual intercourse. Among those ever having intercourse, the mean age at first intercourse was 16.2-16.3 years and only 15% reported always using condoms. 64-66% reported condom use at first intercourse and 59-60% of all episodes of sexual intercourse overall involved condom use. 66% and 73% of the young women who had had intercourse had had more than one partner and 3-7% of all participants reported ever having a sexually transmitted disease. Acceptance of sexuality and control over the sexual encounter were related to a multidimensional measure of condom use self-efficacy, which predicted condom use intentions. Perceived susceptibility to sexually transmitted diseases was both directly related to intentions and indirectly related through perceived benefits and attitudes about condom use. Intentions predicted subsequent reports of condom use.

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PIP: There has been national concern since the early 1980s over the need to prevent teen pregnancy. Much of that concern has stemmed from concerns over the notion that families formed as a result of adolescent parenthood are often poor and welfare dependent. Much of the research on adolescent childbearing implies that having a child disadvantages adolescents in terms of future life options. The author examined the life experiences of 1666 Black female high school graduates of average age 25.4 years 5 years out of high school using data from the National Survey of Family Growth Cycle IV. 474 virgins, 570 never-pregnant women, 65 ever-pregnant women, and 557 adolescent mothers were examined. Most of the women had never married, with virgins and adolescent mothers the least likely to be in marital relationships. Relative to the other subgroups, virgins reported higher educational, financial, and occupational achievement. However, a significant proportion of adolescent mothers were more successful than conventional stereotypes suggest. Several had secured professional jobs, had middle-income status, and were pursuing additional educational training. The implications for future research, education, and policy are discussed.^ieng

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PIP: During an August 1996 conference in Washington, D.C., young women from 28 countries world-wide called for increasing the resources devoted to sex education and adolescent reproductive health needs. The young women want immediate removal of barriers to reproductive health information, counseling, and services and underscored the need for pregnant girls and young mothers to be given full educational opportunities. The young woman noted that enforcing human rights laws will protect millions of young people but that abuses of youth will continue until poverty is alleviated, attitudes about daughters change, and policy-making processes become more humane. Participants pledged to seek opportunities to promote implementation of the agendas from the 1994 International Conference on Population and Development and the Fourth World Conference on Women and to become involved in the political process of their native lands.^ieng

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PIP: First Lady Hillary Rodham Clinton, during her tour of Thailand: 1) joined a panel discussion at New Life Center, a missionary shelter and acquired immunodeficiency syndrome (AIDS) hospice that houses and educates 151 girls from remote hill tribes who were rescued from being, or from becoming, brothel prostitutes or "restaurant hostesses"; 2) inspected a U.S. supported program in Chiang Rai province that provides scholarships, vocational training, and jobs to 1200 girls as income alternatives to their sale; and 3) toured a school that extends the education of girls beyond the mandatory age of 12, the age at which many are sold to Bangkok brothel middlemen. There are 500,000-700,000 prostitutes in Thailand; many die of AIDS. Girls can be sold for $1000 and send money home later; instead of poverty, the family has a new home, a motorcycle, and status. Mrs. Clinton emphasized the lifetime benefit available to a family when a girl is educated.^ieng

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In most tropical regions there is little organized health care for young women, yet their household roles within contexts of worsening socio-economic situations create special health problems. In the area of sexual and reproductive health, the onset of reproductive roles does not entitle the young women to either maternal and child health services or family planning services unless they are married and have children under 5 years. Societal values and norms at macro and micro levels have prevented young women from benefiting from reproductive technology, although they are, at the same time, increasingly expected to spend a great deal of their youth in school and outside marriage. Young women thus live in paradoxical situations as indicated by the increasing levels of early teenage pregnancy, induced abortion and related complications, school drop-out and infection with sexually transmitted diseases including HIV/AIDS. Young women clearly constitute an unrecognized social category, and research focusing on them would be particularly rewarding because of the potential it offers for addressing the gender imbalances and their dynamics in health.

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OBJECTIVE: To examine bone density among adolescents receiving different forms of hormonal contraception along with that of control subjects. METHODS: Baseline and 1-year measures of lumbar vertebral bone density were obtained in girls receiving depot medroxyprogesterone acetate (Depo-Provera) (n = 15), levonorgestrel (Norplant) (n = 7), or oral contraceptives (n = 9) and in girls receiving no hormonal treatment (n = 17). In a subsample of Depo-Provera users (n = 8), Norplant users (n = 3), and control subjects (n = 4), bone density measurements were repeated after 2 years. Bone density was measured by dual-energy x-ray absorptiometry. RESULTS: Body mass indexes, level of pubertal development, substance use, and reproductive histories were not significantly different among the groups. More black girls were represented in the initial Depo-Provera group (p < 0.02), girls in the Norplant group exercised more hours per week (p < 0.02), and control subjects were older (p < 0.01) than those in the other groups. These variables did not significantly affect bone density results. After 1 year, bone density decreased 1.5% in Depo-Provera users, compared with increases of 2.5% in Norplant users, 1.5% in oral contraceptive users, and 2.9% control subjects (p < 0.02). After 2 years, bone density increased a total of 9.3% in Norplant users and 9.5% in control subjects but decreased a total of 3.1% in Depo-Provera users (p < 0.0001). CONCLUSION: These data suggest that Depo-Provera may, at least temporarily, suppress the expected skeletal bone mineralization in adolescents, whereas Norplant and oral contraceptives are associated with the expected increase in bone density in this population.

PIP: In Ohio, data on 31 postmenarcheal women, 12-21 years old and using hormonal contraception (Norplant = 7, Depo Provera = 15, and oral contraceptives [OCs] = 9) were compared with data on 17 controls of similar age to prospectively examine lumbar bone density in girls before and after 1 and 2 years of hormonal contraceptive use and to compare the results with young women not using hormonal contraceptives. The subjects attended a general adolescent clinic at Children's Hospital in Columbus. There was an insufficient number of OC users at 2 years, so they were not included in second year analyses. Initial height and weight were significantly associated with bone density values (p 0.05). Weight accounted for the most variance both at baseline (p 0.001) and after 1 year of treatment (p 0.01). At baseline and 1 year, bone density values between patient groups were not significantly different. At 2 years, however, Norplant users had higher bone density than Depo- Provera users and controls (1.308 vs. 1.004 and 1.087, respectively; p 0.01). After 1 year, Depo-Provera users experienced a decrease (1.53%) in bone density while Norplant users, OC users, and controls experienced an increase in bone density (2.46%, 1.52%, and 2.85%, respectively). The change in bone density between Depo-Provera users and controls was significant (p 0.02). At 2 years, Depo Provera users experienced a decrease in bone density while Norplant users and controls experienced an increase (-3.12% vs. 9.33% and 9.49%, respectively; p 0.0001). This study is important because 50% of adult bone mass is accrued during adolescence. In fact, bone mass peaks during adolescence. It is not known whether bone loss during Depo Provera use is reversible after treatment discontinuation. These findings show that Depo Provera inhibits skeletal bone mineralization in adolescents, at least temporarily, while Norplant and OCs appear to increase bone density.

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PIP: This study is based on interviews with a sample of 400 single women aged 18-25 years from the Fante ethnic group in Cape Coast, Ghana, in 1991, and on focus groups. This case study illustrates the importance of economic and living arrangement support expected from partners in premarital relationships. Support may be for living and maintenance ('chopmoney', provisions, household items, and rent); for financial security (provision of capital); and for clothing and hairdressing. Women did not always require economic support in premarital relationships. Women expect boyfriends to provide 'chopmoney' (money for food and general upkeep) and contribute some money for the rent. Only 36% of sexually active women expected their boyfriends to supply food provisions. Premarital sexual relationships are used to obtain start-up capital. The author refers to evidence that senior government officials engaged in sexual transactions with clients before loans and credit facilities were offered. 87% of sexually experienced women expected their partners to pay for at least part of clothing expenses. The study revealed that there was considerable disparity between women's expectations and actual receipt of economic support. 56% desired, but only 36% received, 'chopmoney' in full. 40% expected their partners to pay for household furnishings in full, while only 10% did so. 55% expected capital, but only 15% received it. The three most frequently received benefits in full were hair dressing, shoes, and dresses. Men provided most non-negotiable items as a means of "boosting their egos." Many young women rely on the support of men in order to improve their status. Ghanaian men control financial resources and economic power. Mothers of adolescent daughters encourage premarital sexual behavior. Prostitution is considered different from sexual exchange relationships. It is argued that gender inequalities and domestic abuse are perpetuated through sexual exchange relationships.^ieng

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To evaluate the relation between contraceptive methods and cervical Chlamydia trachomatis infection, the authors studied a population-based sample of 1,779 nonpregnant women aged 15-34 years who underwent cell culture diagnostic testing for the detection of C. trachomatis at a health maintenance organization. Barrier contraceptive method users were classified as those who reported using one of the following methods at time of testing: condom, diaphragm, cervical cap, spermicidal sponge, foam, or vaginal spermicidal suppositories. Barrier methods were associated with a reduction in the risk of chlamydial infection in women aged 25 years or older when compared with all other women in the same age category (adjusted prevalence odds ratio = 0.15, 95% confidence interval (CI) 0.04-0.66). When compared with only noncontracepting women, the adjusted prevalence odds ratio was 0.34 (95% CI 0.06-1.99). The protective effect of barrier methods was not evident in women younger than age 25 years. Oral contraceptive use was not associated with the risk of C. trachomatis infection using either referent group; the adjusted prevalence odds ratio was 0.99 (95% CI 0.57-1.73) compared with all other women, and 0.88 (95% CI 0.44-1.79) compared with noncontracepting women. These findings suggest that present patterns of use of barrier methods differ by age and afford only selective protection against cervical C. trachomatis infections.

PIP: Chlamydia trachomatis infection is among the most prevalent of sexually transmitted diseases in young women in the US. Approximately 2.6 million women are estimated to be infected annually in the country. The authors investigated the relation between contraceptive methods and cervical Chlamydia trachomatis infection in a population-based sample of 1779 nonpregnant women aged 15-34 years attending two primary care clinics at Group Health Cooperative of Puget Sound between January 1988 and June 1989. 3.8% of the women were infected with C. trachomatis. Cervical chlamydial infection occurred more often in women younger than age 25 years, of black race, low income level, single marital status, in nulliparous women, women having douched during the preceding year, and those having two or more sexual partners in the preceding year. Overall, the risk of cervical C. trachomatis infection among barrier method users was lower than among all other women. Condoms, diaphragms, cervical caps, spermicidal sponges, foam, and vaginal spermicidal suppositories are barrier contraceptives. The greatest protective effect among barrier method users was found in women aged 25 years or older. Overall, there was no association between the use of oral contraceptives and chlamydial infection. These findings therefore suggest that present patterns of use of barrier methods differ by age and afford only selective protection against cervical infection with C. trachomatis.

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PIP: The human rights of female children in India and elsewhere, even when protected on paper, are violated in practice. An equitable and egalitarian world order must be established. A comprehensive campaign is needed that combats gender-based inequalities, discrimination, exploitation, oppression, abuse, violence, inhuman values, and violations of human rights, particularly against female children. People must radically change their attitudes and actions towards female children. Female children are not a commodity or sex-object but "an equally worthy human being to be loved, respected, and cared for." Strategies that accomplish these ends include the promotion of human and spiritual values of love, compassion, and nonviolence, and discouragement of values of consumerism and materialism and worthlessness of human beings. Effective education and mass media should counter corruption, dishonesty, selfishness, and inhuman actions. Family structures need to strengthened and enriched. The abuse of female children occurs due to the following interrelated factors: entrenched patriarchal value systems, the perpetuation of traditions and practices that identify girls as inferior to boys, the gender-biased and discriminatory attitude that identifies girl children as a burden or liability and as a sex-object or commodity, and prevalent illiteracy, poverty, and negative parenting life style patterns. Other factors include the low status of women, the reduction in human and spiritual values, and the rise of consumerism and corruption. Girls are subjected to female infanticide, feticide, lack of social and economic development, burdensome domestic work, early marriage and childbearing, neglect and denial of healthy living conditions, sexual abuse and exploitation, prostitution, rape, and a denial of their right to protection.^ieng

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PIP: This article identifies gender bias against female children and youth in India. Gender bias is based on centuries-old religious beliefs and sayings from ancient times. Discrimination is reflected in denial or ignorance of female children's educational, health, nutrition, and recreational needs. Female infanticide and selective abortion of female fetuses are other forms of discrimination. The task of eliminating or reducing gender bias will involve legal, developmental, political, and administrative measures. Public awareness needs to be created. There is a need to reorient the education and health systems and to advocate for gender equality. The government of India set the following goals for the 1990s: to protect the survival of the girl child and practice safe motherhood; to develop the girl child in general; and to protect vulnerable girl children in different circumstances and in special groups. The Health Authorities should monitor the laws carefully to assure marriage after the minimum age, ban sex determination of the fetus, and monitor the health and nutrition of pre-school girls and nursing and pregnant mothers. Mothers need to be encouraged to breast feed, and to breast feed equally between genders. Every village and slum area needs a mini health center. Maternal mortality must decline. Primary health centers and hospitals need more women's wards. Education must be universally accessible. Enrollments should be increased by educating rural tribal and slum parents, reducing distances between home and school, making curriculum more relevant to girls, creating more female teachers, and providing facilities and incentives for meeting the needs of girl students. Supplementary income could be provided to families for sending girls to school. Recreational activities must be free of gender bias. Dowry, sati, and devdasi systems should be banned.^ieng

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