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Susheela Singh

Publications and source records attributed to Susheela Singh.

18 recordsLinked to original sources
PubMed2006

Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use.

OBJECTIVES: We explored the relative contributions of declining sexual activity and improved contraceptive use to the recent decline in adolescent pregnancy rates in the United States. METHODS: We used data from 1995 and 2002 for women 15 to 19 years of age to develop 2 indexes: the contraceptive risk index, summarizing the overall effectiveness of contraceptive use among sexually active adolescents (including nonuse), and the overall pregnancy risk index, calculated according to the contraceptive risk index score and the percentage of individuals reporting sexual activity. RESULTS: The contraceptive risk index declined 34% overall and 46% among adolescents aged 15 to 17 years. Improvements in contraceptive use included increases in the use of condoms, birth control pills, withdrawal, and multiple methods and a decline in nonuse. The overall pregnancy risk index declined 38%, with 86% of the decline attributable to improved contraceptive use. Among adolescents aged 15 to 17 years, 77% of the decline in pregnancy risk was attributable to improved contraceptive use. CONCLUSIONS: The decline in US adolescent pregnancy rates appears to be following the patterns observed in other developed countries, where improved contraceptive use has been the primary determinant of declining rates.

Adolescent↗
PubMed2006

Unsafe abortion: the preventable pandemic.

Ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative. As with other more visible global-health issues, this scourge threatens women throughout the developing world. Every year, about 19-20 million abortions are done by individuals without the requisite skills, or in environments below minimum medical standards, or both. Nearly all unsafe abortions (97%) are in developing countries. An estimated 68 000 women die as a result, and millions more have complications, many permanent. Important causes of death include haemorrhage, infection, and poisoning. Legalisation of abortion on request is a necessary but insufficient step toward improving women's health; in some countries, such as India, where abortion has been legal for decades, access to competent care remains restricted because of other barriers. Access to safe abortion improves women's health, and vice versa, as documented in Romania during the regime of President Nicolae Ceausescu. The availability of modern contraception can reduce but never eliminate the need for abortion. Direct costs of treating abortion complications burden impoverished health care systems, and indirect costs also drain struggling economies. The development of manual vacuum aspiration to empty the uterus, and the use of misoprostol, an oxytocic agent, have improved the care of women. Access to safe, legal abortion is a fundamental right of women, irrespective of where they live. The underlying causes of morbidity and mortality from unsafe abortion today are not blood loss and infection but, rather, apathy and disdain toward women.

Abortion, Illegal↗
PubMed2006

Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries.

BACKGROUND: Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries. The WHO estimates that one in eight pregnancy-related deaths result from unsafe abortions. The social stigma and legal restrictions associated with abortion in many countries means that data on the magnitude of this problem are scarce; this article estimates the rate and numbers of hospital admissions resulting from unsafe abortions in developing countries to help quantify the problem. METHODS: National estimates of abortion-related hospital admissions in women aged 15-44 years were compiled for 13 developing countries: Africa (Egypt, Nigeria, and Uganda), Asia (Bangladesh, Pakistan, and the Philippines), and Latin America and the Caribbean (Brazil, Chile, Colombia, Dominican Republic, Guatemala, Mexico, and Peru). These data were combined with supplementary data from five countries in sub-Saharan Africa (Burkina Faso, Ghana, Kenya, Nigeria, and South Africa) to give estimates for the three world regions. FINDINGS: The annual hospitalisation rate varies from a low of about 3 per 1000 women in Bangladesh to a high of about 15 per 1000 in Egypt and Uganda. Nigeria, Pakistan, and the Philippines have rates of 4-7 per 1000, and two countries in Latin America with recent data have rates of almost 9 per 1000. In the developing world as a whole, an estimated five million women are admitted to hospital for treatment of complications from induced abortions each year. This equates to an average rate of 5.7 per 1000 women per year in all developing regions, excluding China. By comparison, in developed countries complications from abortion procedures or hospitalisation are rare. INTERPRETATION: These results help quantify the magnitude of the adverse health effects of unsafe abortion in developing countries and highlight the need for improved access to post-abortion care. The provision of abortion services is changing to include the drug misoprostol and this could reduce the severity of abortion complications and the number of women who are hospitalised. Researchers will need to monitor these changes to provide countries with up-to-date information on illness and death from unsafe abortion. Improved contraceptive services are necessary to prevent unintended pregnancy. However, increasing access to safe abortion services is the most effective way of preventing the burden of unsafe abortion, and remains a high priority for developing countries.

Abortion, Illegal↗
PubMed2006

Sexual behaviour in context: a global perspective.

Research aimed at investigating sexual behaviour and assessing interventions to improve sexual health has increased in recent decades. The resulting data, despite regional differences in quantity and quality, provide a historically unique opportunity to describe patterns of sexual behaviour and their implications for attempts to protect sexual health at the beginning of the 21st century. In this paper we present original analyses of sexual behaviour data from 59 countries for which they were available. The data show substantial diversity in sexual behaviour by region and sex. No universal trend towards earlier sexual intercourse has occurred, but the shift towards later marriage in most countries has led to an increase in premarital sex, the prevalence of which is generally higher in developed countries than in developing countries, and is higher in men than in women. Monogamy is the dominant pattern everywhere, but having had two or more sexual partners in the past year is more common in men than in women, and reported rates are higher in industrialised than in non-industrialised countries. Condom use has increased in prevalence almost everywhere, but rates remain low in many developing countries. The huge regional variation indicates mainly social and economic determinants of sexual behaviour, which have implications for intervention. Although individual behaviour change is central to improving sexual health, efforts are also needed to address the broader determinants of sexual behaviour, particularly those that relate to the social context. The evidence from behavioural interventions is that no general approach to sexual-health promotion will work everywhere and no single-component intervention will work anywhere. Comprehensive behavioural interventions are needed that take account of the social context in mounting individual-level programmes, attempt to modify social norms to support uptake and maintenance of behaviour change, and tackle the structural factors that contribute to risky sexual behaviour.

Adolescent↗
PubMed2006

Timing of steps and reasons for delays in obtaining abortions in the United States.

OBJECTIVE: We studied the steps in the process of obtaining abortions and women's reported delays in order to help understand difficulties in accessing abortion services. METHODS: In 2004, a structured survey was completed by 1209 abortion patients at 11 large providers, and in-depth interviews were conducted with 38 women at four sites. RESULTS: The median time from the last menstrual period to suspecting pregnancy was 33 days; the median time from suspecting pregnancy to confirming the pregnancy was 4 days; the median time from confirming the pregnancy to deciding to have an abortion was 0 day; the median time from deciding to have an abortion to first attempting to obtain abortion services was 2 days; and the median time from first attempting to obtain abortion services to obtaining the abortion was 7 days. Minors took a week longer to suspect pregnancy than adults did. Fifty-eight percent of women reported that they would have liked to have had the abortion earlier. The most common reasons for delay were that it took a long time to make arrangements (59%), to decide (39%) and to find out about the pregnancy (36%). Poor women were about twice as likely to be delayed by difficulties in making arrangements. CONCLUSIONS: Financial limitations and lack of knowledge about pregnancy may make it more difficult for some women to obtain early abortion.

Abortion, Induced↗
PubMed2006

Induced abortion and unintended pregnancy in Guatemala.

CONTEXT: Although Guatemalan law permits induced abortion only to save a woman's life, many women obtain abortions, often under unsafe conditions and in response to an unintended pregnancy. Recent studies indicate that unsafe abortion is a key factor contributing to maternal morbidity and mortality in the country, but no national data on the incidence of abortion exist. METHODS: Surveys of all hospitals that treat women for postabortion complications and of 74 professionals who are knowledgeable about the conditions of abortion provision in Guatemala were conducted in 2003. Indirect estimation techniques were used to calculate the number of induced abortions performed annually. Abortion rates and ratios and the level of unintended pregnancy were calculated for the nation and its eight regions. RESULTS: Nearly 65,000 induced abortions are performed annually in Guatemala, and about 21,600 women are hospitalized for treatment of complications. Abortions occur at a rate of 24 per 1,000 women aged 15-49, and there is one abortion for every six births. The abortion rate is higher than average in the Southwest (less developed, mainly indigenous population) and Metropolitan (more developed, mainly nonindigenous population) regions (29-30 per 1,000 women). Over a quarter of all births are unplanned; combining unplanned births with abortions yields estimates that 32% of pregnancies in Guatemala are unintended, with an unintended pregnancy rate of 66 per 1,000 women. CONCLUSIONS: Unsafe abortion has a significant impact on women's health in Guatemala. Comprehensive government programs are needed to address the issues of unintended pregnancy and unsafe abortion, with attention to regional differences.

Abortion, Induced↗
PubMed2006

Changes in formal sex education: 1995-2002.

CONTEXT: Although comprehensive sex education is broadly supported by health professionals, funding for abstinence-only education has increased. METHODS: Using data from the 1995 National Survey of Adolescent Males, the 1995 National Survey of Family Growth (NSFG) and the 2002 NSFG, changes in male and female adolescents' reports of the sex education they have received from formal sources were examined. Life-table methods were used to measure the timing of instruction, and t tests were used for changes over time. RESULTS: From 1995 to 2002, reports of formal instruction about birth control methods declined among both genders (males, from 81% to 66%; females, from 87% to 70%). This, combined with increases in reports of abstinence education among males (from 74% to 83%), resulted in a lower proportion of teenagers' overall receiving formal instruction about both abstinence and birth control methods (males, 65% to 59%; females, 84% to 65%), and a higher proportion of teenagers' receiving instruction only about abstinence (males, 9% to 24%; females, 8% to 21%). Teenagers in 2002 had received abstinence education about two years earlier (median age, 11.4 for males, 11.8 for females) than they had received birth control instruction (median age, 13.5 for both males and females). Among sexually experienced adolescents, 62% of females and 54% of males had received instruction about birth control methods prior to first sex. CONCLUSIONS: A substantial retreat from formal instruction about birth control methods has left increasing proportions of adolescents receiving only abstinence education. Efforts are needed to expand teenagers' access to medically accurate and comprehensive reproductive health information.

Adolescent↗
PubMed2005

Adolescents' reports of parental knowledge of adolescents' use of sexual health services and their reactions to mandated parental notification for prescription contraception.

CONTEXT: Legislation has been proposed that would mandate parental notification for adolescents younger than 18 years (minors) obtaining prescription contraception from federally funded family planning clinics. OBJECTIVE: To determine the extent to which parents are currently aware that their teenage daughters are accessing reproductive health services and how minors would react in the face of mandated parental involvement laws for prescription birth control. DESIGN, SETTING, AND PARTICIPANTS: A total of 1526 female adolescents younger than 18 years seeking reproductive health services at a national sample of 79 family planning clinics were surveyed between May 2003 and February 2004. MAIN OUTCOME MEASURES: Proportions of minor females who reported that a parent or guardian was aware that they were at the family planning clinic and, under conditions of mandated parental involvement, proportions of minors who would access prescription contraceptives at family planning clinics or engage in unsafe sex. RESULTS: Sixty percent of minors reported that a parent or guardian knew they were accessing sexual health services at the clinic. Fifty-nine percent of all adolescents would use the clinic for prescription contraception even if parental notification were mandated. This response was less common (29.5%) among adolescents whose parents were unaware of their clinic visits and more common (79%) among those whose parents were aware. Many adolescents gave more than 1 response to mandated parental involvement. Forty-six percent would use an over-the-counter method, and 18% would go to a private physician. Seven percent said that they would stop having sex as one response, but only 1% indicated this would be their only reaction. One in 5 adolescents would use no contraception or rely on withdrawal as one response to mandated notification. CONCLUSIONS: Most minor adolescent females seeking family planning services report that their parents are aware of their use of services. Most would continue to use clinic services if parental notification were mandated. However, mandated parental notification laws would likely increase risky or unsafe sexual behavior and, in turn, the incidence of adolescent pregnancy and sexually transmitted diseases.

Adolescent↗
PubMed2005

Religious differentials in the sexual and reproductive behaviors of young women in the United States.

PURPOSE: To examine whether religious involvement and affiliation during early adolescence is associated with reduced levels of sexual risk. METHODS: We used nationally representative data from the 1995 National Survey of Family Growth (NSFG) to examine the relationship between religious affiliation and frequency of attendance at religious services at age 14 years and a range of sexual behaviors among women aged 15-24 years, including age of first intercourse, contraceptive use, timing of first family planning visit, timing of birth, and number of sexual partners. The majority of young women had mothers with at least a high school education (79%) and had been living with both parents at age 14 (57%). Two-thirds of the sample was white, 12% Hispanic, and 15% black, and a substantial minority is poor (18%) or low-income (24%). We used bivariate analysis to describe variation in behavior according to religious affiliation and frequency of attendance. We used multivariate techniques to assess the role of religion once other factors are taken into account. RESULTS: Bivariate relationships suggest that both affiliation and attendance are associated with age of first sex, contraceptive use at first sex, teen births, and number of sexual partners. However, most of these associations disappear once we control for young women's demographic characteristics. Multivariate analyses show that religious affiliation shares few associations with sexual behaviors, though frequent attendance at religious services at age 14 years continues to have a strong delaying effect on the timing of first intercourse. CONCLUSION: Frequency of attendance and religious affiliation have little impact on sexual behaviors once intercourse occurs.

Adolescent↗
PubMed2005

The incidence of induced abortion in the Philippines: current level and recent trends.

CONTEXT: In the Philippines, abortion is legally restricted. Nevertheless, many women obtain abortions--often in unsafe conditions--to avoid unplanned births. In 1994, the estimated abortion rate was 25 per 1,000 women per year; no further research on abortion incidence has been conducted in the Philippines. METHODS: Data from 1,658 hospitals were used to estimate abortion incidence in 2000 and to assess trends between 1994 and 2000, nationally and by region. An indirect estimation methodology was used to calculate the total number of women hospitalized for complications of induced abortion in 2000 (averaged data for 1999-2001), the total number of women having abortions and the rate of induced abortion. RESULTS: In 2000, an estimated 78,900 women were hospitalized for postabortion care, 473,400 women had abortions and the abortion rate was 27 per 1,000 women aged 15-44 per year. The national abortion rate changed little between 1994 and 2000; however, large increases occurred in metropolitan Manila (from 41 to 52) and Visayas (from 11 to 17). The proportions of unplanned births and unintended pregnancies increased substantially in Manila, and the use of traditional contraceptive methods increased in Manila and Visayas. CONCLUSION: The increase in the level of induced abortion seen in some areas may reflect the difficulties women experience in obtaining modern contraceptives as a result of social and political constraints that affect health care provision. Policies and programs regarding both postabortion care and contraceptive services need improvement.

Abortion, Induced↗
PubMed2005

The incidence of induced abortion in Uganda.

CONTEXT: Although Uganda's law permits induced abortion only to save a woman's life, many women obtain abortions, often under unhygienic conditions. Small-scale studies suggest that unsafe abortion is an important health problem in Uganda, but no national quantitative studies of abortion exist. METHODS: A nationally representative survey of 313 health facilities that treat women who have postabortion complications and a survey of 53 professionals who are knowledgeable about the conditions of abortion provision in Uganda were conducted in 2003. Indirect estimation techniques were applied to the data to calculate the number of induced abortions performed annually. Abortion rates, abortion ratios and unintended pregnancy rates were calculated for the nation and its four major regions. Data on contraceptive use and unmet need were obtained from Demographic and Health Surveys. RESULTS: Each year, an estimated 297,000 induced abortions are performed in Uganda, and nearly 85,000 women are treated for complications. Abortions occur at a rate of 54 per 1,000 women aged 15-49 and account for one in five pregnancies. The abortion rate is higher than average in the Central region (62 per 1,000 women), the country's most urban and economically developed region. It is also very high in the Northern region (70 per 1,000). Nationally, about half of pregnancies are unintended; 51% of married women aged 15-49 and 12% of their unmarried counterparts have an unmet need for effective contraceptives. CONCLUSIONS: Unsafe abortion exacts a heavy toll on women in Uganda. To reduce unplanned pregnancy and unsafe abortion, and to improve women's health, increased access to contraceptive services is needed for all women.

Abortion, Induced↗
PubMed2005

Reasons U.S. women have abortions: quantitative and qualitative perspectives.

CONTEXT: Understanding women's reasons for having abortions can inform public debate and policy regarding abortion and unwanted pregnancy. Demographic changes over the last two decades highlight the need for a reassessment of why women decide to have abortions. METHODS: In 2004, a structured survey was completed by 1,209 abortion patients at 11 large providers, and in-depth interviews were conducted with 38 women at four sites. Bivariate analyses examined differences in the reasons for abortion across subgroups, and multivariate logistic regression models assessed associations between respondent characteristics and reported reasons. RESULTS: The reasons most frequently cited were that having a child would interfere with a woman's education, work or ability to care for dependents (74%); that she could not afford a baby now (73%); and that she did not want to be a single mother or was having relationship problems (48%). Nearly four in 10 women said they had completed their childbearing, and almost one-third were not ready to have a child. Fewer than 1% said their parents' or partners' desire for them to have an abortion was the most important reason. Younger women often reported that they were unprepared for the transition to motherhood, while older women regularly cited their responsibility to dependents. CONCLUSIONS: The decision to have an abortion is typically motivated by multiple, diverse and interrelated reasons. The themes of responsibility to others and resource limitations, such as financial constraints and lack of partner support, recurred throughout the study.

Abortion, Induced↗
PubMed2005

Parent-child relations among minor females attending U.S. family planning clinics.

CONTEXT: Relatively little is known about parent-child relations among minor females who use family planning clinics. Such information could inform the debate on parental involvement legislation and help clinics develop effective strategies to promote positive parental engagement. METHODS: Self-administered surveys were completed in 2003-2004 by 1,526 women younger than 18 attending 79 U.S. family planning clinics, providing measures of parent-child relations, perceived parental attitudes toward sex and birth control, and parental knowledge of the clinic visit. Associations between relationships with parents and parental knowledge of clinic visits were examined using t tests and logistic regression. RESULTS: Many adolescents had talked to parents about sexual issues (50-80%, depending on the topic) and reported high levels of connectedness with parents (68%). A substantial minority (19%) perceived that parents disapprove of their both having sex and using birth control. The majority (60%) reported that a parent knew of their clinic visit; such reports were most common among those who had high levels of connectedness to parents and communication with parents about sexual issues, and those who did not perceive parents to disapprove of sex and birth control. Adolescents aged 15 and younger were more likely than 17-year-olds to indicate that a parent knew they were at the clinic and to report that a parent suggested the clinic. CONCLUSIONS: Overall, minors attending family planning clinics have good relations with parents. The youngest adolescents may be at family planning clinics specifically because parents are involved in their reproductive health decisions.

Adolescent↗
PubMed2004

A, B and C in Uganda: the roles of abstinence, monogamy and condom use in HIV decline.

Uganda is often cited as a role model in the fight against HIV/AIDS because of its success in reducing both prevalence and incidence of HIV infection since the late 1980s. Although an increase in sexual abstinence has been highlighted as a primary cause of the declines, large increases have also been recorded in monogamy and condom use. The extent to which each of these factors actually influenced the overall decline in Uganda's HIV rates has become a highly charged political issue in the United States, leading to restrictions on how US development funding for combatting HIV is allocated. The Alan Guttmacher Institute investigated changes that occurred in abstinence, monogamy and condom use in Uganda in the 1990s, using nationally representative data from Uganda's Demographic and Health Surveys of 1988 (women only), 1995 and 2000 (women and men), and national-level findings from two surveys by the Global Programme on AIDS in 1989 and 1995 (women and men). Reduction of infection risk by lowering numbers or types of partners among people with more than one relationship was not covered. Here we reprint the chapter on "Implications" from the AGI report, a commentary on the lessons that can and cannot be taken from the data, published in a 2003 Guttmacher Report on Public Policy.

Condoms↗
PubMed2002

Issues in measuring HIV prevalence: the case of Nigeria.

This article reviews methodologies and data sources that have been used to measure HIV prevalence and sexual behaviours associated with the transmission of HIV in Nigeria. The review includes 35 studies on HIV prevalence and methodology and 34 studies on sexual behaviour published between 1990 and 2000. As at 1999, 5.1-5.4% of the general population was estimated to be infected with HIV. Trend data, although limited, indicate that HIV prevalence is increasing among both the general population and specific subgroups. Data on sexual behaviours indicate that risk behaviours are very common in Nigeria while condom use remains low. Studies in local areas and on population subgroups indicate great variability in both HIV prevalence and sexual risk behaviour. Comparability of data is limited as a result of differences in design and measurement across studies. Also, there is a dearth of information on certain groups at high risk for HIV. Despite efforts to establish and improve HIV surveillance in Nigeria, this review illustrates limitations and challenges undoubtedly shared by other countries.

Adolescent↗
PubMedDate not supplied

Factors associated with the content of sex education in U.S. public secondary schools.

CONTEXT: While sex education is almost universal in U.S. schools, its content varies considerably. Topics such as abstinence, and basic information on HIV and other sexually transmitted diseases (STDs), are commonly taught; birth control and how to access STD and contraceptive services are taught less often. Factors potentially associated with these variations need to be examined. METHODS: Data on 1,657 respondents to a 1999 national survey of teachers providing sex education in grades 7-12 were assessed for variation in topics covered. Logistic regression was used to ascertain factors associated with instruction on selected topics. RESULTS: The content of sex education varied by region and by instructors' approach to teaching about abstinence and contraception. For example, teaching abstinence as the only means of pregnancy and STD prevention was more common in the South than in the Northeast (30% vs. 17%). Emphasizing the ineffectiveness of contraceptives was less common in the Northeast (17%) than in other regions (27-32%). Instructors teaching that methods are ineffective and presenting abstinence as teenagers' only option had significantly reduced odds of teaching various skills and topics (odds ratios, 0.1-0.5). CONCLUSIONS: Instructors' approach to teaching about methods is a very powerful indicator of the content of sex education. Given the well-documented relationship between what teenagers learn about safer sexual behavior and their use of methods when they initiate sexual activity, sex education in all U.S. high schools should include accurate information about condoms and other contraceptives.

Adolescent↗