Also in this issue of International Perspectives on Sexual and Reproductive Health :
"Fertility Among Orphans in Rural Malawi: Challenging Common Assumptions About Risk and Mechanisms," by by Rachel Kidman of Stony Brook University and Philip Anglewicz
"Risk for Coerced Sex Among Female Youth in Ghana: Roles of Family Context, School Enrollment And Relationship Experience," by Jeffrey Bingenheimer of George Washington University and Elizabeth Reed of the University of California at San Diego
"Gender-Based Power and Couples’ HIV Risk In Uttar Pradesh and Uttarakhand, North India," by Alpna Agrawal, Shelah S. Bloom, Chirayath Suchindran, Siân Curtis and Gustavo Angeles
Comment: "Achieving the Goal of the London Summit on Family Planning By Adhering to Voluntary, Rights-Based Family Planning: What Can We Learn from Past Experiences with Coercion?," by Karen Hardee, Shannon Harris, Mariela Rodriguez, Jan Kumar, Lynn Bakamjian, Karen Newman and Win Brown
While there are no official eligibility requirements for obtaining modern contraceptives in Senegal, health care providers often impose their own age and marital status restrictions on women seeking family planning services. According to "Young Women’s Access to and Use of Contraceptives: The Role of Providers’ Restrictions in Urban Senegal," by Estelle M. Sidze of the African Population and Health Research Center, et al., more than half (57%) of the public-sector providers surveyed applied age restrictions to provision of the pill and slightly fewer than half (44%) to provision of the injectable―the two methods most often used by young women in urban Senegal. In private facilities, those proportions were 49% and 41%, respectively. The average minimum age providers required for contraceptive provision was 18.
Fewer providers applied eligibility restrictions on the basis of young women’s marital status. Even though one in 10 unmarried, sexually active young women have an unmet need for modern contraception, 12–14% of public-sector providers refused to supply the pill or the injectable to young unmarried women, leaving them vulnerable to unwanted pregnancy and its potential consequences, including unsafe abortion and early school dropout. Providers’ imposition of marital status restrictions reflects a long history of limiting family planning services in a socially conservative environment in which premarital sexual activity is frowned upon, especially for women.
The restrictions providers placed on young women varied with the characteristics of providers in the public sector, but not in the private sector. In the public sector, male providers were more likely than their female counterparts to impose age restrictions on provision of the injectable (54% vs. 39%), and nurses were more likely than other providers to apply age restrictions to provision of the pill (62% vs. 33–43%). Providers aged 40 or older were more likely than younger providers to refuse to prescribe the pill to unmarried women.
The researchers analyzed survey data from staff at facilities providing reproductive health services and from sexually active urban Senegalese women aged 15–29. They advise that staff in all facilities be trained and educated, with training targeted to the providers most likely to impose restrictions—men, nurses and older providers. They also recommend that national family planning service delivery protocols and policies make clear that adolescents are eligible for services, since leaving this unstated allows providers to define their own criteria.
"Young Women’s Access to and Use of Contraceptives: The Role of Providers’ Restrictions in Urban Senegal" by Estelle M. Sidze of the African Population and Health Research Center, et al., is currently available online in International Perspectives on Sexual and Reproductive Health.
REMINDER: As of the March 2015 issue, IPSRH will be published online only. In 2015, IPSRH will be available free to all readers through no-cost online institutional subscriptions from the JSTOR/Current Scholarship Program (CSP) and through the Guttmacher Web site.