Educational homogamy lowers the odds of reproductive failure

Assortative mating based on education is a common phenomenon. We investigated whether it affected parameters of reproductive performance such as childlessness, offspring number and age at first marriage. On the basis of the US census from 1980 (n = 670,631 married US couples), we find that the proportion of childless individuals is usually minimal in women married to a husband of the same educational level. This holds particularly true in the highest and the lowest educated women. Educational homogamy is also associated with a lower average age at first marriage. No obvious effect of educational homogamy on a woman''s average offspring number is found, where mean offspring number generally increases both with decreasing woman''s and decreasing husband''s educational attainment. We conclude that educational homogamy reduces the likelihood of reproductive failure.     

Father's physique influences mate preferences but not the actual choice of male somatotype in heterosexual women and homosexual men

Body constitution plays an important role in human mate choice. Cross-cultural research reports that women on average prefer men with muscular physique. It is still unclear, however, what mechanisms influence the inter-individual variation in mate preferences and choices of partner's physique. In this study, we tested the mechanisms of an imprinting-like effect (similarity between father and an ideal and actual partner) and of homogamy (similarity between self and an ideal and actual partner) for male physique in heterosexual women and homosexual men. To assess the variation in male physique, we employed somatotype paradigm which characterizes body constitution using three components: endomorphic (heavy-set), mesomorphic (muscular), and ectomorphic (lean). In total, 149 homosexual men and 769 heterosexual women from the Czech Republic indicated the somatotype of their father, ideal and actual partner, and in homosexual men also their own somatotype. In line with previous research, the somatotype most preferred by both men and women was the mesomorphic, followed by the ectomorphic and the endomorphic one. Women's preferences for an ideal partner somatotype weakly correlated with their fathers' somatotype, especially in women who reported a positive relationship with their fathers during childhood. Among homosexual men, we found imprinting-like preferences only for the ectomorphic somatotype component and no significant association with the quality of their relationships with their fathers. We also found no significant relationship between the fathers' and actual partners' somatotype in either heterosexual women or homosexual men. Our research indicates that fathers have a rather weak influence on mate preference for somatotypes and no influence on actual mate choice.     

Circumcision of male children for reduction of future risk for HIV: acceptability among HIV serodiscordant couples in Kampala, Uganda

Introduction

The ultimate success of medical male circumcision for HIV prevention may depend on targeting male infants and children as well as adults, in order to maximally reduce new HIV infections into the future.

Methods

We conducted a cross-sectional study among heterosexual HIV serodiscordant couples (a population at high risk for HIV transmission) attending a research clinic in Kampala, Uganda on perceptions and attitudes about medical circumcision for male children for HIV prevention. Correlates of willingness to circumcise male children were assessed using generalized estimating equations methods.

Results

318 HIV serodiscordant couples were interviewed, 51.3% in which the female partner was HIV uninfected. Most couples were married and cohabiting, and almost 50% had at least one uncircumcised male child of ≤18 years of age. Overall, 90.2% of male partners and 94.6% of female partners expressed interest in medical circumcision for their male children for reduction of future risk for HIV infection, including 79.9% of men and 87.6% of women who had an uncircumcised male child. Among both men and women, those who were knowledgeable that circumcision reduces men''s risk for HIV (adjusted prevalence ratio [APR] 1.34 and 1.14) and those who had discussed the HIV prevention effects of medical circumcision with their partner (APR 1.08 and 1.07) were significantly (p≤0.05) more likely to be interested in male child circumcision for HIV prevention. Among men, those who were circumcised (APR 1.09, p = 0.004) and those who were HIV seropositive (APR 1.09, p = 0.03) were also more likely to be interested in child circumcision for HIV prevention.

Conclusions

A high proportion of men and women in Ugandan heterosexual HIV serodiscordant partnerships were willing to have their male children circumcised for eventual HIV prevention benefits. Engaging both parents may increase interest in medical male circumcision for HIV prevention.     

Symbolic violence and sexualities in the myth making of Mexican national identity

Symbolic violence has the capability to transform aspects of gender, race, ethnicity and sexuality and it is portrayed in a vast iconography, from myth, historic documents, prints and drawings. In this article I focus on two constructions of national identity that are entwined with gender and sexual roles: first, the mestizo myth, or the narrative of the common ethnic origins of the Mexican nation, and, second, the popular consumption of this national myth in the form of pictures and drawings depicting mestizo couples, the progenitors of idealized Mexican families conforming an integrative nation. To illustrate my argument I have used newspaper articles written by nineteenth-century women and picture cards of calendars and almanacs (mid-twentieth century) which give account of roles of sexuality and gender in shaping the nationalist mythology of common origin.     

Risk of Death or Life-Threatening Injury for Women with Children Not Sired by the Abuser

Women who are abused by their male intimate partners incur many costs, ranging in severity from fleeting physical pain to death. Previous research has linked the presence of children sired by a woman’s previous partner to increased risk of woman abuse and to increased risk of femicide. The current research extends this work by securing data from samples of 111 unabused women, 111 less severely abused women, 128 more severely abused women, and 26 victims of intimate partner femicide from the Chicago Women’s Health Risk Study to document an ordinal trend in the risk of experiencing more severe forms of violence for women who have children in the household sired by a previous partner. The discussion addresses two potential explanations for this trend and highlights directions for future research.     

Risk Factors for Men’s Lifetime Perpetration of Physical Violence against Intimate Partners: Results from the International Men and Gender Equality Survey (IMAGES) in Eight Countries

This paper examines men’s lifetime physical intimate partner violence (IPV) perpetration across eight low- and middle-income countries to better understand key risk factors that interventions can target in order to promote gender equality and reduce IPV. We use data from men (n = 7806) that were collected as part of the International Men and Gender Equality Survey (IMAGES) in Bosnia and Herzegovina, Brazil, Chile, Croatia, Democratic Republic of Congo (DRC), India, Mexico, and Rwanda. Results show that there is wide variation across countries for lifetime self-reported physical violence perpetration (range: 17% in Mexico to 45% in DRC), men’s support for equal roles for men and women, and acceptability of violence against women. Across the sample, 31% of men report having perpetrated physical violence against a partner in their lifetime. In multivariate analyses examining risk factors for men ever perpetrating physical violence against a partner, witnessing parental violence was the strongest risk factor, reinforcing previous research suggesting the inter-generational transmission of violence. Additionally, having been involved in fights not specifically with an intimate partner, permissive attitudes towards violence against women, having inequitable gender attitudes, and older age were associated with a higher likelihood of ever perpetrating physical IPV. In separate analyses for each country, we found different patterns of risk factors in countries with high perpetration compared to countries with low perpetration. Findings are interpreted to identify key knowledge gaps and directions for future research, public policies, evaluation, and programming.     

Population demographic structure of the city of Ulan Ude: Ethnic composition and age at marriage

The marriage structure of the population of Ulan Ude, the capital of Buryat Republic, which is characterized by a mixed ethnic composition, has been studied. Differences between Ulan Ude districts in a number of genetic demographic parameters have been found. In ethnic terms, the city district populations differ from one another in the number of ethnic groups and the proportions of the largest groups (Russians and Buryats). In the total Ulan Ude population, the proportions of Russian men and women among persons contracting marriages are 71.44 and 73.79%, respectively; those of Buryat men and women are 23.36 and 22.79%, respectively. The total proportion of all other ethnic groups among both men and women contracting marriages is no more than 5.2%. The mean ages at first marriage in both indigenous and immigrant populations of Ulan Ude are relatively old; these values are 25.9 and 24.72 years for Buryat men and women and 24.86 and 22.69 for non-indigenous men and women, respectively.     

Relationship Factors and Trajectories of Intimate Partner Violence among South African Women during Pregnancy and the Postpartum Period

Intimate partner violence (IPV) is a significant public health problem in South Africa. However, there is limited research on whether and how IPV changes during pregnancy and the postpartum period and on the factors that might affect women''s risk during this time. In this study, we describe the mean trajectories of physical and psychological IPV during pregnancy and the postpartum period and examine whether relationship power, partner social support, and relationship stress are associated with women''s trajectories of IPV. Data come from a longitudinal study with 1,480 women recruited during pregnancy between May 2008 and June 2010 at a public clinic in Durban. Women completed behavioral assessments at their first antenatal visit, at fourteen weeks and at nine months postpartum. Women''s experiences of IPV were measured at all three time points and relationship power, partner social support and relationship stress were each measured at the baseline assessment. We used multilevel random coefficients growth modeling to build our models. The mean trajectory for both types of IPV was flat which means that, on average, there was not significant change in levels of IPV over pregnancy and the postpartum period. However, there was significant individual variability in trajectories of IPV over the study period. Women who had higher relationship power had lower levels of physical and psychological IPV over time than women with lower relationship power. Additionally, women with higher relationship stress and lower partner support had higher levels of psychological IPV at pregnancy. Interventions that maximize women''s relationship power and partner social support and minimize relationship stress during this transformative time are needed.     

The Contribution of Emotional Partners to Sexual Risk Taking and Violence among Female Sex Workers in Mombasa,Kenya: A Cohort Study

Objectives

To assess sexual risk-taking of female sex workers (FSWs) with emotional partners (boyfriends and husbands), compared to regular and casual clients. Experiences of violence and the degree of relationship control that FSWs have with emotional partners are also described.

Design

Cohort study with quarterly follow-up visit over 12-months.

Methods

Four hundred HIV-uninfected FSWs older than 16 years were recruited from their homes and guesthouses in Mombasa, Kenya. A structured questionnaire assessed participant characteristics and study outcomes at each visit, and women received risk-reduction counselling, male and female condoms, and HIV testing.

Results

Four or more unprotected sex acts in the past week were reported by 21.3% of women during sex with emotional partners, compared to 5.8% with regular and 4.8% with casual clients (P<0.001). Total number of unprotected sex acts per week was 5–6-fold higher with emotional partners (603 acts with 259 partners) than with regular or casual clients (125 acts with 456, and 98 acts with 632 clients, respectively; P<0.001). Mostly, perceptions of “trust” underscored unprotected sex with emotional partners. Low control over these relationships, common to many women (36.9%), was linked with higher partner numbers, inconsistent condom use, and being physically forced to have sex by their emotional partners. Half experienced sexual or physical violence in the past year, similarly associated with partner numbers and inconsistent condom use.

Conclusions

High-risk sexual behaviour, low control and frequent violence in relationships with emotional partners heighten FSWs'' vulnerability and high HIV risk, requiring targeted interventions that also encompass emotional partners.     

Is Younger Really Safer? A Qualitative Study of Perceived Risks and Benefits of Age-Disparate Relationships among Women in Cape Town,South Africa

Young women in age-asymmetric relationships may be at an elevated risk for acquisition of HIV, since relationships with older men are also correlated with other risk behaviors like less condom use. Qualitative studies have shown that women are motivated to participate in these relationships for money and emotional support. However, there is a paucity of research on women’s perceived risks of these relationships, particularly in South Africa. To this end, we conducted in-depth interviews with 23 women recruited from three urban communities in Cape Town. A thematic question guide was used to direct the interviews. Thematic content analysis was used to explore women’s perceived risks of age-disparate and non-age-disparate relationships, the benefits of dating older men, and risk perceptions that influence decisions around beginning or ending a relationship. A plurality of women thought that dating an older man does not bring any adverse consequences, although some thought that older men do not use condoms and may be involved in concurrent partnerships. Many women were less inclined to date same-age or younger men, because they were viewed as being disrespectful and abusive. This study points to the need for more awareness raising about the risks of age-disparate relationships. In addition to these initiatives, there is an urgent need to implement holistic approaches to relationship health, in order to curb intimate partner violence, improve gender equity and make non-age-disparate relationships more attractive.     

Intimate Partner Violence,Relationship Power Inequity and the Role of Sexual and Social Risk Factors in the Production of Violence among Young Women Who Have Multiple Sexual Partners in a Peri-Urban Setting in South Africa

Introduction

This paper aims to assess the extent and correlates of intimate partner violence (IPV), explore relationship power inequity and the role of sexual and social risk factors in the production of violence among young women aged 16–24 reporting more than one partner in the past three months in a peri-urban setting in the Western Cape, South Africa. Recent estimates suggest that every six hours a woman is killed by an intimate partner in South Africa, making IPV a leading public health problem in the country. While there is mounting evidence that levels of IPV are high in peri-urban settings in South Africa, not much is known about how it manifests among women who engage in concomitantly high HIV risk behaviours such as multiple sexual partnering, transactional sex and age mixing. We know even less about how such women negotiate power and control if exposed to violence in such sexual networks.

Methods

Two hundred and fifty nine women with multiple sexual partners, residing in a predominantly Black peri-urban community in the Western Cape, South Africa, were recruited into a bio-behavioural survey using Respondent Driven Sampling (RDS). After the survey, focus group discussions and individual interviews were conducted among young women and men to understand the underlying factors informing their risk behaviours and experiences of violence.

Findings

86% of the young women experienced IPV in the past 12 months. Sexual IPV was significantly correlated with sex with a man who was 5 years or older than the index female partner (OR 1.7, 95% CI 1.0–3.2) and transactional sex with most recent casual partner (OR 2.1, 95% CI 1.1–3.8). Predictably, women experienced high levels of relationship power inequity. However, they also identified areas in their controlling relationships where they shared decision making power.

Discussion

Levels of IPV among young women with multiple sexual partners were much higher than what is reported among women in the general population and shown to be associated with sexual risk taking. Interventions targeting IPV need to address sexual risk taking as it heightens vulnerability to violence.     

Prevalence of DNA-HPV in male sexual partners of HPV-infected women and concordance of viral types in infected couples

Investigation of HPV infection in men remains important due to its association with genital warts and anorectal cancer, as well as to the role men play in HPV transmission to their female sexual partners. Asymptomatic men (n = 43), whose sexual partners had presented cervical HPV infection, were enrolled in this study. Among the 43 men, 23 had their female partner included and tested for HPV-DNA, totaling 23 couples. HPV-DNA was detected by PCR. Type specific PCR to detect HPV 16, 18, 31, 33, 45 and 6/11 was performed. At least one type of HPV was detected in 86.0% (37/43) of the male patients and more than one HPV type was identified in 39.5% (17/43) of the samples, including high and low risk HPV. HPV-16 proved to be the most prevalent viral type in both male and female samples. Concordance of at least one viral type was observed in 56.5% (13/23) of the couples. Among couples that have shown concordance of viral types, 84.6% (11/13) of the men had the same high risk viral type presented by the female sexual partner. These data suggest that HPV infected men is an important reservoir, contributing to a higher transmission to women and maintenance of infection, and consequently, a higher risk of developing cervical cancer. HPV vaccination in men will protect not only them but will also have implications for their sexual partners.     

Physical violence against intimate partners and related exposures to violence among South African men

Background

Despite high rates of intimate partner violence in South Africa, there have been no national studies of men''s perpetration of violence against female partners.

Methods

We analyzed data from the South Africa Stress and Health Study, a cross-sectional, nationally representative study, specifically examining data for men who had ever been married or had ever cohabited with a female partner. We calculated the prevalence of physical violence against intimate female partners and used logistic regression to examine associations with physical abuse during childhood and exposure to parental and community violence.

Results

A total of 834 male participants in the South Africa Stress and Health Study met the study criteria. Of these, 27.5% reported using physical violence against their current or most recent female partner during their current or most recent marriage or cohabiting relationship. Crude odds ratios (ORs) and 95% confidence intervals (CIs) indicated significant associations between perpetration of violence against an intimate partner and witnessing parental violence (OR 3.91, 95% CI 2.66–5.73) or experiencing physical abuse during childhood (OR 3.24, 95% CI 2.27–4.63), but not exposure to community violence (OR 1.29, 95% CI 0.88–1.88). The 2 significant associations persisted in adjusted analyses: OR 3.22 (95% CI 1.94–5.33) for witnessing parental violence and OR 1.73 (95% CI 1.07–2.79) for experiencing physical abuse during childhood.

Interpretation

We found a high prevalence of physical violence perpetrated by men against their intimate partners. Men who experienced physical abuse during childhood or were exposed to parental violence were at the greatest risk.Most research about men''s perpetration of violence against female intimate partners has concentrated on elucidating the factors that put women at risk for experiencing such violence and identifying the related service needs. Less work has been done to investigate the factors affecting men''s risk of perpetrating violence against women. Such work is needed to inform development of empirically based public health programs to reduce men''s use of such violence. Intimate partner violence is of pandemic proportions, with global estimates indicating that 15% to 75% of women have experienced such abuse.^1,2 Such violence may confer grave health consequences, including transmission of HIV/AIDS.³The overwhelming majority of research on violence against intimate partners perpetrated by men has been conducted in Western countries, with the focus on men at high risk for such activity (e.g., prisoners, people enrolled in intervention programs for batterers).^4,5 This work has highlighted the importance of exposure to violence early in life (e.g., witnessing parental violence, experiencing child abuse) in predicting perpetration of violence against a partner during adulthood.⁶ Recently, the potential relations between community violence and men''s perpetration of violence against intimate partners have also been examined.⁷Fewer studies have been done in developing nations, but several notable investigations have recently assessed men''s perpetration of violence against intimate partners in South Africa, specifically in Eastern Cape and Cape Town. Two of these studies have indicated high rates of violence against intimate partners: 31.8% in Eastern Cape⁸ and 42.3% in Cape Town.⁹ The extent to which these findings reflect national rates is unknown. Furthermore, work with both men and women in South Africa has demonstrated strong relations between violence (men''s perpetration and women''s victimization) and higher rates of sexually risky behaviours.^3,8 Associations between women''s experience as victims of intimate partner violence and HIV infection have also been documented.³ These data strongly suggest that men''s perpetration of violence against intimate partners is common in South Africa and that it may play an important role in this nation''s HIV epidemic,^3,8 which currently ranks highest in the world with respect to the number of people living with HIV.¹⁰In the study reported here, we sought to build upon prior work by using a national sample of South African men to examine the prevalence of physical violence perpetrated by men against their female intimate partners and potential violence-related risk factors (i.e., exposure to parental violence, experience of abuse in childhood and exposure to community violence).     

Addressing the conflict between partner notification and patient confidentiality in serodiscordant relationships: How can Ubuntu help?

This study evaluates the conflict between patient confidentiality and partner notification in sero‐discordant relationships, and argues the thesis that based on a theoretical formulation of Ubuntu, a health provider is obliged to facilitate friendly relationships in which individuals are true subjects and/or objects of communal friendship. In serodiscordant relationships, the health professional can fulfil this obligation by notifying “others” (particularly a partner with whom an HIV positive patient has a “present” and “actual relationship”) of their spouse's HIV seroconversion, since without such relevant information a partner (subject) of an HIV positive patient cannot “appropriately” care for the patient's condition (object). There is a need to move away from the medical traditional emphasis that has for so long put primacy on doctor‐patient confidentiality as is the case with the Health Professions Council of South Africa Guidelines (Booklet 12) which favours patient confidentiality over partner notification. Given empirical evidence to support effectiveness of partner notification amongst sero‐discordant couples, there is thus, a need to focus emphasis on latter. This shift is necessary for achieving the United Nations’ Sustainable Development of Goal of ending HIV/AIDS epidemic by 2030. I proposed in this study that African ethics, specifically Ubuntu, will do a better job than current ethical frameworks at ensuring that partner notification receives more emphasis in the care of serodiscordant couples. If this framework is integrated into ethical guidelines and codes, it would significantly enhance the care of serodiscordant couples, as well as further boost global effort at ending HIV/AIDS epidemic by 2030.     

High Rates of HIV Seroconversion in Pregnant Women and Low Reported Levels of HIV Testing among Male Partners in Southern Mozambique: Results from a Mixed Methods Study

Introduction

Prevention of acute HIV infections in pregnancy is required to achieve elimination of pediatric HIV. Identification and support for HIV negative pregnant women and their partners, particularly serodiscordant couples, are critical. A mixed method study done in Southern Mozambique estimated HIV incidence during pregnancy, associated risk factors and factors influencing partner''s HIV testing.

Methods

Between April 2008 and November 2011, a prospective cohort of 1230 HIV negative pregnant women was followed during pregnancy. A structured questionnaire, HIV testing, and collection of dried blood spots were done at 2–3 scheduled visits. HIV incidence rates were calculated by repeat HIV testing and risk factors assessed by Poisson regression. A qualitative study including 37 individual interviews with men, women, and nurses and 11 focus group discussions (n = 94) with men, women and grandmothers explored motivators and barriers to uptake of male HIV testing.

Results

HIV incidence rate was estimated at 4.28/100 women-years (95%CI: 2.33–7.16). Significant risk factors for HIV acquisition were early sexual debut (RR 3.79, 95%CI: 1.04–13.78, p = 0.04) and living in Maputo Province (RR 4.35, 95%CI: 0.97–19.45, p = 0.05). Nineteen percent of women reported that their partner had tested for HIV (93% knew the result with 8/213 indicating an HIV positive partner), 56% said their partner had not tested and 19% did not know their partner test status. Of the 14 seroconversions, only one reported being in a serodiscordant relationship. Fear of discrimination or stigma was reported as a key barrier to male HIV testing, while knowing the importance of getting tested and receiving care was the main motivator.

Conclusions

HIV incidence during pregnancy is high in Southern Mozambique, but knowledge of partners'' HIV status remains low. Knowledge of both partners'' HIV status is critical for maximal effectiveness of prevention and treatment services to reach elimination of pediatric HIV/AIDS.     

A community mobilisation intervention to prevent violence against women and reduce HIV/AIDS risk in Kampala, Uganda (the SASA! Study): study protocol for a cluster randomised controlled trial

ABSTRACT: BACKGROUND: Gender based violence, including violence by an intimate partner, is a major global human rights and public health problem, with important connections with HIV risk. Indeed, the elimination of sexual and gender based violence is a core pillar of HIV prevention for UNAIDS. Integrated strategies to address the gender norms, relations and inequities that underlie both violence against women and HIV/AIDS are needed. However there is limited evidence about the potential impact of different intervention models. This protocol describes the SASA! Study: an evaluation of a community mobilisation intervention to prevent violence against women and reduce HIV/AIDS risk in Kampala, Uganda. METHODS: The SASA! Study is a pair-matched cluster randomised controlled trial being conducted in eight communities in Kampala. It is designed to assess the community-level impact of the SASA! intervention on the following six primary outcomes: attitudes towards the acceptability of violence against women and the acceptability of a woman refusing sex (among male and female community members); past year experience of physical intimate partner violence and sexual intimate partner violence (among females); community responses to women experiencing violence (among women reporting past year physical/sexual partner violence); and past year concurrency of sexual partners (among males). 1583 women and men (aged 18-49 years) were surveyed in intervention and control communities prior to intervention implementation in 2007/8. A follow-up cross-sectional survey of community members will take place in 2012. The primary analysis will be an adjusted cluster-level intention to treat analysis, comparing outcomes in intervention and control communities at follow-up. Complementary monitoring and evaluation and qualitative research will be used to explore and describe the process of intervention implementation and the pathways through which change is achieved. DISCUSSION: This is one of few cluster randomised trials globally to assess the impact of a gender-focused community mobilisation intervention. The multi-disciplinary research approach will enable us to address questions of intervention impact and mechanisms of action, as well as its feasibility, acceptability and transferability to other contexts. The results will be of importance to researchers, policy makers and those working on the front line to prevent violence against women and HIV.     

‘Leemos!’: Perceptions of ethnic identity among settlers in north west river,Labrador*’

The influence of gender on patterns of ethnic violence in ex‐Yugoslavia has commanded considerable international attention. This article acknowledges the groundbreaking role of feminist scholarship in bringing the gender variable to the forefront in analyses of political and interpersonal violence. However, feminist applications of gender frameworks are to some extent constrained by feminism's normative commitments. The present article argues for a more balanced and inclusive understanding of the role gender plays in conditioning the actions and experiences of men and women alike, in the Balkans war and other conflicts. Towards this end, a detailed evaluation of gender‐specific and gender‐selective violence in ex‐Yugoslavia is presented, with particular attention to the group that appears to constitute the majority of victims ‐ males between the ages of eighteen and sixty‐five. The article concludes by stressing the importance of the gender variable in analysing ethnic and political violence, and suggests that a more nuanced approach to this variable's operations would shed important light on ethnic violence in ex‐Yugoslavia and worldwide.     

Development of the Partner’s Treatment of Animals Scale

Although studies of the relationship between animal abuse and intimate partner violence have proliferated in recent years, building upon previous work and making cross-study comparisons have been rendered difficult by the utilization of differing operationalizations of animal maltreatment within this literature. This paper aims to mitigate this problem by introducing and detailing a scale of animal maltreatment by romantic partners, developed and tested with a sample of 55 women in domestic violence shelters who self-identified as victims of intimate partner violence. The Partner’s Treatment of Animals Scale (PTAS) is comprised of five scales (emotional animal abuse, threats to harm animals, animal neglect, physical animal abuse, and severe physical animal abuse) that have strong demonstrated reliability. The construction of the scales is presented in this paper, and recommendations are made for employing the PTAS in subsequent studies.     

Institutional Delivery and Satisfaction among Indigenous and Poor Women in Guatemala,Mexico, and Panama

Indigenous women in Mesoamerica experience disproportionately high maternal mortality rates and are less likely to have institutional deliveries. Identifying correlates of institutional delivery, and satisfaction with institutional deliveries, may help improve facility utilization and health outcomes in this population. We used baseline surveys from the Salud Mesoamérica Initiative to analyze data from 10,895 indigenous and non-indigenous women in Guatemala and Mexico (Chiapas State) and indigenous women in Panama. We created multivariable Poisson regression models for indigenous (Guatemala, Mexico, Panama) and non-indigenous (Guatemala, Mexico) women to identify correlates of institutional delivery and satisfaction. Compared to their non-indigenous peers, indigenous women were substantially less likely to have an institutional delivery (15.2% vs. 41.5% in Guatemala (P<0.001), 29.1% vs. 73.9% in Mexico (P<0.001), and 70.3% among indigenous Panamanian women). Indigenous women who had at least one antenatal care visit were more than 90% more likely to have an institutional delivery (adjusted risk ratio (aRR) = 1.94, 95% confidence interval (CI): 1.44–2.61), compared to those who had no visits. Indigenous women who were advised to give birth in a health facility (aRR = 1.46, 95% CI: 1.18–1.81), primiparous (aRR = 1.44, 95% CI: 1.24–1.68), informed that she should have a Caesarean section (aRR = 1.41, 95% CI: 1.21–1.63), and had a secondary or higher level of education (aRR = 1.36, 95% CI: 1.04–1.79) also had substantially higher likelihoods of institutional delivery. Satisfaction among indigenous women was associated with being able to be accompanied by a community health worker (aRR = 1.15, 95% CI: 1.05–1.26) and facility staff speaking an indigenous language (aRR = 1.10, 95% CI: 1.02–1.19). Additional effort should be exerted to increase utilization of birthing facilities by indigenous and poor women in the region. Improving access to antenatal care and opportunities for higher-level education may increase institutional delivery rates, and providing culturally adapted services may improve satisfaction.     

Physical abuse during pregnancy: prevalence and risk factors

BACKGROUND: Violence during pregnancy is a health and social problem that poses particular risks to the woman and her fetus. To address the lack of Canadian information on this issue, the authors studied the prevalence and predictors of physical abuse in a sample of pregnant women in Saskatoon. METHODS: Of 728 women receiving prenatal services through the Saskatoon District public health system between Apr. 1, 1993, and Mar. 31, 1994, 605 gave informed consent to participate in the study and were interviewed in the second trimester. Of these, 543 were interviewed again late in the third trimester. During the initial interview, information was collected on the women''s sociodemographic characteristics, the current pregnancy, health practices and psychosocial variables. The second interview focused on the women''s experience of physical abuse during the pregnancy and during the preceding year, the demographic characteristics and the use of alcohol or illicit drugs by their male partner. RESULTS: In all, 31 (5.7%) of the women reported experiencing physical abuse during pregnancy; 46 (8.5%) reported experiencing it within the 12 months preceding the second interview. Of the 31 women 20 (63.3%) reported that the perpetrator was her husband, boyfriend or ex-husband. Although all ethnic groups of women suffered abuse, aboriginal women were at greater risk than nonaboriginal women (adjusted odds ratio 2.8, 95% confidence interval [CI] 1.0-7.8). Women whose partner had a drinking problem were 3.4 times (95% CI 1.2-9.9) more likely to have been abused than women whose partner did not have a drinking problem. Perceived stress and number of negative life events in the preceding year were also predictors of abuse. Abused women tended to report having fewer people with whom they could talk about personal issues or get together; however, they reported socializing with a larger number of people in the month before the second interview than did the women who were not abused. INTERPRETATION: Physical abuse affects a significant minority of pregnant women and is associated with stress, lack of perceived support and a partner with a drinking problem.