Research

Sexual and reproductive behaviour and attitudes in Australia

The Australian Study of Health and Relationships, Australia's first survey of sexual behaviour and attitudes, has collected and collated data from telephone interviews of 19,300 respondents aged 16–59. Mean age at first vaginal intercourse has declined from over 19 among men and women born in the early 1940s to around 16 among those born in the 1980s. Contraceptive use at first intercourse has increased from less than 30% in the 1950s to over 90% in the 2000s. Men reported more sexual partners than women. Most people–85.3% of men and 89.5% of women–were in a regular heterosexual relationship. People with regular partners had had sex an average of 1.84 times a week in the four weeks before interview. Most respondents (96%) expected themselves and their partners not to have sex with other people, though 35% of men and 20% of women had not explicitly discussed this with their partner. Only 4.9% of all men and 2.9% of men in regular heterosexual relationships had had concurrent sexual partners in the last 12 months.

Of respondents apparently at risk of unplanned pregnancy, over 95% were using contraception at least some of the time. No women cited religious objections or lack of access to services as a reason for non-use. The most used methods were sterilisation of either partner (over 40% of users), oral contraceptives (34%) and condoms (21%). Of the women surveyed, 15.5% had experienced difficulty in becoming pregnant and 76.1% had been pregnant at least once; 33.4% had experienced a miscarriage and 22.6% a termination of pregnancy. Among women aged 50–59, 22.8% had first been pregnant as a teenager; this had declined to 16.9% among women aged 20–29. Some 15.6% of men had ever paid for sex, almost all for sex with a woman; 1.9% had paid for sex in the last year. Of people who had sex with casual partners, 44.6% of men and 35.4% of women reported consistent condom use in casual sex in the past six months; 86.8% of men who had anal intercourse with other men had always used condoms for casual sex in the last six months. Condom use was lower in regular relationships and among people using other contraceptive methods.¹

1.	Smith AMA, Rissel CE, Richters J, et al. Sex in Australia. Australian and New Zealand Journal of Public Health 2003;27(2):103–256. At: 〈www.latrobe.edu.au/ashr/〉.

Coercive sex in rural Uganda

In a study of coercive sex in a rural area of Uganda, 24.2% of the 4,262 women questioned had been forced to have sex at least once by their current sexual partner. Of these 10.3% reported a single incident of coercive sex, 73.4% said it occurred occasionally, 16.1% frequently and 0.2% always. In the majority of cases (78.2%), women were pushed, pulled or held down. On other occasions they were verbally threatened (21.4%), slapped (5.4%), intimidated (4.3%) or hit (1.3%). Yet only 8% of male respondents reported having coerced their partner into sex. Three major risk factors for coercion emerged from the study: younger age of the woman at first intercourse; alcohol consumption before sex by the man; and perceptions by the woman of the male partner's HIV risk. One possible explanation for this latter finding is that women may resist sex with partners they perceive to be at risk. Although in some cases this may result in successful negotiation by women to avoid sex, in a significant number of cases coercive sex will follow. In contrast to the findings regarding perceived risk, there was no correlation between sexual coercion and the actual HIV status of either male or female partners. There was also no correlation of risk with socio-economic status or alcohol consumption by the woman. These findings suggest that it is important to address sexual and physical violence in current HIV prevention programmes. ¹

1.	Koenig MA, Lutalo T, Zhao F, et al. Coercive sex in rural Uganda: prevalence and associated risk factors. Social Science and Medicine 2004;58:787–98.

Sexual behaviour among married rural Vietnamese women

This study regarding sex and sexuality in Vietnam among 25 rural northern Vietnamese women shows that they believe men should be initiators of sexual relations, and women remain passive. These women had almost never initiated sex. Many of them believed they had no right to refuse the sexual demands of their husbands. Communication between husband and wife about sex and sexuality was limited. However, the women were not passive in their relationships. They spoke gently to postpone sex, pretended not to know about their husbands' affairs and used sweet words to persuade their husbands to come back home.¹

1.	Song Ha V. The harmony of family and the silence of women: sexual behaviour among married women in two northern rural areas in Vietnam. From Jvnet at 〈[email protected]〉 26 August 2003.

What people tell their sexual partners

A youth-focused survey of 150,000 people in 34 countries in all world regions found that 45% of people would not tell their long-term partners if they were currently suffering from an STI, a figure that varied between 10% in Hungary and 90% in Malaysia. 51% would divulge the number of their previous sexual partners, but only 38% would admit to being unfaithful. About two-thirds talked about their sexual fantasies with their partners. ¹

1.	Durex global sex survey 2003. At: 〈www.durex.com〉.

Sex differences in infant mortality in India

There are more men than women in India, and this reversal of the male:female sex ratio compared to elsewhere in the world is partly due to sex selection but also to high levels of mortality in female infants. Of 7,012 live births (3,752 boys and 3,260 girls) in this study, there were 442 deaths in infants less than one year old. The mortality rate was 1.3 times higher in females (72 per 1000) than males (55 per 1000). The most common cause of death, diarrhoea, killed twice as many girls as boys, despite being relatively easy to prevent and treat. About 10% of deaths were unexplained; 19 of the 22 such deaths in infants under one month old were in female infants.¹

1.	Khanna R, Kumar JF, Sreenivas V, et al. Community based retrospective study of sex in infant mortality in India. BMJ 2003;327:126–29.

Proportion of children living with a single mother in 17 western countries

This study investigated patterns and periods of time children aged 0–15 have spent with a single mother, using data from the Fertility and Family Surveys of 17 western and eastern European countries, the USA, New Zealand and Canada.

The estimated proportion of children living with a single mother for some period of time range from about one in ten children in Italy (10.9%) to the highest in New Zealand and the US, where the mothers of about half of all children (49.0% and 51.3% respectively) will spend some time as single mothers. Six other countries, Sweden, Canada, Czech Republic, Germany, Austria and Latvia, have single parenting rates of over 30%. With the exception of Switzerland and Sweden, these rates are gradually rising. In the US and New Zealand a child can expect to spend over five years living with their mother but not their father. The equivalent figure in Austria, Latvia and Germany is nearly four years and in Spain and Italy around one year. This does not necessarily mean they are living with only their mother as their mother may have found another partner.

The two routes to having a single parent are being born to a single mother and the separation of parents; the latter route is the more important. In all the countries studied, married parents are two to four times less likely to separate than cohabiting parents. However, married couples in the US are more likely to separate than cohabiting couples in Sweden. Thus, variations between countries reflect social pressures on single mothers to marry, the acceptability of divorce and cohabitation, and rates of remarriage. Nevertheless, the overall trend is that childrearing in western countries is increasingly being shifted to single mothers.¹

1.	Heaveline P, Timberlake JM, Furstenberg FF Jr. Shifting childrearing to single mothers: results from 17 Western countries. Population and Development Review 2003;29(1):47–71.

Prospects of a vaccine to prevent malaria in first pregnancies

Malaria infection in pregnancy commonly results in high parasitaemia and anaemia in the mother and low birthweight in the baby, and may lead to the death of up to 370,000 infants a year worldwide. Women who live in endemic areas, and who have therefore developed partial immunity, are more susceptibile to malaria during pregnancy than non-pregnant women. The reason why has not been successfully explained. Theories put forward, such as that pregnant women are generally immunosuppressed or that the placenta is a particularly nutritious niche for the malaria parasite, do not explain why increased susceptibility lessens with each subsequent pregnancy after the first. The recent discovery that parasites isolated from the placenta of infected mothers attach to a molecule which is only found in the placenta, may help to explain this phenomenon, however. Experiments using sera from multiparous women across the world suggest that women can develop antibodies to of the parasite, antibodies which are not found in men or in women in their first pregnancy. This suggests the possibility of the development of a targeted vaccine against pregnancy-related malaria. ¹

1.	McCarthy M. Preventing pregnancy malaria. Lancet 2004;363:132–33.

Cardiovascular diseases the biggest killer of women

Although emphasis is put on women's health problems such as breast and cervical cancer, death in childbirth, and infections such as malaria, tuberculosis and HIV, the latest findings from the WHO MONICA project are that cardiovascular diseases are the biggest killer of women worldwide, claiming 8.6 million women's lives annually. Most of these deaths are in countries with low or medium income, and it is estimated that by 2010 cardiovascular diseases will be the leading cause of death in developing countries. Cardiovascular diseases include conditions such as coronary heart disease, cerebrovascular disease, hypertension, heart failure and rheumatic heart disease. Contrary to popular belief, women are more likely to die from these than men. Life-style changes such as stopping smoking, eating healthily, alcohol in moderation, maintaining a healthy weight and taking regular exercise could help to prevent up to half of these deaths. Raising awareness among women of the risk of heart disease and a more proactive approach by health care professionals are needed to address this problem. ¹

1.	The greatest threat to women's health [Editorial]. Lancet 2003;362:1165.

Breast cancer incidence varies with socio-economic status in Denmark

Breast cancer is the most common cancer in women in the western world, with a lifetime incidence of 1 in 10. The incidence in Denmark rose from 43 per 100,000 women in 1945 to 83 per 100,000 women in 1996, although mortality increased less during the same period, from 23 to 27 per 100,000 women. This study shows that the risk of developing breast cancer in Denmark varies between the different socio-economic groups, with academics (women with at least 5 years university education) having twice the risk of agriculture workers. Those in urban trade (self-employed and in small companies), functionaries (office workers, teachers and nurses), skilled workers, unskilled workers and the economically inactive were intermediate between the two groups. There was no difference in health care parameters or age distribution between the groups.¹

1.	Dano H, Andersen O, Ewertz M, et al. Socioeconomic status and breast cancer in Denmark. International Journal of Epidemiology 2003;32:218–24.

Varicocele repair fails to improve pregnancy rates

Varicocele (varicose veins in the scrotum) is often quoted as a well-established cause of male subfertility, and varicocele repair is widely used as a treatment for male subfertility. This systematic review of seven studies on such repairs records a total of 61 pregnancies among 281 (22%) treated couples, compared with 50 among 259 (19%) controls. Although the numbers are small, varicocele repair did not seem to be an effective treatment for male subfertility. ¹

Waiting for medical exam, Kuekoue, Côote d'Ivoire, 2003

1.	Evers JLH, Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Lancet 2003;361:1849–52.