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Abstract: Involuntary infertility and induced abortion exist on opposite sides of the spectrum: the first being the unwanted loss of childbearing potential while the second is the intentional termination of pregnancy. However, this paper proposes that these two poles of pregnancy loss are in fact related in Yoruba society, Nigeria. This argument is supported by qualitative and quantitative data drawn from an applied research project in communities and health institutions of Lagos State, from 1996 to 1999, where a total of 693 women recounted 1114 personal abortion experiences, and 233 women shared their experiences of fertility problems. Study statistics show that 37% of secondary infertility was most probably the result of induced abortion and that half of women with abortion complications interviewed in a referral hospital will have fertility problems. This paper provides insight into the reasons why single and married women decide to abort, and use unsafe methods, despite awareness of the serious health risks, including infertility. This is paradoxical given that fear of infertility is a major reason why women do not use modern contraceptives when trying to prevent unwanted pregnancy. By analysing the relations between infertility and abortion within the socio-cultural, economic, and services-related structures that influence women’s decisions, this paper suggests ways of addressing the problems related to both types of pregnancy loss. [Copyright &y& Elsevier]

Health systems' responsiveness encompasses attributes of health system encounters valued by people and measured from the user's perspective in eight domains: dignity, autonomy, confidentiality, communication, prompt attention, social support, quality of basic amenities and choice. The literature advocates for adjusting responsiveness measures for reporting behaviour heterogeneity, which refers to differential use of the response scale by survey respondents. Reporting behaviour heterogeneity between individual respondents compromises comparability between countries and population subgroups. It can be studied through analysing responses to pre-defined vignettes – hypothetical scenarios recounting a third person's experience in a health care setting. This paper describes the first comprehensive approach to studying reporting behaviour heterogeneity using vignettes. Individual-level variables affecting reporting behaviour are grouped into three categories: (1) sociodemographic, (2) health-related and (3) health value system. We use cross-sectional data from 150 000 respondents in 64 countries from the World Health Organization's World Health Survey (2002–03). Our approach classifies effect patterns for the scale as a whole, in terms of strength and in relation to the domains. For the final eight variables selected (sex; age; education; marital status; use of inpatient services; perceived health (own); caring for close family or friends with a chronic illness; the importance of responsiveness), the strongest effects were present for education, health, caring for friends or relatives with chronic health conditions, and the importance of responsiveness. Patterns of scale elongation or contraction were more common than uniform scale shifts and were usually constant for a particular factor across domains. The dependency of individual-level reporting behaviour heterogeneity on country is greatest for prompt attention, quality of basic amenities and confidentiality domains. [ABSTRACT FROM AUTHOR]

Racial disparities in outcomes of assisted reproductive technologies (ART) are well-documented, and evidence of racial disparities in other forms of fertility treatments has also been observed. To date, much of the research on these disparities has focused on individual-level causes. This paper contextualizes these disparities using the weathering hypothesis. Using the National Survey of Family Growth and exploratory analyses of the National Health and Nutrition Examination Survey, this study evaluates whether there is evidence of weathering among women of color seeking fertility treatments. The study finds inconsistent evidence of weathering among these groups. However, the study is limited by weaknesses in the available data. The paper demonstrates the promise and limits of the available data to answer empirical questions regarding disparities in fertility treatments that have spurred a national public health action plan and numerous commentaries from scholars and professional organizations. The paper concludes with a discussion of other possible causes of these disparities and a description of next steps needed in the field to better understand both the "under the skin" and social processes that underlie disparities in fertility treatment outcomes. • The weathering hypothesis is applied to race disparities in fertility treatments. • Evidence of weathering among treatment-seekers is inconsistent in two national surveys. • Expanded collection of data in national surveys is needed. • Continued development of social and institutional explanations is also necessary. [ABSTRACT FROM AUTHOR]

The internet is becoming a favored technology for carrying out survey research, and particularly sexual health research. However, its utility is limited by unresolved sampling questions such as how biased internet samples may be. This paper addresses this issue through comparison of a 'gold standard' random selection population-based sexual survey (The Swedish Sexual Life Survey) with an internet-based survey in Sweden which used identical demographic, sexual and relationship questions, to ascertain the biases and degree of comparability between the recruitment methods. On the internet questionnaire, there were significant differences between males and females on all the measured indices. There were no significant differences in proportions of males and females, or nationality, between the two samples. However, the internet samples for both males and females were significantly more likely to be younger, originally from and currently living in a major city, better educated, and more likely to be students and less likely to be retired. Relationship variables were less likely to be significantly different between samples: there were no differences for males or females between the SSS and the internet samples on having been in a committed relationship, and how they met their present partner, nor for males in having discussed separation in the past year. However, there was a higher proportion of people attracted to the same sex, and higher numbers of sex partners (as well as a higher proportion of people reporting no sex) in the past year, in the internet sample. These data suggest that apart from the demographics of age, location, and education, currently being in a committed relationship, and the number of sex partners in the past year, internet samples are comparable for relationship characteristics and history with a national sexual life survey. Comparison of internet data with random survey data in other western countries should occur to determine if these patterns are replicated. [ABSTRACT FROM AUTHOR]

While rationing is present in many health care systems, little empirical research has been undertaken to investigate the public''s preferences and information needs towards the rationing of their care. This paper reports the results of an interactive survey administered via an internet survey panel to investigate preferences for the provision of information about explicit rationing decisions. We presented a series of vignettes to respondents, describing hypothetical patients and explicit rationing decisions. In two different survey versions, patients were either characterized as matching or mismatching respondents’ age and gender.We observed strong preferences for the disclosure of rationing information to patients. Seventy one percent of responders expressed a general attitude in favor of explicitly informing patients about the rationing of their care. In the presented scenarios, the fraction supporting disclosure to patients ranged from 63% to 89%. The clinical situation described in the vignettes, a positive, general attitude towards the disclosure of rationing decisions, age, and gender of respondents were main predictors for participants’ votes. Preferences were relatively unaffected and insensitive to the matching of hypothetical patients and respondents’ characteristics. This study suggests that if doctors are to play an active role in health care rationing, patients expect them to honestly discuss the decisions made, the economics behind these and finally, to deal with those patients that do not accept the final decision. [Copyright &y& Elsevier]

Malawi is one of the world''s most AIDS-afflicted countries. In order to cope with the AIDS pandemic, we must know what the people most at risk think about it, how they evaluate their situation and that of their community, and what actions they would consider adopting to lower their risk. However, the main research methods in studying attitudes—surveys and questionnaires—have only a limited ability to capture what people think about AIDS. In order to get a more naturalistic perspective on attitudes towards AIDS from 1999 to 2001 six Malawian research assistants who lived in rural villages were asked to keep journals in which they wrote down information about all the conversations they participated in or witnessed in which the topic of AIDS surfaced in any way. The conversations ranged from graveside condolences following a funeral to stories told during men—only beer—drinking sessions, to women chatting on the bus. In this paper, I analyse these journals in order to see how men talk about AIDS in naturalistic settings, what they perceive as the impact of the AIDS epidemic, and how they understand AIDS risk. [Copyright &y& Elsevier]