having a demand for contraception; those who want to wait at least two years before having a child or do not want any more children but are not using a contraceptive method are considered to have an unmet need for contraception. 2 ) For example, in Bihar, where the mean age at cohabitation after marriage is just 17, more than a third of married women aged 15-19 (34%) and 20-24 (40%) have a demand for contraception, and similar proportions (31% and 33%, respectively) have an unmeet need for contraception (primarily for spacing). 4,5 The benefits of contraceptive use by young couples in India are many, especially in states where the age at marriage is very low, and levels of fertility, population growth, infant and child mortality, and abortion are high. 6 Delaying first births until age 21 and increasing the interval between the first and second births would help lower infant and child mortality, 2,7 increase the mean age of childbearing and reduce India's high momentum effect* on population growth. 8 Cultural barriers impede young women in rural India, especially northern India (including Bihar), from postponing childbearing. Parents and relatives are eager to see newly married women become pregnant and give birth soon after marriage and cohabitation. Many fear that the capacity for childbearing may decline with age, and there- times those in comparison areas.Women in intervention areas had elevated odds of knowing that fertility varies during the menstrual cycle,and of agreeing that early childbirth can be harmful and that contraceptive use is necessary and safe for delaying first births (odds ratios,1.6-3.0). CONCLUSION: Culturally appropriate,community-based communication programs that target youth and those who influence their decisions can create demand for contraception among young couples and lead to increased contraceptive use.International Family Planning Perspectives,2008,34(4):189-197 By India is home to one-sixth of the world's population, and to 30% of youth aged 10-24. 1 There are more than 211 million 15-24-year-olds in India, 2 and they account for 48% of the country's fertility. The total fertility rate in 2005-2006 was 2.7 children per woman, but there was much variation among states, from 2.0 (below replacement level) in Kerala to 4.0 in Bihar and 4.6 in Meghalaya. 3 Early marriage and childbearing are common in India: The median age at marriage for females is 16.7, well below the legal age of 18, and 28% of women aged 20-49 gave birth before age 18. 1 Contraceptive use by mothers younger than 25 is negligible, resulting in short interpregnancy intervals. Women usually achieve their desired fertility of 2-3 children by age 25 and then adopt a permanent method.Although contraceptive use among women younger than 25 is low, the demand for contraception in this population is high. (The National Family Health Survey classifies married women who want to wait at least two years before having a child or do not want any more children as *The momentum effect in India can be explained as follows: Bec...

Cervix and Breast cancers are the most common cancers among women worldwide and extract a large toll in developing countries. In May 1998, supported by a grant from the NCI (US), the Tata Memorial Hospital, Mumbai, India, started a clusterrandomized, controlled, screening-trial for cervix and breast cancer using trained primary health workers to provide healtheducation, visual-inspection of cervix (with 4% acetic acid-VIA) and clinical breast examination (CBE) in the screening arm, and only health education in the control arm. Four rounds of screening at 2-year intervals will be followed by 8 years of monitoring for incidence and mortality from cervix and breast cancers. The methodology and interim results after three rounds of screening are presented here. Good randomization was achieved between the screening (n 5 75360) and control arms (n 5 76178). In the screening arm we see: High screening participation rates; Low attrition; Good compliance to diagnostic confirmation; Significant downstaging; Excellent treatment completion rate; Improving case fatality ratios. The ever-screened and never-screened participants in the screening arm show significant differences with reference to the variables religion, language, age, education, occupation, income and health-seeking behavior for gynecological and breast-related complaints. During the same period, in the control arm we see excellent participation rate for health education; Low attrition and a good number of symptomatic referrals for both cervix and breast.Of the estimated 470,000 new cases of cervix cancer diagnosed each year worldwide, 80% occur in developing countries and around 27% occur in India from where 126,000 new cases are diagnosed annually and over 71,000 deaths because of cervix cancer are reported each year.1,2 Nearly 70% of cervix cancer patients in India present at stages III and IV.3 Around 20% of women who develop cervix cancer die within the first year of diagnosis and the 5-year relative survival rate is 50%. 4 Breast cancer is the most common cancer among women worldwide and is also the leading cause of cancer deaths in women. Breast cancer is responsible for an estimated 189,000 and 184,000 deaths in developed and developing countries respectively thus accounting for 16% and 12% of all cancer deaths in women. Although the age-standardized incidence of breast cancer is generally lower in developing countries than in developed countries (23.1 vs. 63.2 per 100,000 women), incidence rates are seen to vary widely between and within countries. Breast cancer is already more common than cervix cancer in a number of developing countries.5 Data from developing countries suggests that age-standardized incidence rates of breast cancer are rising rapidly in low-incidence regions such as Africa and Asia. 6 There are no organized screening programmes for cervix and breast cancers in India. Cervix Cytology and Mammography based screening programmes are difficult to organize in India because of issues related to absence of trained manpower, infrastructu...

Critical program elements to improving voluntary contraceptive use among married youth included: (1) use of a socioecological intervention model of behavior change; (2) engaging both women and men; and (3) calibrating interventions to different moments in the life cycle of adolescents and youth. Trade-offs between intensive NGO-led models and less intensive government-led models occurred in effectiveness, scale of interventions, and sustained behavior changes.

The association of multipronged reproductive health programs like PRACHAR with contraceptive awareness and practices may last for years beyond the project's conclusion.

This article examined the association among polyvictimization, sex work, and depressive symptomology among transgender women and men who have sex with men (MSM) in India. Data comes from a cross-sectional epidemiological study with 1,366 transgender women (from three states) and 2,182 MSM participants from five states of India. Multivariate regressions were used to examine how polyvictimization and sex work are associated with depressive symptoms. In total, 70% of transgender women and 44% of MSM participants in the sample reported being in sex work; 30% of transgender women and 17% of MSM reported at least one experience of abuse in last 6 months. In bivariate analysis, transgender women in sex work were more likely to report sexual abuse, and MSM in sex work more likely to report all types of abuse (physical, sexual, verbal, and property), compared to their peers. In multivariate models (with transgender women and MSM), increase in endorsement on types of abuses (polyvictimization) and being in sex work were associated with higher odds of reporting depressive symptoms. Both models controlled for age and marital status, while the model with transgender women also controlled for gender transitioning, and the model with MSM controlled for identity typology. National intervention program on HIV risk reduction must prioritize victimization screening and crisis management as part of their work. In addition, the interventions must be responsive to the diversity of the population, including those who engage in sex work, and address issues of access and support to gender transitioning services, and focus on psychosocial interventions to reduce stress due to gender-based stigma and discrimination among transgender women and MSM.