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DECEMBER 2012 ISSUE OF
PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH
Under our Early View feature, articles in Perspectives on Sexual and Reproductive Health are published online as they complete the production process, which allows us to get material to you weeks before the printed journal arrives in your mailbox. Sign up at this link to receive an alert when new materials become available.
HERE'S WHAT YOU CAN FIND IN THE DECEMBER ISSUE OF PERSPECTIVES:
Teens' sexual behavior may not predict reproductive health outcomes in young adulthood
Findings from a new study suggest that most teens' first sexual experiences may not be as strongly linked to reproductive health outcomes later in life as previously thought, according to "Associations Between Patterns of Emerging Sexual Behavior and Young Adult Reproductive Health" by Abigail A. Haydon of the National Institutes of Health et al. The authors simultaneously considered multiple characteristics related to teens' sexual experience—the types of activities they engaged in and the timing of initiation of those activities—to assess the interrelationships between patterns of behaviors and selected outcomes. They found that the most frequent pattern of sexual behavior during adolescence involved initiation of vaginal sex and then another behavior (typically oral sex) within two years. When compared with young adults reporting this pattern of behavior, only those teens who had postponed sexual activity were consistently less likely to have poor reproductive health outcomes and engage in sexual risk-taking in young adulthood, even when demographic and other important characteristics were controlled for. However, the authors caution that the "postponer" category of teens is not typical, making up fewer than one in 10 American teens. Outcomes for those reporting other patterns of early sexual behavior, including patterns considered high-risk, varied.
The authors found evidence of significant differences in reproductive health outcomes and sexual risk-taking across racial and ethnic groups, even when patterns of teenage sexual behavior were taken into account. Specifically, black and Hispanic teens in each sexual behavior category were the most likely to experience all of the adverse reproductive health outcomes examined. For example, they had a higher likelihood of recent and lifetime STD diagnosis than whites, regardless of sexual behavior category.
This analysis is one of the first to examine a range of sexual behaviors and experiences in adolescence and how they relate to reproductive health and sexual risk-taking in young adulthood. It is based on data from 9,441 respondents to three waves of the National Longitudinal Study of Adolescent Health, conducted in 1994–1995, 2001–2002 and 2008.
The findings suggest that early teen sexual behavior in and of itself does not negatively affect future well-being. The authors recommend more research into understanding how various sexual behaviors interact and lead to healthy sexual development as teens develop into young adults.
Study among low-income Latinas suggests barriers to sterilization services
Many women in a sample of low-income Latina pill users reported that they planned to have no further children and were interested in undergoing sterilization, yet at follow-up 18 months later, the majority had not received the desired services, according to "Frustrated Demand for Sterilization Among Low-Income Latinas in El Paso, Texas" by Joseph E. Potter, of the University of Texas, et al. The authors suggest that low-income and minority women have an unmet demand for sterilization because of the barriers they face in trying to obtain the procedure. They analyzed data from the 2006–2008 Border Contraceptive Access Study to determine what motivates these women to choose sterilization and what barriers they encounter in trying to obtain the procedure.
At the first interview, 56% of the 801 respondents reported that they planned to have no further children, and 72% of these reported that they wanted a sterilization procedure. Yet despite the high proportions of women who reported that they had completed their childbearing and wanted a sterilization procedure, only six of the 152 women screened for follow-up had actually had one.
The most common reason women reported for not following through with sterilization was lack of funds. Some faced bureaucratic hurdles related to the Medicaid consent form or other barriers related to limited funding, while other women were told by their doctors that they were too young to obtain the procedure. The authors caution that these women's limited options result in inconsistent use of less effective contraceptive methods, increasing their risk for unintended pregnancy. They suggest that programs and policies address the structural factors that underlie contraceptive inequity and the resulting high rates of unintended pregnancy among Latinas in underserved communities.
Ambivalence about pregnancy related to reduced likelihood of contraceptive use among men
In a 2008–2009 nationally representative survey of 18–29-year-olds, 45% of respondents reported ambivalence about pregnancy. Men were more likely to lack clarity about their pregnancy intentions than were women, according to "Pregnancy Ambivalence and Contraceptive Use Among Young Adults in the United States" by Jenny Higgins, of the University of Wisconsin, et al. The authors analyzed data on pregnancy ambivalence and contraceptive practices among participants in the National Survey of Reproductive and Contraceptive Knowledge, and found that ambivalence about pregnancy was associated with a reduced likelihood of contraceptive use. However, this finding was statistically significant only for men.
This study was the first on this topic to examine pregnancy ambivalence specifically among young adults, and few previous studies have included men. The authors encourage future research to examine pregnancy ambivalence within the context of demographic characteristics that are linked to an increased risk of unintended pregnancy, such as socioeconomic disadvantage, and to analyze ambivalence by contraceptive method. They recommend that program and policy efforts aimed at reducing unintended pregnancy and improving contraceptive use include both men and women.
Understanding adolescents' pregnancy desire can help inform prevention efforts
A new study suggests that understanding the pregnancy desires of young women and men may be beneficial to improving pregnancy prevention efforts. Many programs designed to reduce sexual risk-taking among teens and young adults assume that pregnancies among this population are unwanted. However, a study of 296 pregnant women aged 14–21 and their male partners surveyed at Connecticut clinics in 2007–2011 found that 49% of young women and 53% of young men had wanted the pregnancy, according to "Pregnancy Desire Among a Sample of Young Couples Who Are Expecting a Baby," by Heather Sipsma, of Yale University, et al.
The authors examined characteristics thought to be associated with pregnancy desire and found that levels of desire were elevated among men and among young people who were expecting their first baby or perceived that their partner wanted the pregnancy; levels of desire were relatively low among those who were in school, were employed or had a supportive family environment. Additionally, participants who had wanted to become pregnant were more satisfied in their relationship with their partner and in life generally than those who had not desired a pregnancy. Although many young people had inaccurate perceptions of their partner's pregnancy desire, 73% of young women and 65% of young men who thought their partner had wanted a pregnancy were correct in that perception.
The authors suggest that their findings support pregnancy prevention programs that take into consideration teens' and young adults' pregnancy desires, and that target both men and women. Rather than assuming that pregnancies in younger age-groups are unwanted, and focusing narrowly on knowledge and skills to reduce sexual risk-taking (effective contraceptive use, condom negotiation etc.), programs could be improved by acknowledging that some young people desire pregnancy. Indeed, traditional interventions may not help these young women and men avoid or delay wanted pregnancies. The authors also suggest that providers may want to identify young expectant parents with low pregnancy desire and offer additional support and resources to help them transition to parenthood.
Pregnancy ambivalence linked to less effective contraceptive use among homeless youth
In a survey of homeless youth in Los Angeles County, most participants (75% of males and 71% of females) reported that it was important to them to avoid pregnancy. Additionally, 75% of females and 57% of males indicated they would be upset to some extent if they found out they were or had gotten someone pregnant. However, many youth who participated in in-depth interviews held ambivalent attitudes toward pregnancy, and those who were ambivalent reported less contraceptive use than other teens, according to "Understanding Pregnancy-Related Attitudes and Behaviors: A Mixed-Methods Study of Homeless Youth," by Joan S. Tucker, of RAND Corporation, et al. Even among survey respondents who were highly motivated to avoid a pregnancy, one-third of males and four in 10 females had either used no contraceptive method or relied on withdrawal at last sex.
The authors conducted 37 semistructured interviews and analyzed data from 277 surveys of sexually active homeless 13–24-year-olds in Los Angeles County to better understand homeless youths' attitudes toward pregnancy and the relationship between those attitudes and contraceptive use. Data from the in-depth interviews revealed that many homeless youth were concerned that the day-to-day realities of homelessness would create barriers to raising and caring for a child. Several participants expressed concerns about their ability to provide adequate food, shelter and stability to a child while homeless. Although many participants recognized their lack of readiness or maturity to have a child, some reported that having a child would be a positive experience or would improve their intimate relationships.
Survey data suggested that youth who were highly motivated to avoid pregnancy were more likely to use a combination of condoms and prescription birth control, and less likely to use no method, than were those with low motivation. Additionally, the more committed teens' relationships were, the more likely they were to view pregnancy positively, and the less likely they were to use effective contraceptives.
The authors suggest that effective and accessible pregnancy prevention and family planning programs for homeless youth are needed. They recommend that such programs both address and counter some of the perceived advantages of pregnancy among this population in order to reduce feelings of ambivalence and improve teens' commitment to consistent contraceptive use. Additionally, they argue for a comprehensive approach for this population that also addresses the need to create a stable living situation and incorporates academic and employment activities.
Title X–funded clinics in California facilitate access to care better than other providers
Title X–funded clinics in California are more likely than other public providers in the state's family planning program, Family PACT, to have features that reduce barriers to and improve the quality of care, according to "Enhancing Service Delivery Through Title X Funding: Findings from California" by Heike Thiel de Bocanegra et al., of the University of California, San Francisco. They are more likely to offer services during evenings or weekends; to provide outreach to hard-to-reach populations, such as males, teens and individuals with limited English proficiency; and to use advanced technologies, such as electronic medical records and online appointment scheduling, to streamline clinic operations.
The study relied on survey data from more than 1,000 public- and private-sector Family PACT clinicians in 2010 to assess whether funding streams were associated with the availability of a broader range of services. They found that Title X–funded clinics have implemented a greater array of infrastructure enhancements that promote access to and improve the quality of services for underserved populations than have other providers.
The authors suggest that Title X–funded clinics can serve as a model for reducing barriers to medical care at both traditional women's health clinics and primary care facilities. They recommend that nationwide health care reform build on the California model to improve infrastructure and the quality of care as family planning providers increasingly serve marginalized populations.