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Rebecca Wind
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JUNE 2013 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 JUNE ISSUE OF PERSPECTIVES:


Sexual minority women's risk of STDs is underrecognized

Women who identify themselves as mostly straight are more likely—and those considering themselves mostly gay or gay are less likely—than straight women to have had an STD diagnosis in the past year, according to "Invisible and at Risk: STDs Among Young Adult Sexual Minority Women in the United States," by Lisa L. Lindley, of George Mason University, et al. Additionally, women who have had two or more female partners are more likely to have recently received an STD diagnosis than are women who have had only male partners. However, those associations disappeared after sexual behaviors (e.g., having had anal sex) were accounted for.

To examine the relationship between sexual orientation and recent STD diagnosis, the authors analyzed data from 24–32-year-old women who participated in Wave 4 of the National Longitudinal Study of Adolescent Health. They used a more nuanced measure of sexual identity than traditional classifications of straight, gay and bisexual, and found that nearly four times as many young adult women identified themselves as mostly straight as considered themselves bisexual, mostly gay and gay combined.

The authors suggest that further research into STD risk include "mostly straight" as a separate category for measuring sexual identity in order to more adequately estimate risk. Additionally, they suggest that health care providers consider young women's sexual identity and sexual behaviors, as well as the gender of their partners, and ensure that their patients are taking precautions to prevent STD transmission with both male and female partners.


Use of withdrawal as a primary contraceptive method is common among women attending family planning clinics in Victoria, Australia

Withdrawal is the primary contraceptive method of a significant portion of patients visiting three family planning clinics in Victoria, Australia, according to "Prevalence of and Characteristics Associated with Use of Withdrawal Among Women in Victoria, Australia," by Jason Ong, of the University of Melbourne, et al. In 2011, an anonymous questionnaire was completed by 1,006 sexually active women aged 16–50 who were not seeking pregnancy. The survey inquired about the types of methods used by the women and the frequency of use. It also gathered information about women's demographic characteristics and about their behaviors and attitudes related to contraception. The findings show that withdrawal was the third most commonly used method by the study group, after male condoms and the pill; 32% of respondents reported use in the past three months. Withdrawal use was more common among women aged 16–19 (37% reported any use of the method) than among those in any other age-group. Among all withdrawal users, 40% relied solely on this method. Sole users were more likely than other women to report dissatisfaction with their method, consider contraceptive use inconvenient, report difficulty accessing contraceptives and have had multiple partners in the past three months.

The findings of this study are consistent with those of previous research suggesting that use of withdrawal is common, especially among younger age-groups. The authors recommend that health care providers specifically address withdrawal when discussing method options with their patients to ensure that women can make an informed decision and know how to properly use withdrawal as a contraceptive method if they so choose.


Stigma related to abortion varies by women's characteristics

Women's experiences with abortion stigma may differ by various personal characteristics, according to "The Stigma of Having an Abortion: Development of a Scale and Characteristics of Women Experiencing Abortion Stigma," by Kate Cockrill, of the University of California, San Francisco, et al. The authors developed and validated a scale to measure individual-level abortion stigma, which included worry about judgment by others, isolation, self-judgment and community condemnation. They then administered a survey based on that scale to patients visiting 13 Planned Parenthood health centers across six states; 627 women reported having had an abortion and were included in the analysis.

The study found multiple links between abortion stigma and religious denomination or religiosity. Protestant and Catholic women were more likely than nonreligious women to experience some forms of stigma, and women who reported being very religious perceived greater levels of stigma than those who were somewhat religious. The authors suggest that highly religious Christian women are at the greatest risk for stigma after having an abortion.

Additionally, experiences of abortion stigma varied by women's age, race, education and whether they had previously given birth. Women aged 19–24 experienced more stigma than did older groups. Black women were less likely than white women to worry about judgment by others, but were more likely than whites to experience isolation. Isolation was also more common among women with some college education than among high school–educated women. Women who already had children were less likely to worry about judgment than were women who did not.

This study is the first to use abortion stigma measures validated among women who have had an abortion; it is also the first to allow women to account for experiences of stigma at the time of the procedure and later. The authors recommend using this new scale and their findings to inform future interventions to reduce stigma, as well as to evaluate the efficacy of established initiatives. They also point to the potential utility of their scale for research on mental health outcomes associated with abortion.


Disparities in teen birthrates may be related to variations in the context of teens' lives

Black and Hispanic teens are substantially more likely than white teens to give birth, and these disparities may be related to differences in teens' family environment, social characteristics and sexual experiences, according to "Racial and Ethnic Differences in the Transition to a Teenage Birth in the United States," by Jennifer Manlove, of Child Trends, et al. The authors analyzed data from the 1997 cohort of the National Longitudinal Survey of Youth to explore the relationship between teen births and teens' family background, individual, peer and dating characteristics, and sexual behaviors.

They found that the odds of giving birth during adolescence were more than three times as great among foreign-born Hispanics as among whites, and were about twice as high among U.S.-born Hispanic and black teens as among whites. Those differences decreased once contextual characteristics were factored in. In particular, having a parent who had less than a high school education, living in a family that did not include two biological or adoptive parents, and having a mother who had given birth as a teen were linked to increased odds of teen childbearing. The disproportionate disadvantage of blacks and U.S.-born Hispanics among youth with these characteristics helps account for their relatively high teen birthrates. The authors estimate that if black and U.S.-born Hispanic youth had the same characteristics as whites, their probability of giving birth as teens would fall by more than one-third.

The authors point to the need to take cultural differences within teen populations into consideration for future pregnancy prevention research and programming. They recommend that family planning clinics and programs focus their outreach to recruit high-risk and difficult-to-reach groups, including foreign-born Hispanics, who may have additional language and structural barriers to accessing services. Additionally, they suggest that future research explore whether investing in education could be an effective approach to preventing teen pregnancy.


Instability during teen years may influence risky sexual behavior

A new analysis examines the relationship between instability in the lives of a sample of sexually active teens and the young people's likelihood of engaging in risky sexual behaviors. According to "Life Experiences of Instability and Sexual Risk Behaviors Among High-Risk Adolescent Females," by Molly Secor-Turner, of North Dakota State University, et al., teens' level of individual risk (reflecting substance use, violence perpetration, violence victimization and having witnessed violence) was positively related to the number of sex partners they reported at a six-month follow-up, while extent of family disengagement (encompassing family disconnection, poor family communication and perceived lack of safety at home) was negatively associated with consistent condom use six months later.

The authors analyzed data from a 2007–2008 study of 241 sexually active teen females in Minnesota who were at high risk for pregnancy and STDs. They suggest that directly addressing the individual and social contexts related to risky sexual behavior may help contribute to decreases in teen pregnancy and STDs. They recommend that teen health services include an assessment of teens' individual- and family-level instability, and that health systems address the unique service needs of vulnerable youth.

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