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DECEMBER 2013 ISSUE OF
PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH
Beginning in 2014, Perspectives on Sexual and Reproductive Health will be published online only. Sign up at this link to receive an alert when new materials become available.
HERE'S WHAT YOU CAN FIND IN THIS ISSUE OF PERSPECTIVES:
Latino Youths' Sexual Values Are Linked to Their Negotiation of Condom Use
A survey of 571 Latino men and women aged 16–22 in the San Francisco Bay Area found that these youths' sexual values were linked to the strategies they employed to negotiate using or avoiding use of condoms in their relationships. According to "Latino Youths' Sexual Values and Condom Negotiation Strategies," by Julianna Deardorff, of the University of California, Berkeley, et al., the more Latino men and women valued female virginity, the less often they used direct communication with their partner to encourage using condoms.
Among both sexes, the more individuals valued satisfying their own and their partner's sexual needs, the more often they expressed dislike of condoms to avoid using condoms. The more comfortable young women (but not young men) were with sex and communicating about sex, the more often they used direct communication to encourage condom use. Also among young women but not among young men, the more individuals considered it disrespectful to speak about sex, the more often they shared risk information to encourage condom use.
The study's authors recommend that researchers who design interventions meant to influence English-speaking Latino youths' sexual decision making and behaviors consider including program components that address sexual values.
Health Educators and Clinicians Differ in Knowledge and Practices
About Long-Acting Reversible Contraceptives
A survey conducted at 40 Planned Parenthood clinics in 2011–2012, among 410 staff members, has shown differences between health educators' and clinicians' practices regarding the provision of long-acting reversible contraceptives (LARC). According to "Counseling for IUDs and Implants: Are Health Educators and Clinicians on the Same Page?" by Kirsten M.J. Thompson of the University of California, San Francisco, et al., health educators considered a smaller proportion of their clients eligible to use LARC than did clinicians (57% vs. 77%), and they were less likely to consider offering IUDs to teenagers (79% vs. 96%), women who had never had children (82% vs. 98%) and unmarried women (90% vs. 99%). Additionally, the researchers found that 64% of health educators and 40% of clinicians desired additional LARC training.
The researchers conclude that even in clinics that specialize in reproductive health care, health educators are less likely than clinicians to apply current evidence-based information in counseling their clients about LARC methods. They note that health educators are often the first—and sometimes the main—source of contraceptive counseling in such clinics, which makes it essential that these staff provide high-quality and evidence-based contraceptive counseling. They suggest that when possible, health educators and clinicians be trained together to ensure consistency in counseling and method provision.
Planned Contraceptive Use and Happiness About a Possible Pregnancy
Are Not Mutually Exclusive Among Latina Women
Nearly half of Latina pill users who took part in a survey in Texas reported that they did not want any more children, and 77% reported that they planned to use the pill for at least one more year. Yet 44% also said they would feel happy or somewhat happy if they became pregnant within the next three months, according to "Are Latina Women Ambivalent About Pregnancies They Are Trying to Prevent? Evidence from the Border Contraceptive Access Study," by Abigail R.A. Aiken and Joseph E. Potter, of the University of Texas, Austin. The authors analyzed data from the 2006–2008 Border Contraceptive Access Study in El Paso to compare women's planned pill use and childbearing intentions with their feelings about a possible pregnancy.
Forty-one percent of the women who planned to use the pill for at least one more year said they would feel very or somewhat happy about a pregnancy, as did 34% of women who wanted no more children. Thirty-six women became pregnant during the study; of these, 24 reported feeling very happy about the pregnancy after the fact, although only 14 had reported feeling happy about a possible pregnancy before they became pregnant.
The authors caution that women's reported feelings about pregnancy should not necessarily be used to gauge their ambivalence or lack of seriousness about avoiding a pregnancy. Rather, women may feel happy about the prospect of a pregnancy while also being motivated to avoid one. The researchers suggest that viewing happiness about pregnancy and intention to become pregnant as distinct concepts may be useful in future studies measuring and interpreting pregnancy intentions among Latinas.
Men in Their 30s Who Are Married or Cohabiting Have Lower Levels
Of Sexual Risk than Men Who Are Not in Cohabiting Relationships
Although overall levels of sexual risk behavior are low among men in their 30s, men who are married or cohabiting engage in significantly lower levels of risky sexual behavior than men who are not in coresidential unions, according to "Union Status and Sexual Risk Behavior Among Men in Their 30s," by Nan Marie Astone, of the Urban Institute, et al. The authors examined data on risky sexual behavior from 1,083 men aged 34–41 who participated in the 2008–2010 wave of the National Survey of Adolescent Males. They found that men who were married or cohabiting were less likely than others to report having had three or more sexual partners, having had one risky partner or having had concurrent partners in the last 12 months.
No matter what level of risk men had exhibited in past waves of the survey, the lowest levels of current risk behavior were found among married men, the next lowest among cohabiting men and the highest among men outside a coresidential union. The one-quarter of surveyed men in this last category reported levels of risk as high as those reported when they were teens and young adults. The authors suggest that interventions intended to reduce men's levels of risky sexual behavior should not focus entirely on younger men or those in very high risk groups, but should also include counseling and care focused on men living outside residential unions.
Who Are the Women Who Seek Later Abortions?
Women who have later abortions are similar to those who obtain first-trimester procedures in many ways, including in race, ethnicity, number of previous births or abortions, and mental health history. However, the groups display several significant differences. Women who have later abortions are younger, less likely to be married and less likely to be employed, according to "Who Seeks Abortions at or After 20 Weeks?" by Diana Greene Foster and Katrina Kimport of the University of California, San Francisco. The authors analyzed data from a subsample of the 2008–2010 Turnaway Study—272 women who sought and received an abortion at or after 20 weeks' gestation for reasons other than fetal anomaly or life endangerment and 169 women who sought a first-trimester abortion at the same facilities. They sought to provide context for discussions about state bills seeking to ban later abortions, and to provide data on who will be most affected by those bills. On the basis of their findings, they conclude that bans on later abortions will disproportionately affect young women and women with limited financial resources.
Most women seeking later abortions fell into at least one of five categories. They were raising children on their own, had substance use or mental health problems, were experiencing conflict with their partner or domestic violence, had had trouble deciding whether to have an abortion and then had problems accessing services, or were young and had never had children. Forty-two percent of later abortion patients fit one group; 38% belonged in two or more groups.
A majority both of women seeking first-trimester abortions (80%) and of those seeking abortions at or after 20 weeks (94%) experienced delays in accessing services. Forty-three percent of all women interviewed reported that not recognizing they were pregnant delayed them in seeking care. Thirty-seven percent reported that the process of deciding whether to have an abortion slowed them down. One in five said that disagreement with the man involved in the pregnancy caused a delay. In all three categories, there was no significant difference between women seeking first-trimester and later abortions. However, although women in both groups reported having trouble finding a facility, this obstacle was much more common among women seeking later abortions than among those seeking first-trimester procedures (38% vs. 18%).