December Issue of Perspectives on Sexual and Reproductive Health Now Available

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HERE'S WHAT YOU CAN FIND IN THIS ISSUE OF PERSPECTIVES:


 

Laws Promoting Preabortion Ultrasound Are Not Having the Emotional Impact on Women that Abortion Opponents Predicted

Abortion opponents' belief that viewing an ultrasound prior to obtaining an abortion could dissuade women from terminating pregnancies has led to an abundance of state-level legislation regulating ultrasound provision for women seeking abortions. Little research has examined women's reactions to seeing these images, but a new study examines the frequency with which women who received abortions were offered the opportunity to view an ultrasound prior to obtaining an abortion, whether they chose to do so and what their emotional response was to viewing the image. According to "Beyond Political Claims: Women's Interest in and Emotional Response to Viewing Their Ultrasound Image in Abortion Care," by Katrina Kimport et al., of the University of California, San Francisco, many women reported neutral or positive emotions following viewing of a preabortion ultrasound.

The authors analyzed data from 702 women participating in the Turnaway Study, who obtained abortions at 30 facilities throughout the United States in 2008–2010. They found that 48% of study participants were offered the opportunity to view an ultrasound prior to obtaining an abortion, and 65% of those women (31% of all women) chose to do so. Among women who visited a facility with a policy requiring that they be offered the opportunity to view an ultrasound, 75% reported receiving this offer, and 34% chose to view the ultrasound. Among women who visited facilities that were subject to state laws with this requirement, 91% reported being offered the opportunity to view their ultrasound, and 44% chose to view the image. By comparison, 33% of women who were subject to neither a state nor a facility policy were offered the opportunity to view the ultrasound, and just 27% did so. Additionally, women who had never had children and black women were more likely to receive this offer than were women with children and white women, respectively.

One week after their abortion, women reported a range of emotional responses to viewing the ultrasound. Most commonly, they described neutral or positive emotions: Of the 212 women who reported emotional responses, 77 reported feeling nothing or feeling fine, while 22 women said that they felt happy or excited after viewing the ultrasound, 15 felt comforted and 11 felt good. In contrast, 49 women reported feeling sad or depressed, 30 reported that viewing the ultrasound made them feel guilty about their decision, and 29 said that viewing the ultrasound made them feel upset or bad. Women who had never had children were more likely than others to express positive emotions in response to viewing the ultrasound.

The authors suggest that, particularly in situations where state law mandates that women be offered the opportunity to view the image, "offers" may be misconstrued by patients as "recommendations" that cannot be declined. The authors suggest that providers pay close attention to how they are offering this viewing opportunity, "to ensure that patients do not feel pressured."


 

The Links Between Cultural Practices and Sexual Behavior Vary Among Latino Youth

The relationship between cultural practices and sexual risk-taking among Latino youth varies by gender and by sexual outcome, according to "Cultural Measures Associated with Sexual Risk Behaviors Among Latino Youth in Southern California: A Longitudinal Study," by Davida Becker, of the University of Southern California, et al. For example, the more members of a sample of Latino youth identified with U.S. cultural practices during high school, the more likely they were to be sexually experienced or to have concurrent sexual partners in emerging adulthood. Increases in this measure of acculturation were linked to increases in males' lifetime number of sexual partners. However, this measure was not related to the age at which youth first had sex or to their use of condoms, drugs or alcohol the last time they had had sex.

The degree to which youth identified with Latino cultural practices was linked to the number of sexual partners they had ever had, but the relationship differed by gender: Among females, a stronger endorsement of Latino cultural practices was linked to fewer partners; among males, it was linked to more partners.

The study analyzed data collected from 995 Latino youth in Southern California in 2005–2012 to investigate the relationship between cultural values youth reported in 10th grade and sexual behavior they reported as young adults.

Among the study's other findings are that the more highly youth valued showing respect to their parents and other authority figures, the less likely they were to have first had sex at an earlier age or not to have used a condom the last time they had intercourse. And the more youth agreed with traditional gender roles, the more likely they were to have ever had sexual intercourse.

The authors recommend not overgeneralizing the link between culture and youth sexual risk behavior, as that link depends on the aspect of culture and the specific sexual behavior examined. They note that qualitative research could help explain why specific cultural measures are linked to particular sexual outcomes but not to others. They suggest that those who design sexual health programs for Latino youth may "need to be sensitive to gender differences and cultural factors."


 

Women with Disabilities Are as Likely to Want and Intend to Have Children as Women Without Disabilities, yet Face Additional Challenges in Achieving Their Childbearing Goals

Women with and without disabilities are equally likely to want a child and to intend to have one, according to "Planning for Motherhood: Fertility Attitudes, Desires and Intentions Among Women with Disabilities," by Carrie L. Shandra, of the State University of New York at Stony Brook, et al. However, childless women with disabilities who want and intend to have a child are more likely to report uncertainty that they will be able to achieve their childbearing intentions than are childless women without disabilities. Among mothers, those with disabilities are more likely to want another child, but less likely to intend to have one, than are those without disabilities. The authors conclude from these findings that there is a disconnect between the fertility desires of mothers with disabilities and their childbearing intentions that is not seen among childless women with disabilities. This study relied on data from 10,782 women aged 15–44 who participated in the 2006–2010 National Survey of Family Growth.

The authors suggest that researchers and practitioners in reproductive health need a better understanding of the childbearing desires, needs and challenges of women with disabilities. They suggest that, as with many aspects of life among persons with disabilities, childbearing goals are not easy to accomplish, yet women with disabilities want children and are acting on those goals, challenges notwithstanding. The authors argue that it falls to health care providers to ensure that all women who desire pregnancy and motherhood are able to achieve their goals, including by addressing the unique challenges faced by women with disabilities.


 

The Relationship Between Social Conventionality and Postponement of First Sex Is Unexpectedly Complex

Are individuals who conform to conventional society more likely than others to postpone sexual activity until early adulthood? The answer to this question is complex, according to "Correlates of Adolescent and Young Adult Sexual Initiation Patterns," by Bianka M. Reese et al., of the University of North Carolina at Chapel Hill. In fact, the authors found that sexual initiation patterns were correlated with various measures of conventionality in unexpected and often inconsistent ways.

The authors analyzed data from 12,378 respondents to two waves of the National Longitudinal Study of Adolescent Health (1994–1995 and 2008). They studied five previously described patterns of sexual initiation, which reflect respondents' first reported sexual behavior (vaginal, oral-genital or anal sex), their age at first experience, and the spacing between initial and subsequent sexual behaviors. These patterns were examined for correlations with measures of psychosocial conventionality (based on respondents' personality traits, behaviors and perceptions of their environment), physical variables (i.e., timing of puberty, actual body weight and perceived body weight), and social and demographic characteristics.

Reese et al. found that some aspects of psychosocial conventionality distinguished the small proportion of young people who postponed sexual activity (4% of females and 6% of males) from those who initiated various sexual behaviors during adolescence (roughly 80% of each). However, associations differed for males and females. For example, while males who attended religious services at least weekly were relatively likely to have postponed sex, the same was not true for females. By contrast, the more strongly females expected to attend college, the greater their likelihood of having followed the majority patterns of sexual initiation, rather than having postponed their first sexual experience; this was not the case for males.

The authors note that further examination of psychosocial characteristics and their complex relationships with patterns of sexual initiation could potentially yield valuable data. However, additional research is needed to determine how relevant these findings may be to health outcomes for adolescents and young adults. The authors also recommend further study of sexual and developmental trajectories after sexual initiation, as such data may be particularly relevant for long-term health outcomes.


 

Reproductive Health Care Providers May Be Missing Opportunities in Counseling Young Women

Providers' approaches to counseling may have an impact on teens' and young adults' reproductive health decision making and contraceptive method choice and continuation, according to "Provider Counseling to Young Women Seeking Family Planning Services," by Alexandra M. Minnis, of RTI International, et al. The authors analyzed data on 67 women aged 16–21 recruited as part of cohort study conducted in 2009–2012 to examine provider-patient interactions during family planning visits at six San Francisco clinics. In assessing the strategies that providers at these clinics adopted to guide young women's decision making and address contraceptive concerns, the authors found some missed opportunities.

The authors found that some teens' stated method preference prior to counseling and their actual method choice after counseling differed. Prior to counseling, 77% of young women reported wanting a highly effective method—a hormonal or long-acting reversible contraceptive (LARC) method—while 13% had no preference. Immediately following counseling, 98% selected a highly effective method, which suggests that 21% of young women in this study wanted a more effective method after counseling than they had prior. Young women who had had interactive counseling had a higher level of hormonal or LARC use at a six month follow-up (80%) than women who had had noninteractive counseling (50%).

Providers' responses to young women's prior discontinuation of methods, fear of side effects or misinformation about methods varied widely. In many cases, clinicians focused on safety and medical risks, and appeared to strive for neutrality to such a large degree that they failed to guide their patients in a helpful way. Additionally, providers missed opportunities to address potentially important contextual issues such as partners' influence on method choice and continuation, STD prevention, alcohol and drug use, healthy weight and sexual violence.

Ensuring access to high-quality, comprehensive and youth-friendly reproductive health services is critical to addressing the health needs of young people. The authors recommend that increased attention be paid to developing and encouraging age-appropriate, interactive counseling as one step to ensuring that young women are able to make fully informed, critical decisions about their reproductive health.


 

How Providers Inform Patients About Their Contraceptive Options Varies

A study of 50 family planning visits in the San Francisco Bay Area found that providers employed one of three approaches to contraceptive counseling, and that each approach offered a different level of information and guidance to patients, according to "A Qualitative Analysis of Approaches to Contraceptive Counseling," by Christine Dehlendorf et al., of the University of California, San Francisco. In the foreclosed approach (used in 48% of visits), providers offered information only about methods that patients explicitly mentioned, and did not assist women in deciding which method to choose. Providers using the informed choice approach (representing 30% of visits) shared information and introduced new methods into the conversation, but left all decision making to the patient. Those taking the shared decision-making approach (employed in 22% of visits) offered both information and guidance, collaborating with patients to help them exclude some methods and select others.

Counseling sessions using a foreclosed approach offered patients the smallest average number of methods. Providers who offered their patients foreclosed or informed choice counseling sessions did not engage in discussion about what their patients valued in a method; nor did they offer consistent information about the methods that were discussed. Women aged 25 or younger encountered a foreclosed approach to counseling more often than older women, and patients older than 35 were much more likely than their younger counterparts to experience a shared decision-making approach.

The authors suggest that variations in types of counseling by age warrant further research, as providers could play a role in helping younger women explore all of their contraceptive options and find one that is most effective and best fits their needs. Additionally, they recommend that providers be encouraged to engage with patients of all ages in contraceptive counseling sessions, to provide adequate information to help them choose an effective contraceptive method, while respecting patients' autonomy to make their own choices.


 

Digests

The Digests section of this issue contains summaries of studies on different second-trimester medication abortion regimens, associations between "sexting" and sexual experience in a sample of middle school students, condom use problems among men who have sex with men and more. Click here to access these valuable resources.

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