Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 34, Number 5, September/October 2002
FYI


NORPLANT: NO PROBLEM...EXCEPT THAT IT'S OFF THE MARKET

Updating a two-year old advisory on the provision and use of Norplant contraceptive implants, the manufacturer of the device has announced some good news and some not-so-good news.1 In 2000, amid concerns about the effectiveness of the implants from specified lots, Wyeth, the manufacturer, advised health care professionals to stop providing implants from those lots; the company also advised women who already had devices from the lots in question to use a barrier or nonhormonal contraceptive method to ensure protection. After conducting several product tests, however, Wyeth announced in July that the implants provided the intended level of contraceptive protection and that women no longer needed to use backup methods. At the same time, citing "limitations in product component supplies," the company said that it will not reintroduce the device to the market.

1. Wyeth, Back-up contraception no longer required for women using Norplant® system, news release, Madison, NJ: Wyeth, July 26, 2002.

BIG CHANGES IN JAPAN

Marriage is occurring later than ever before in Japan, premarital childbearing has reached unprecedented levels and the pace of change is accelerating.1 According to a government report, women's median age at marriage rose by one year (from 25 to 26) during the 15-year period 1977-1992, but in just the eight years from then until 2000, it increased by another year. The average age at first birth, meanwhile, rose from 26 to 28 between 1975 and 2000. Furthermore, the proportion of first-born babies who were conceived by never-married women doubled from 13% in 1980 to 26% in 2000; among women in their early 20s, the increase was even more dramatic--from 20% to 58%. Eighty-two percent of first births to Japanese teenagers in 2000 followed premarital conceptions, compared with 47% two decades earlier. The complete report is available, in Japanese only, at <www.mhlw. go.jp/toukei/saikin/hw/jinkou/ tokusyu/syussyo-4/index.html>.

1. Kashiwase H, Shotgun weddings a sign of the times in Japan, Population Today, 2002, 30(5):1 & 4.

NO PILL-BREAST CANCER LINK

Neither current nor former pill use increases the risk of breast cancer among women aged 35-64, who have the highest incidence of the disease.1 In a population-based study of nearly 5,000 women with breast cancer and a similar number of cancer-free controls, current and previous pill users had essentially the same risk of cancer as never-users when a wide range of risk-related factors were taken into account. Duration of pill use, age at initiation of pill use, estrogen dose and amount of time elapsed since last use also showed no association with breast cancer risk. Results were similar regardless of women's family history of breast cancer, body mass index or meno-pausal status; moreover, the findings were the same for women younger than 45 and those aged 45-64. The authors of an editorial accompanying the study write that "the results . . . should be reassuring to the millions of women who take oral contraceptives."2

1. Marchbanks PA et al., Oral contraceptives and the risk of breast cancer, New England Journal of Medicine, 2002, 346(26):2025-2032.

2. Davidson NE and Helzlsouer KJ, Good news about oral contraceptives, New England Journal of Medicine, 2002, 346(26):2078-2079.

MINNESOTA IS THE PLACE FOR KIDS

Minnesota ranks top in the nation on a composite measure of 10 key indicators of children's well-being, and Mississippi occupies the bottom slot.1 The measure combines information on low birth weight; infant and child mortality; teenage deaths, births, schooling and employment; and family-level socioeconomic indicators. Minnesota ranks among the top seven states on seven individual measures (falling to the 11th-14th positions for infant, child and adolescent deaths), and Mississippi is in the bottom nine for all measures except the proportion of children living in families in which no parent has full-time, year-round employment. New Hampshire has the lowest birthrate among 15-17-year-olds (11 per 1,000), and Mississippi's rate is the highest (45 per 1,000). Infant mortality is lowest in Utah (five deaths per 1,000 live births) and highest in South Carolina (10 per 1,000). The proportion of infants who are low-birth-weight ranges from 5% in Oregon to 10% in Mississippi.

1. Annie E. Casey Foundation, Kids Count Wall Chart, Baltimore: Annie E. Casey Foundation, 2002.

THEIR LIPS ARE SEALED

Thirty-seven percent of sexually active 15-17-year-olds in a nationwide survey said that their parents do not know that they are having sex, and 20% said that their parents know but not because they have told them.1 Overall, roughly 50-60% of the 503 young people had never talked with a parent about how to discuss sexual health issues with a boyfriend or girlfriend, about how to know when you are ready to have sex, or about birth control, condoms or sexually transmitted diseases; the proportions were similar among sexually active youth. Even higher proportions--about 70-80% overall--had never discussed these issues with a health care provider. When asked why people their age do not talk with their parents about sexual health, eight in 10 youth said they worried about their parents' reaction, they were afraid that their parents would think they were having sex, they were embarrassed or they did not know how to raise the topic; two-thirds believed that their parents would not understand. Results of the survey show that communication between teenage partners also needs improvement: Among sexually active respondents, 20-28% had never talked with a partner about sexual behavior that they are comfortable with, condoms or contraception; 39-41% had never talked about HIV and other sexually transmitted diseases.

1. The Henry J. Kaiser Family Foundation and Seventeen, Sexsmarts, Menlo Park, CA: The Henry J. Kaiser Family Foundation, 2002.

WITH THIS RING...

A vaginal ring that offers hormonal contraceptive protection on a monthly basis is now available on the U.S. market.1 The Nuva-Ring, a small, flexible device that women themselves insert into the vagina, releases a continuous flow of estrogen and progestin for 21 days; the dose of estrogen administered daily is lower than that provided by combined oral contraceptives. In addition to the device's long-term effectiveness, the ease with which it is inserted offers an advantage for women: In contrast to the diaphragm, which must be positioned correctly to work properly, the ring cannot be inserted incorrectly. The device comes with a timer, which reminds women when to replace the ring. Since the ring is not a barrier method, it does not protect women against sexually transmitted diseases; users may experience the types of side effects associated with use of any hormonal contraceptive method.

1. Organon, NuvaRing, world's first vaginal birth control ring, now available in U.S., news release, West Orange, NJ: Organon, July 16, 2002.

NIPPING OBESITY IN THE BUD

Infants who are exclusively breastfed are less likely than those who are fed only formula to be obese in early childhood, according to findings from a Scottish study of children born in 1995-1996.1 Overall, 9% of the more than 32,000 children were obese (i.e., had a body mass index at or above the 95th percentile for their age and sex) at 39-42 months of age. The proportion was 9% among those who had been exclusively formula-fed during their first 6-8 weeks and 7% among those who had been exclusively breastfed; results of analyses controlling for socioeconomic status, sex and birth weight confirmed that breastfed infants had a significantly lower risk of obesity than their formula-fed peers (odds ratio, 0.7). Four percent of all children studied were severely obese (i.e., had a body mass index in the 98th percentile or higher) when they were 39-42 months old; again, when potentially confounding factors were taken into account, the risk was reduced among youngsters who had been fed only breast milk (odds ratio, 0.7). The researchers conclude that "breastfeeding is . . . potentially useful for population-based strategies aimed at obesity prevention."

1. Armstrong J, Reilly JJ and the Child Health Information Team, Breastfeeding and lowering the risk of childhood obesity, Lancet, 2002, 359(9322): 2003-2004.

IS ANYBODY OUT THERE LISTENING?

Only 45% of adults surveyed in June and July said they had followed news stories about the effects of hormone replacement therapy on women's health; fewer than 40% of the 1,208 respondents had followed stories about recent findings on the pill's role in breast cancer risk [see "No Pill-Breast Cancer Link," above] or about the international AIDS conference in Barcelona.1 By contrast, 55% had kept abreast of congressional debate about Medicare prescription drug benefits, 64% had followed the news about corporate accounting scandals and 82% had stayed on top of news about U.S. military efforts in Afghanistan. When asked to choose a statement that best summarized reports coming out of Barcelona on the global scope of the AIDS epidemic, only 39% of those polled correctly indicated that researchers have revised upward their estimates of the worldwide number of cases of AIDS in the next 20 years; 27% gave incorrect answers, and 33% said that they did not know. Similarly, 35% knew that a study of hormone replacement therapy had been discontinued because researchers found an association between use of the therapy and an increased risk of breast cancer and heart disease; 22% chose wrong answers, and the rest indicated that they did not know.

1. Kaiser/Harvard School of Public Health Program on the Public and Health Policy, Health News Index, 2002, 7(4).

THE PERILS OF PARENTAL NOTIFICATION

More than half of teenagers younger than 18 who participated in a survey conducted at Planned Parenthood clinics throughout Wisconsin in 1999 would discontinue use of at least some of the agency's services if their parents were notified that they were seeking prescription contraceptives.1 Forty-seven percent of the 950 respondents would no longer use any of the agency's services, and another 12% would stop using particular services (testing or treatment for sexually transmitted diseases, pregnancy testing, health examinations or contraceptive care). Black teenagers were less likely than others to say that mandatory parental notification would make them stop using all Planned Parenthood services, and 17-year-olds were less likely than younger women to give this response. In a supplementary survey of young women attending three Milwaukee clinics in 2001, 57% of those who said that they would discontinue their use of Planned Parenthood services would use condoms instead, 29% would rely on withdrawal, the same proportion would have unprotected intercourse and 1% would engage in oral rather than vaginal sex. The researchers conclude that requiring parental consent for obtaining prescription contraceptives could increase unintended pregnancies, abortions, nonmarital births and sexually transmitted diseases among teenagers.

1. Reddy DM, Fleming R and Swain C, Effect of mandatory parental notification on adolescent girls' use of sexual health care services, JAMA, 2002, 288(6):710-714.