Advancing Sexual and Reproductive Health and Rights
Perspectives on Sexual and Reproductive Health
Volume 34, Number 6, November/December 2002


Between 1991 and 2001, the proportion of U.S. high school students who had ever had intercourse dropped significantly, from 54% to 46%, according to an analysis of data from six Youth Risk Behavior Surveys.1 Declines occurred among males and females, 10th-12th graders, and black and white youngsters, but not among ninth graders or Hispanics. During the same period, students became less likely to say that they had had four or more sex partners (19% in 1991 vs. 14% in 2001); males, 11th and 12th graders, blacks and whites registered declines. The level of current sexual activity remained stable overall, but fell for 11th graders and blacks. The prevalence of condom use at last intercourse increased from 46% in 1991 to 58% in 1999, then leveled off; every subgroup studied mirrored this general trend. One risky behavior--substance use at most recent intercourse--became more common: Prevalence rose from 22% to 26% over the decade, and increases were evident in all groups except females, 10th graders and white students. In 2001, 86% of high school students either had never had sex, had had intercourse but not in the last three months, or had used a condom during their last sexual encounter in the previous three months--an improvement over the 1991 level (80%) but not yet at the national objective for 2010 (95%).

1. Centers for Disease Control and Prevention, Trends in sexual risk behaviors among high school students--United States, 1991-2001, Morbidity and Mortality Weekly Report, 2002, 51(38):856-859.


The number of condoms donated each year to developing countries has fallen during the past decade, from 970 million to 950 million, according to the United Nations Population Fund (UNFPA).1 The U.S. donation decreased dramatically--from 800 million condoms in 1990 to 360 million in 2000--because some countries were disqualified from receiving foreign aid and because the implementation of "buy American" laws increased condom prices. Despite efforts of the United Nations and European aid agencies to make up for the decrease in U.S. donations, the gap between supply and demand in poor countries is likely to widen. UNFPA estimates that developing nations currently need 10 billion condoms a year and will need nearly twice as many by 2015. Countries in Africa are the most in need of condom donations, and if donors are to meet Africa's condom requirements, they will need to double their current level of support.2

1. McNeil DG, Jr., Global war on AIDS runs short of key weapon, New York Times, Oct. 9, 2002.

2. United Nations Population Fund (UNFPA), Global Estimates of Contraceptive Commodities and Condoms for STI/HIV Prevention 2000-2015, New York: UNFPA, 2002.


In 2000, the year after the Centers for Disease Control and Prevention (CDC) initiated the National Plan to Eliminate Syphilis in the United States, the rate of primary and secondary syphilis dropped to a record low of 2.1 cases per 100,000 persons; the next year, however, it rose, for the first time since 1990, to 2.2 per 100,000.1 (The CDC's plan sets a target of no more than 0.4 cases per 100,000 by 2005.) Between 2000 and 2001, the rate declined by 18% among women but increased by 15% among men; for the later year, men's rate was more than twice that of women (3.0 vs. 1.4 per 100,000). While the rate among non-Hispanic blacks declined by 10% from 2000 to 2001, rates went up for all other racial and ethnic groups examined; all of the increases were driven by increased rates among men. The South continues to have the highest regional syphilis rate, but the rate there has declined, whereas it has risen in the West and the Northeast. Some 80% of U.S. counties reported no cases of syphilis in 2001; an objective of the national plan is for 90% of counties to be syphilis-free by 2005. According to the CDC, the data suggest that the increased syphilis rates among men are attributable to increased rates among men who have sex with men.

1. Centers for Disease Control and Prevention, Primary and secondary syphilis--United States, 2000-2001, Morbidity and Mortality Weekly Report, 2002, 51(43 .971-973.


Three in 10 women surveyed at a gynecology clinic in England said that they would not permit a medical student to perform an "intimate examination," regardless of the student's gender.1 Nearly one-quarter said they would allow a female student but not a male to perform such an examination, and two-fifths said that they would permit both male and female students to perform an intimate examination. Women who had had children and those who were older than 40 were more likely than childless and younger women to say that they would permit a student of either gender to examine them; even among these groups, however, only about half would agree to an intimate examination by a student. The findings suggest that "it may be appropriate to use different teaching methods and settings" for teaching various aspects of gynecology.

1. O'Flynn N and Rymer J, Women's attitudes to the sex of medical students in a gynaecology clinic: cross sectional survey, British Medical Journal, 2002, 325(7366):683-684.


The number of newly diagnosed HIV infections that were sexually acquired increased by 20% between 1995 and 2000 in 10 western European countries that collaborate on routine AIDS surveillance.1 With the overall number of diagnoses relatively stable during that period, the proportion represented by sexually acquired infections increased from 66% to 74%. This increase is attributable to a 48% rise in infections resulting from heterosexual contact; infections acquired through sexual activity between men have declined by 12%. Other sexually transmitted infections (STIs) are not routinely monitored in Europe, but national data suggest that rates of gonorrhea have been climbing, particularly in recent years. For example, the number of gonorrhea diagnoses doubled in STI clinics in England and Wales over the five-year period, and the increase was 29% between 1999 and 2000. Data on syphilis are rare in Europe, but available evidence points to recent outbreaks of infection among men who have sex with men. The authors comment that "complacency over HIV prevention efforts" appears to have overcome many Europeans and their governments. And they emphasize that "consistent surveillance" is needed to monitor key trends in STIs in Europe.

1. Nicoll A and Hamers FF, Are trends in HIV, gonorrhoea, and syphilis worsening in western Europe? British Medical Journal, 2002, 324(7349): 1324-1327.


Forty-two percent of young people who begin engaging in intercourse at ages 16-18 have their first sexual experience between 10 p.m. and seven a.m., and another 28% first have sex during the hours of 6-10 p.m.1 Only 15%, according to data from the 2000 wave of the National Longitudinal Survey of Youth, first have sex in the late afternoon, just after school lets out, and the rest have their first sexual experience earlier in the day. For most young people who make the transition to first intercourse, that event occurs at the home of their partner's family (34%) or their own family (22%). Considerably smaller proportions first have sex at a friend's house (12%), at their partner's own house, apartment or dormitory (9%), or in any of a variety of other places--a car; their own house, apartment or dormitory; an outdoor place; or a hotel or motel.

1. Papillo AR et al., Facts at a Glance, Washington, DC: Child Trends, 2002.


The vaginal route of pill use is better tolerated than the oral route, according to a clinical trial conducted at a family planning clinic in Tehran, Iran.1 The study participants--143 fertile women aged 18-40 who were not lactating, had not used the pill for two months and had never used an implant--received low-dose combined pills orally for three months and then vaginally for three months, and recorded side effects before and after the switch. Participants reported nausea, vertigo and headache, breast tenderness, period pain and digestive problems less commonly during vaginal pill use than they did during oral pill use (3-21% vs. 32-58%); however, the proportion of women who bled between periods was similar (6% vs. 9%). Most participants (80%) found the vaginal route of pill administration acceptable and said they would use this method in the future. The researchers note that only one woman, who had used the vaginal method incorrectly, became pregnant during the trial. They conclude that common side effects of oral contraceptives can be reduced if the same pills are used vaginally.

1. Ziaei S et al., Comparative study and evaluation of side effects of low-dose contraceptive pills administered by the oral and vaginal route, Contraception, 2002, 65(5):329-331.


Over the six years following the UN International Conference on Population and Development, unwanted pregnancies led to the deaths of nearly 700,000 women worldwide, accounting for about 21% of maternal mortality.1 According to a Global Health Council report, at least 338 million unwanted pregnancies occurred during that period. Of these, about 251 million ended in abortion, resulting in 441,000 maternal deaths. Another 88 million unwanted pregnancies were carried to term, with 246,000 women dying from complications of pregnancy, labor and delivery. Rates of death were much lower in industrialized countries than in developing countries. For example, 675 of every 100,000 abortions and 857 of every 100,000 births resulting from an unwanted pregnancy led to a maternal death in Africa, compared with one per 100,000 abortions and 11 per 100,000 births in North America. The authors conclude that these statistics are "evidence of a serious health crisis...that will only deepen as more women move into their prime reproductive years."

1. Daulaire N et al., Promises to Keep: The Toll of Unintended Pregnancies on Women's Lives in the Developing World, Washington, DC: Global Health Council, 2002.


Only 47% of American children younger than six included in a nationally representative survey taken in 1991-1994 had been exclusively breastfed when they were one week old, and only 10% at six months of age.1 Exclusive breastfeeding for the first six months reduces infants' risk of many illnesses and is strongly encouraged by the American Academy of Pediatrics and the World Health Organization. The survey reveals that exclusive breastfeeding at six months of age was particularly uncommon among low-birth-weight and preterm infants, and among those born to black women, teenagers, smokers, residents of the South and women at the lowest income and educational levels (3-7%). Data on the proportions of children who had ever been breastfed showed similar patterns. Only three subgroups of women met the Healthy People 2010 objective of having at least 75% of mothers breastfeed at some time: women who had graduated from college (82%), those who lived in a household headed by a college graduate (80%) and those in the highest income category (75%).

1. Ruowei L et al., Prevalence of exclusive breastfeeding among US infants, American Journal of Public Health, 2002, 92(7):1107-1110.