Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 35, Number 2, March/April 2003
FYI


A BLOW FOR ABORTION LAW APPEAL

An eight-year-old Indiana law requiring that women seeking abortion receive in-person counseling at least 18 hours before the procedure may go into effect for the first time, now that the Supreme Court has declined to consider a challenge to that requirement.1 In 2002, a lower court ruled that the law, which specifies that counseling cover the medical risks associated with abortion and alternatives to pregnancy termination, is constitutional because it does not create an excessive burden for women. However, clinics and women's organizations argue that it is too onerous, because many women, forced to make two clinic visits a day or more apart, would have difficulty explaining their absence to employers or partners; the difficulties could be most severe for poor women and residents of rural areas. Opponents of the law also argue that the provision of certain information substantially in advance of an abortion could frighten some women. Further, they point out that similar laws in other states have been associated with declines in state abortion rates, but not necessarily in levels of abortion among state residents, because many women travel out of state to circumvent the restrictions.

1. Associated Press, Supreme Court denies abortion law appeal, New York Times, Feb. 24, 2003, <http://www.nytimes.com/aponline/national/AP-Scotus-Abortion.html>, accessed Feb. 24, 2003.

THE VATICAN EXPLAINS IT ALL

Just when you thought that the English language was hopelessly muddled, the Vatican is coming to the rescue with a work that will clarify some 90 "neologisms, ambiguous terms and difficult concepts in frequent use"--such as "reproductive health" and "sexual education."1 The soon-to-be-published Lexicon of the Family and Life will strip the political overtones from terms like "gender" and "reproductive rights," which some Catholic leaders view as "code" for issues that they consider morally questionable--namely, feminist and gay issues and abortion. In the works for almost two years, the lexicon has been shaped by the contributions of anthropologists, sociologists, physicians and psychologists, not all of them Catholic. While it will cover the Church's teachings on contraception, sexuality education, assisted reproduction and homosexuality, it is intended to reach an audience of "world leaders of all faiths...who are engaged in discussion of family-oriented public issues."

1. Harper J, Vatican writes 'glossary' on sex terminology, Washington Times, Jan. 17, 2003, <http://www.washtimes. com/national/2003/0117-79632399. htm>, accessed Jan. 17, 2003.

HAVING TWO PARENTS HELPS

Children living with only one parent have a higher risk of death, mental illness and injury than those in two-parent families, even when their socioeconomic disadvantage is taken into account.1 In a population-based study in Sweden, researchers analyzed the risks of morbidity and mortality through 1999 of nearly one million youngsters aged 6-18 in 1991, adjusting for the children's age and parents' characteristics, including psychiatric problems and substance use. The results indicated that those who had lived with a single parent between 1985 and 1990 had significantly elevated risks of psychiatric diseases; suicide; traffic injuries; involvement in violence, falls or poisoning; and alcohol or drug addiction. For females, odds ratios ranged from 1.2 to 2.4; for males, 1.1 to 3.0. Males who had lived with only one parent also had an elevated risk of overall mortality. The researchers remark that "everyday life...characterised by psychosocial stress and loss of control" is sure to have adverse effects on children. They conclude that social policies and maternal and child health care can help improve family circumstances "so that children gain access to environments outside the family."

1. Weitoft GR et al., Mortality, severe morbidity, and injury in children living with single parents in Sweden: a population-based study, Lancet, 2003, 361(9354):289-295.

LESSON NOT LEARNED

Three-quarters of women surveyed at school-based programs for pregnant teenagers and young mothers in Los Angeles County reported using condoms no more than half the time they had intercourse, and fewer than one in five said they had used a condom the last time they had sex.1 For the sample of 572 women, of whom most were Hispanic and almost all were unmarried, the most important determinants of unprotected intercourse were psychosocial, behavioral and demographic characteristics: When potentially confounding factors were controlled for, women who were pregnant, had a steady partner, did not intend to use condoms, engaged in anal sex or attended church frequently had an increased risk of having unprotected intercourse; those who used injectable contraceptives, were older, got high before sex or had been sexually abused had a marginally elevated risk. Notably, knowledge about AIDS and condom use were not significant factors. The analysts stress that pregnant adolescents and teenage mothers need "broad-based HIV prevention programs" that "reflect...the realities" of their lives.

1. Koniak-Griffin D et al., Teen pregnancy, motherhood, and unprotected sexual activity, Research in Nursing & Health, 2003, 26(1):4-19.

BLACK WOMEN AND MENOPAUSE

The largest study yet of the predictors of natural menopause among black women in the United States shows that smokers reach menopause earlier than other women.1 More than 17,000 women who were 35-55 years old and premenopausal in 1995 completed mailed surveys in that year and a follow-up questionnaire in 1997 or 1999 (or both); by the end of the study, 1,323 had reached natural menopause. In analyses adjusting for factors potentially associated with menopause, current and former smokers had significantly elevated risks of reaching menopause (hazard ratios, 1.4 and 1.2, respectively); the risk increased with the amount that women smoked. Women who had used the pill for more than one year and obese women had reduced risks of reaching menopause (0.9 and 0.8, respectively). Because previous research has suggested that women who are subjected to the stresses of racist discrimination may reach menopause earlier than others, the survey explored women's perceptions of their experiences of racism; the results showed little support for racism as a factor in menopause.

1. Palmer JR et al., Onset of natural menopause in African American women, American Journal of Public Health, 2003, 93(2):299-306.

THE SPONGE BOUNCES BACK

The Today contraceptive sponge is once again available to American women.1 As thousands of women, family planning professionals and viewers of Seinfeld are aware, the over-the-counter method, introduced to the U.S. market in 1983, was discontinued in 1995 because the factory that produced it failed to meet Food and Drug Administration (FDA) manufacturing standards. While a new manufacturer awaits FDA approval to sell the device in the United States, it is already shipping the sponge to stores across Canada. In the meantime, two Canadian Internet sites are selling the sponge on-line, so for U.S. women, it is only a mouse click away. The polyurethane device prevents pregnancy by covering the cervix and releasing the spermicide nonoxynol-9; its protection begins immediately after it is inserted and lasts for 24 hours. Hundreds of women have already ordered the sponge, which is easier to use and less expensive than similar devices that have been available on-line since Today was withdrawn from the market.

1. Associated Press, Contraceptive sponge back on the market, Washington Post, Mar. 5, 2003, p. A7.

SEX IN THE COUNTRYSIDE

Substantial proportions of HIV-infected men and women surveyed in rural areas of 12 states reported recently engaging in unsafe sexual behavior.1 Of the 149 men and 67 women who participated in the survey, 49% and 57%, respectively, said that they had had intercourse within the past three months; half of these had had at least one episode of unprotected intercourse. Five in 10 men and four in 10 women who were in a romantic relationship said either that their partner was HIV-negative or that they did not know their partner's HIV status. Males reported predominantly same-sex relations; 51% of those who had had anal sex during the 90-day recall period had never used condoms, and only 30% had used them often. By contrast, three-quarters of men who had recently had vaginal sex had used condoms often. Women who had had vaginal intercourse reported less condom use than men: Only 46% reported frequent use in the past three months, and 31% reported none. The results, according to the researchers, illustrate the need for risk reduction interventions for "geographically isolated" HIV-infected individuals who "have difficulty refraining from" risky behaviors.

1. Heckman TG et al., HIV transmission risk practices in rural persons living with HIV disease, Sexually Transmitted Diseases, 2003, 30(2):134-136.

THE CIRCLE OF LIFE

For teenage mothers who are wards of the state, whether a main parenting figure had been a teenage parent could be a critical predictor of psychosocial outcomes, according to findings based on telephone interviews with 139 mothers aged 14-20 who were in the care of the Illinois child welfare agency.1 Nearly all of the young mothers had a main parenting figure, and half reported that this person (typically their mother or another female relative) had been a teenage parent. On average, those whose main parenting figure had been a teenage parent scored signifcantly higher than others on a standard scale measuring parenting stress. Their scores on two subscales indicated that they experienced elevated levels of parental distress (e.g., depression and social isolation) and reduced levels of satisfaction with their interactions with their child. Furthermore, their educational attainment was reduced by about one-half year. The researchers comment that if "'problems beget problems,'... then perhaps the converse is true; promoting safe, stable, and nurturing relationships across generations for at-risk mothers may benefit the next generation."

1. Felix ED et al., Cross-generational parenting influences on psychosocial functioning of adolescent mothers in substitute care, Journal of Adolescent Research, 2003, 18(2):154-168.

IN BRIEF

• Under a proposal made by the Food and Drug Administration early this year, labeling for over-the-counter contraceptives containing nonoxynol-9 would state that these preparations do not prevent infection with HIV or other sexually transmitted diseases. In addition, labeling would include a warning that users of these products might experience vaginal irritation, which could increase the risk of infection. The proposal follows the release of research showing that nonoxynol-9 does not prevent HIV infection. [Dow Jones Newswires, FDA proposes warning for contraceptives with nonoxynol 9, Wall Street Journal Online, Jan. 16, 2003, <http://online.wsj.com/article/0,,BT_CO_2003116_ 010108-search, 00.html?collection=autowire30day&vql_string-contraception <in>(article body)>, accessed Jan. 17, 2003.]

Understanding Medical Abortion: Policy, Politics, and Women's Health, the University of Oregon's Center for the Study of Women in Society presents the most up-to-date information about medical abortion and lays out the legal and political issues that have influenced its provision in the United States. For further information about the publication, contact csws@oregon.uoregon.edu.