Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 35, Number 5, September/October 2003
FYI


HOW DO YOU USE THIS THING?

Women often put condoms on their partners, but they do not always do it properly.1 In a survey of 102 college students who had put condoms on their partners at least once in the previous three months, 83% said that they had not checked the condom for signs of damage, and 71% reportedly had failed to check the expiration date; roughly half had put the condom on too late (51%) or had not left space at the tip (46%). Of the 49% of women reporting that they and their partner had switched between vaginal, oral and anal sex during a single encounter, three-quarters had not put on a fresh condom when switching. Most other errors and problems were reported by about 15-30% of respondents; these included putting a condom on the wrong way and flipping it over, using a condom without a lubricant, removing a condom before finishing intercourse and having a condom break or slip. Women who had never had instruction on using condoms, who used another contraceptive, who reported condom breakage or slippage, or whose partner had erection problems while using condoms reported more than the average number of five errors. Noting that women "may play a substantial role in condom use," the researchers remark that efforts to educate them about correct use and how condoms work "could be an important public health strategy."

1. Sanders SA et al., Condom use errors and problems among young women who put condoms on their male partners, Journal of the American Medical Women's Association, 2003, 58(2):95-98.

BOYS TAKE MORE ENERGY

Pregnant women take in 10% more energy daily if they are carrying a boy than if they are carrying a girl, according to an analysis of data on 244 Boston women who gave birth in 1994-1995.1 On average, the difference comes to about 190 calories (say a bagel's worth) when maternal age, height, prepregnancy weight and other confounding factors are taken into account. Sex of the fetus is not related to maternal weight gain during pregnancy, even though weight gain is associated with birth weight. The researchers suggest that the difference in maternal energy intake may help explain why newborn boys weigh about 100 g more than newborn girls, a finding that has been observed across populations.

1. Tamimi RM et al., Average energy intake among pregnant women carrying a boy compared with a girl, British Medical Journal, 2003, 326(7401): 1245-1246.

BREASTFEEDING IS CATCHING ON

Sixty-five percent of U.S. children aged 19-35 months in 2001 had ever been breastfed; this proportion is significantly higher than the 54% found in 1988-1994 and close to the Healthy People 2010 goal of 75%.1 Analyses of the latest data show that 27% of infants were still being breastfed at six months, and 12% at 12 months; these rates reflect essentially no change over the decade and are considerably behind the national goals of 50% and 25%, respectively. Breastfeeding prevalence falls most sharply between two and three months after birth (from 54% to 39%), the period when, as the analysts point out, many women return to work. Only about four in 10 black women breastfeed, compared with seven in 10 white and Hispanic women; black women also have the lowest rates of continued breastfeeding at six and 12 months. The analysts consider workplace facilities and policies that accommodate breastfeeding women "essential" to promoting the practice, and they urge health care facilities and providers to take an active role in encouraging breastfeeding.

1. Li R et al., Prevalence of breastfeeding in the United States: the 2001 National Immunization Survey, Pediatrics, 2003, 111(5):1198-1201.

HOW TO WIN FRIENDS...?

Sexually active teenagers may strike their peers as popular, but they may not be seen as the most desirable company.1 In a survey of 212 suburban New England 10th graders, the 40% who reported having oral sex and the 30% who said they had sexual intercourse received higher ratings on a scale of popularity than those who said they did not engage in these behaviors. However, the more oral sex partners a youth had had, the lower the popularity score; furthermore, students who engaged in oral sex or intercourse did not rank high on a scale measuring whom teenagers most liked to spend time with. A majority of students who had experience with oral sex said that their best friend also had such experience, and the number of oral sex partners was significantly correlated with the perceived number among students' best friends; similar associations were not found for sexual intercourse. Commenting on their findings, the researchers observe that "adolescents' engagement in sexual behavior is associated with social influences in a manner that [prevention programs] could use to promote safer sexual behavior."

1. Prinstein MJ, Meade CS and Cohen GL, Adolescent oral sex, peer popularity, and perceptions of best friends' sexual behavior, Journal of Pediatric Psychology, 2003, 28(4):243-249.

DISEASE BURDEN FOR BLACKS

By applying a mathematical model of HIV transmission to data from the Centers for Disease Control and Prevention, analysts have estimated that 545 new HIV infections among black men and women in 2000, or 3-5% of new HIV infections among blacks, were attributable to the effects of infectious syphilis.1 Over the affected individuals' lifetime, these infections will result in an estimated $113 million ($207,000 per person) annually in direct medical costs. By contrast, nationwide syphilis prevention programs would cost $60 million each year; the analysts note that such programs would avert the cost of treating not only syphilis-attributable HIV but also other consequences of syphilis infection. Moreover, syphilis prevention efforts might promote sexual behaviors that lower the risks of other sexually transmitted diseases. The analysts conclude that a "successful national syphilis elimination program" could substantially reduce the burden of HIV among black Americans.

1. Chesson HW et al., HIV infections and associated costs attributable to syphilis coinfection among African Americans, American Journal of Public Health, 2003, 93(6):943-948.

TOO MANY CESAREANS?

In 1999-2001, 8% of deliveries at nearly 2,000 hospitals in 18 states were planned cesareans performed on women who had not gone into labor and had not previously had a cesarean; 22% of these operations involved women who had none of 12 clinical conditions that have been characterized as appropriate indications for cesarean delivery.1 Analysts who compared the actual number of cesareans performed with the number expected for clinical reasons found that 24% of hospitals performed more than the expected number of procedures. This finding, they comment, may reflect a demand for cesareans done simply because women choose them--a practice whose appropriateness, risks, benefits and ethics have stirred much debate. On the other hand, 29% of hospitals performed fewer cesareans than expected--possibly, according to the analysts, in response to pressure from organizations that advocate lowered rates of cesarean delivery. The downside to underuse of the procedure may be poor maternal outcomes: Vaginal complications were significantly more prevalent in hospitals where unexpectedly few procedures were performed (14%) than in others (11-13%). Poor outcomes from underuse would be "counterproductive to the goals of a lowered national primary cesarean rate."

1. Health Grades, First time preplanned and "patient choice" cesarean section rates in the United States, Lakewood, CO: Health Grades, 2003.

ABORTION RESTRICTIONS IN RUSSIA GROW

Russia's health ministry has reduced from 13 to four the number of social circumstances under which women can obtain legal induced abortions 12-22 weeks into pregnancy.1 Under regulations that took effect in mid-August, abortion remains available to women who have been raped, are imprisoned or have lost their parental rights, or whose husbands have died or been severely disabled. However, divorce, poverty, unemployment, poor housing, single parenthood and refugee status, among other circumstances, no longer serve as grounds for obtaining an abortion after 12 weeks. (During the first 12 weeks of pregnancy, abortion is available without limits; at 12-22 weeks, it is available to women who need to terminate a pregnancy for medical reasons.) By eliminating most of the social indicators for abortion, which had been in place since 1987 and accounted for 40,000 of 1.7 million abortions performed in 2002, the health ministry hopes to encourage women to practice contraception rather than relying on abortion to avoid unwanted births. Debate about the morality of abortion appears to be growing in Russia, as conservative lawmakers and clerics press for tighter restrictions on its availability.

1. Myers SL, After decades, Russia narrows grounds for abortions, New York Times, Aug. 24, 2003, p. 3.

WOMEN'S PILL IQ IS LACKING

Only about half of women surveyed in four clinics in Portland, Oregon, knew that the pill lowers the risk of acne and menstrual irregularities, and that it raises the risk of weight gain, headaches and thrombosis.1 Nearly three in 10 were aware that pill use protects against ovarian cancer, but far smaller proportions knew of other benefits of use, such as a reduced risk of anemia, pelvic inflammatory disease and endometrial cancer. Women said that their information about the pill's effects on general well-being and reproductive health came mainly from their own experiences; printed materials were the most frequent sources of information on its association with cardiovascular illness and cancer. Medical personnel generally were the second most frequently cited source of information; few women mentioned getting information from the Internet. Understanding and expanding women's knowledge of the health benefits of pill use, the researchers remark, "may improve satisfaction and compliance and, consequently, reduce the risk of unintended pregnancy."

1. Picardo CM et al., Women's knowledge and sources of information on the risks and benefits of oral contraception, Journal of the American Medical Women's Association, 2003, 58(2):112-116.

LEARNING WHO STOPS CARE

A substantial proportion of HIV-infected men and women cease seeking medical care for their illness within a short time, according to a study conducted in two hospitals in New England.1 Twenty percent of patients interviewed in 1994-1996 at their first visit for HIV-related primary care discontinued care within six months. Using multiple logistic regression analysis, the researchers found that the odds of discontinuing care were raised by 20% among those with a high CD4 cell count (odds ratio, 1.2) and were more than doubled among those who had not graduated from high school, those who had not experienced physical or sexual abuse, and those who had served time in jail in the past 10 years (2.2-2.7). The likelihood of discontinuation varied between sites, suggesting that not only patient characteristics but also features of the health care system may affect individuals' inclination to obtain ongoing care. Contrary to the researchers' expectations, homelessness and substance abuse were not associated with the likelihood of infected individuals' discontinuing care. The investigators comment that research into factors influencing discontinuation of HIV primary care "can lay the foundation for interventions that make [it] a much rarer event."

1. Samet JH et al., Discontinuation from HIV medical care: squandering treatment opportunities, Journal of Health Care for the Poor and Underserved, 2003, 14(2):244-255.