Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 36, Number 3, May/June 2004

IN THIS ISSUE

Over the years, several studies have suggested that teenagers who have been sexually abused are at increased risk of being involved in unintended pregnancy and engaging in unsafe sexual behaviors. Owing to characteristics of their samples or designs, however, most of these studies have been limited in their ability to flesh out the association. In this issue of Perspectives on Sexual and Reproductive Health (see article), Elizabeth M. Saewyc and colleagues report on a study of young people’s sexual and reproductive experiences in the wake of sexual abuse, using a data set that offers substantial advantages over ones that have been the sources for other analyses.

Most research in this area has been based on surveys conducted among nonrepresentative samples or including only one question about sexual abuse history. By contrast, the Minnesota Student Survey, on which Saewyc and her team based their analyses, is a statewide census study of ninth and 12th graders, and it contains multiple measures of interest. Thus, using data on sexually experienced students surveyed in 1992 and 1998, the authors determined not only that pregnancy involvement and risk behaviors associated with teenage pregnancy were more common among those with a history of abuse than among others, but also that the likelihood of these outcomes was lower for youth who had been abused only by family members or only by individuals outside their families than for those who had experienced both incest and nonfamilial abuse. Other key findings illustrate how the experience of abuse and its aftermath differ for females and males: A higher proportion of female students than of males reported any type of sexual abuse, but the differential between nonabused and abused youth in the odds of pregnancy involvement and most risk behaviors was markedly larger for males than for females.

As the authors note, sexually abused youth have gone largely unnoticed by teenage pregnancy prevention and sexual health efforts. Yet these young people have specific needs, and adolescent health providers, counseling and educational programs, and teenage pregnancy and parenting services all have a role in ensuring that these needs are met.

Also in This Issue

•When women with HIV infection think about having children, what considerations come into play? Sheri B. Kirshenbaum and colleagues interviewed 56 HIV-positive women in four U.S. cities, and found them grappling with a complex array of issues (see article). Among women’s main concerns were the risk of vertical transmission of the virus and the effectiveness of methods to prevent it; their partners’ childbearing desires; societal norms that pressure women to become mothers; attitudes of health care providers; the potential impact on their children if they get progressively sicker and die; and the stigma still associated with having HIV infection. One striking finding was the extent to which women overestimated the risk of vertical transmission. The researchers stress the need for targeted interventions that are sensitive to the needs and concerns of HIV-positive women.

•In a randomized crossover trial reported by Andrzej Kulczycki and colleagues (see article), 108 women in Alabama tried both male and female condoms, and provided detailed reports of their experiences with and responses to each method. Neither device scored high on user satisfaction measures, but the male condom received higher ratings on a range of factors, including ease of use, effect on sexual pleasure and discomfort during intercourse. The male condom also came out ahead in direct comparisons of the two methods, and women said that their partners preferred the male condom, too. Recognizing the need for "a viable woman-initiated and potentially empowering complement to male condoms," and the potential for the female condom to address that need, the authors encourage modifications to the device that will enhance its acceptability without compromising its effectiveness.

•In a viewpoint article spurred by Kulczycki and coauthors’ condom study, Susie Hoffman and colleagues argue that if the female condom were properly promoted, it could play an important role—and would be well accepted—in efforts aimed at preventing unintended pregnancy and sexually transmitted disease (see article). Recognizing the need for "adequate empirically driven promotion and evaluation," the authors urge a "renewed commitment" to realizing the potential of this method, which would also lay the groundwork for promoting other effective female-initiated barrier methods.

•Whereas microbicides have sometimes been touted for their potential to be used covertly, Cynthia Woodsong is not so sure that this feature is either a necessary or a good thing. In her viewpoint (see article), she emphasizes that now, with the introduction of microbicides onto the market still several years away, is the time for research into the implications and advisability of covert use. Rather than focus on women’s being able to use a microbicide without their partner’s knowledge, Woodsong would like to see an emphasis on culturally sensitive strategies to ensure that the product’s purpose and effectiveness are clear to both women and men.

—The Editors