IN THIS ISSUE
Lesson learned again and again: When assessing—and addressing—sexual and reproductive behaviors, attitudes and outcomes, we cannot assume that the same patterns will hold in all population subgroups. In California, for instance, Aimee Afable-Munsuz and Paula Braveman have found that pregnancy intention is associated with the likelihood of preterm birth among immigrant Latinas, but not among their U.S.-born counterparts, whites or blacks. Afable-Munsuz and Braveman detail their findings in this issue of Perspectives on Sexual and Reproductive Health (see article).
The California study involved a large, population-based sample of women who had recently given birth and a more extensive set of socioeconomic data than was available for earlier studies exploring the same issue. Its results lead the authors to conclude that socioeconomic factors “may play different roles in relation to pregnancy intention and preterm birth for different groups of women.” Moreover, the findings leave no question that further work is needed on what unintended pregnancy means in different subgroups. Ensuring optimal maternal and child health, the researchers write, requires “a more nuanced understanding of women’s pregnancy goals and desires.”
Also in This Issue
•Teenage pregnancy prevention programs that focus on helping youth to formulate and realize vocational or educational goals may be missing the point, according to a study by Sarah Jumping-Eagle and others (see article). For teenagers in a clinic-based sample, simply having conventional goals was not an independent predictor of pregnancy avoidance measures. Rather, regarding pregnancy as an impediment to achieving goals was the key, predicting contraceptive use and intended use, intention to avoid pregnancy and even intention to have an abortion in the event of pregnancy. “In practical terms,” the authors write, their findings “may mean that parents, teachers and prevention interventions should focus on helping female teenagers understand why they may want to postpone childbearing.”
•U.S. women’s use of emergency contraception, while increasing, remains rare, and one reason may be that clinicians seldom discuss the method with their patients. In an analysis of data from the National Survey of Family Growth (see article), Megan L. Kavanaugh and Eleanor Bimla Schwarz find that only 3% of all women have received counseling about emergency contraception from a health care provider in the past year; the proportion is not much different—4%— among those who have visited a gynecologist in the past year. Some groups of women are more likely than others to have received counseling, and women who have had counseling are more likely than others ever to have used the method. The researchers note that clinicians can have a “pivotal role” in informing women about emergency contraception, but that “alternative ways of delivering counseling” need to be explored.
•Teenagers who think that abstaining from sexual activity is a good idea or who intend to abstain may end up having sex anyway—or, as N. Tatiana Masters and colleagues put it (see article), teenagers do not necessarily consider abstinence “the opposite of sex.” Masters and her team analyzed data collected from a sample of Seattle teenagers, and found that intention to have sex was a stronger predictor of behavior than was intention to abstain. Thus, they argue that “if the goal is preventing adolescent sex, programs aimed simply at strengthening abstinence intentions might not have the intended effects, especially if they do not affect sex intentions at the same time.”
•With contraceptive users accounting for nearly half of unintended pregnancies in the United States, it is important to understand what factors lead to inconsistent or ineffective contraceptive use. Reporting on a nationwide survey of women using reversible methods (see article), Jennifer J. Frost and Jacqueline E. Darroch show that attitudes toward pregnancy prevention, motivation to avoid unwanted pregnancy and women’s experiences with their providers and methods are among the most important predictors of consistent use. Frost and Forrest suggest that providers, educators and counselors all have a part to play in helping women and their partners improve their contraceptive use; of particular note, they urge “extending the mandate of contraceptive care…to include ongoing support and assessment of contraceptive needs throughout women’s reproductive lives.”
•Using data from the National Longitudinal Survey of Youth, Jennifer Manlove and coinvestigators analyze, in ways that have not been possible with other data sets, whether and how family religiosity affects teenagers’ sexual and contraceptive behavior (see article); their structural equation models permit them to tease out both direct and indirect effects. Among the principal findings are that religiosity is directly (and negatively) associated with sexual experience, but only indirectly associated with teenagers’ number of partners (again negatively) and consistency of contraceptive use (positively). Mediators of all of these associations include indicators of family cohesion and peer environments. The results, according to the researchers, point to steps that both parents and programs might take to help reduce levels of teenage pregnancy and STDs.