Advancing Sexual and Reproductive Health and Rights
Perspectives on Sexual and Reproductive Health
Volume 45, Number 2, May 2013


A growing literature documents the sexual health and behavior of sexual minority women, but definitions of “sexual minority” have been broad, and STD risk among young adult women classified as such has received relatively little attention. In this issue of Perspectives on Sexual and Reproductive Health (page 66), Lisa L. Lindley and coauthors present findings on the association between sexual orientation and recent STD diagnosis in the 24–32-year-old women who participated in Wave 4 of the National Longitudinal Study of Adolescent Health. Adding nuance to the description of sexual minority populations, the researchers use women's self-reported sexual identity to categorize them as straight, mostly straight, bisexual, or mostly gay or gay; they categorize relationship histories as including only male partners, one female partner or more than one female partner.

Many more women defined themselves as mostly straight than as bisexual, mostly gay or gay; four in 10 mostly straight women had had more than one female partner. Mostly straight women and women who had had multiple female partners appeared to be at greater risk for STDs than straight women and those reporting only male partners, respectively, but the associations were not apparent when sexual behaviors were controlled for. Nevertheless, the findings lead the authors to several conclusions that could help guide research and practice. For example, they write, the “traditional” classification of heterosexual/bisexual/homosexual may not be adequate, and how sexual identity exploration, sensation-seeking and forced sex are related to sexual risk-taking may warrant particular attention. An improved understanding of “the experiences and motivations that shape women's sexual decisions,” they note, “is crucial in order to prevent STDs and promote the sexual health of all women.”

Also in This Issue

• “If people are using withdrawal properly and are making an informed choice, it may be inappropriate to dissuade them,” Jason Ong and colleagues conclude after studying use of the method among clients of an Australian sexual and reproductive health agency (page 74). Withdrawal was the third most commonly used method (after male condoms and the pill) in this population, and for four in 10 users, it was the only method reported. However, “sole users” had elevated odds of saying that they were dissatisfied with their method and that they had had multiple partners in recent months. Furthermore, the vast majority of them were inconsistent in their use, and this group were more likely than other women to say that their partners would not use another method and that they lacked access to contraceptives. The authors emphasize that individuals who use withdrawal ineffectively require “support and accurate information about [its] failure rate, proper use and inability to protect against STDs.”

• Kate Cockrill and coauthors describe the development and validation of a scale for measuring individual-level stigma associated with having an abortion, and show what it revealed in a sample of women surveyed at 13 Planned Parenthood clinics in 2011 (page 79). The scale taps four dimensions of stigma—worries about judgment, isolation, self-judgment and community condemnation—and addresses women's feelings about their abortion at the time of the procedure and subsequently. In the clinic-based sample, the scale suggested that the type of stigma women felt was associated with their religion, race, age, motherhood status and education. The researchers view the scale as a potentially important tool for initiatives aimed at reducing abortion-related stigma, and they note that it can be adapted for use in other contexts, as well as to assess community-level attitudes and to explore mental health outcomes related to abortion.

• Black and Hispanic teenagers are substantially more likely than their white counterparts to give birth, and Jennifer Manlove and colleagues demonstrate that the disparities may be related to differences in the context of adolescents' lives (page 89). Using data from the 1997 cohort of the National Longitudinal Survey of Youth, the researchers found that controlling for family environment, social characteristics and sexual experience reduced the differences in teenage childbearing between whites and both blacks and foreign-born Hispanics; it eliminated the difference between whites and U.S.-born Hispanics. Moreover, the authors estimated that if black and U.S.-born Hispanic teenagers had the same characteristics as whites, their predicted probability of giving birth during adolescence would fall by more than one-third. While programs are needed “to help improve reproductive health outcomes across populations,” Manlove and colleagues observe, it may be important for them “to take into account cultural differences within teenage populations.”

• Coming at the issue of adolescent sexual risk from a social ecological perspective, Molly Secor-Turner and colleagues examine how chaos and instability in young people's lives relate to their likelihood of engaging in risky behaviors (page 101). They measure chaos and instability through latent constructs of individual risk (encompassing experiences related to violence and substance use) and family disengagement (reflecting, among other characteristics, communication within the family), which they assessed among a sample of sexually active teenage women at high risk of pregnancy and STDs. In their models, level of individual risk was positively associated with number of male partners six months later, but was not related to inconsistent condom use. Level of family disengagement, by contrast, was negatively associated with subsequent consistency of condom use, but was unrelated to number of partners. According to the authors, the findings support the importance of research and interventions that focus on “the wider circle of [adolescents'] social contextual characteristics.”

—The Editors