In the debate about the content of and approaches to sex education, one view seems to be almost a given: that parents have the primary responsibility for teaching their daughters and sons about appropriate, safe sexual behavior. But can it be accepted as a given that parents have the information they need to explain to their children how to have fulfilling and healthy sexual relationships? Analyses by Marla E. Eisenberg and colleagues reported in the lead article of this issue of Perspectives on Sexual and Reproductive Health (see article) suggest that it cannot.
Eisenberg and her team found that in Minnesota and Wisconsin, substantial proportions of parents of 13-17-year-olds underestimate the effectiveness and safety of condoms and oral contraceptives; the majority do not think that most teenagers are capable of using these methods effectively. Not all parents are equally uninformed: White parents are more likely than nonwhites to have medically accurate views of the pill, and the more liberal parents are, the more likely they are to have accurate beliefs about condom effectiveness. Mothers have more accurate views of the pill than fathers, but fathers' understanding of condoms is more accurate than mothers'. The researchers point out that the societal acceptance that parents should be their children's primary sex educators implies a societal obligation to provide parents with medically accurate information, tailored as need be to specific populations and disentangled from political rhetoric.
Also in This Issue
•The nationwide shortage of abortion providers has been extensively documented, but strategies for alleviating it have received less attention. Results of a survey conducted among second-year health professions students at the University of Washington, reported by Solmaz Shotorbani and coauthors (see article), suggest that part of the solution may lie in training and in rethinking who is permitted to provide abortions. Half of the students thought that advanced clinical practitioners—physician assistants, nurse practitioners and nurse-midwives—should be permitted to provide medical abortions, and four in 10 thought they should be able to provide surgical abortions. Students also indicated that abortion is not adequately covered in their training, and most expressed willingness to attend a program that included an abortion training requirement. Shotorbani and colleagues conclude that "making abortion a standard part of clinical training will open avenues for both future physicians and advanced clinical practitioners who are in favor of providing these services."
•Maybe the diaphragm isn't perfect, but it is fairly effective at preventing pregnancy and, if used with a microbicide, has potential to help prevent sexually transmitted diseases. What is more, women who use the method are generally satisfied with it, according to Julie E. Maher and colleagues' findings from a sample of women in one managed care program (see article). While the women in the sample disliked some aspects of diaphragm use, the vast majority were satisfied with it and intended to use it again. Two key factors that motivated women to choose the diaphragm were their dissatisfaction with other methods and a health care provider's recommendation. Thus, the authors believe, the method could make a "dramatic comeback" if it is proven to help prevent disease and if health care providers encourage its use.
•Coverage of reversible contraceptive services by employer-sponsored managed care plans increased dramatically between 1993 and 2002, as Adam Sonfield and coauthors report (see article). Whereas 32-59% of such plans covered various services in the earlier year, 78-97% did so in 2002. Only a negligible proportion do not offer coverage for any of the leading reversible methods, and the proportion covering all of them has more than tripled. What accounts for these changes? Sonfield and colleagues find that the increase in coverage was due primarily to "environmental factors," such as guaranteed coverage for federal employees, sex discrimination decisions and heightened publicity to the issue; a considerable share was attributable to state mandates requiring equitable contraceptive coverage. Important as the changes of the past decade have been, however, the authors conclude that the only way to guarantee affordable coverage of contraceptive services is to incorporate them into a national health insurance program.
•For adolescents, the assurance that providers and insurers will maintain their confidentiality may make or break the decision to seek reproductive health services. A federal rule in place since August 2002 complements established laws and guidelines on individuals' rights regarding access to their medical records, and specifically addresses the protected health information of minors. Abigail English and Carol A. Ford's comment (see article) outlines the implications of the HIPAA rule for private practitioners, school-based health centers and clinics that provide reproductive health care to adolescents, as well as the questions that the rule leaves unanswered and types of further changes its implementation may spur.