Think of "the abortion issue," and you probably think about judicial and legislative actions, the future of Roe v. Wade, funding problems and other obstacles to the provision or receipt of care. But what about the women who seek abortions? Their circumstances, the factors that motivated their decision to end a pregnancy, receive little attention. Yet without an understanding of these circumstances and factors, neither public opinion, policies nor programs can be adequately informed. In the lead article of this issue of Perspectives on Sexual and Reproductive Health (see article), Lawrence B. Finer and colleagues explore the reasons that U.S. women terminate pregnancies.
In quantitative and qualitative analyses, the researchers found that women's reasons for choosing to have an abortion are complex and often intertwined, and represent a careful weighing of how a birth would affect various aspects of their lives. For many women, a sense of responsibility to their children and other dependents is a main motivation; financial constraints and lack of partner support also loom large. Some women cite the importance of appropriate birthspacing, and others acknowledge that they are not yet ready to become mothers. Many women consider abortion the only right choice, given their circumstances. So much for the notion that women take the decision to terminate a pregnancy lightly.
In helping to explain why women seek abortion, these findings also suggest the role of public assistance in helping disadvantaged women avoid having abortions and underscore the importance of public funding of family planning programs "as an effective means of reducing the incidence of both unintended pregnancy and abortion."
Also in This Issue
• Would strong enforcement of child support reduce men's likelihood of involvement in an unwanted pregnancy? Chien-Chung Huang's analysis of the 1982-2002 waves of the National Longitudinal Survey of Youth (see article) suggests that it might. Huang found marginally significant associations between strong child support enforcement and lowered odds of unwanted pregnancy; additionally, he calculated that if enforcement had not improved over the 20-year period, the unwanted pregnancy rate would have been 7% higher than it actually was. Including information on child support, Huang concludes, may help programs influence men to avoid unintended pregnancies.
• Features of people's neighborhood likely influence their lives; using data from the National Longitudinal Study of Adolescent Health, Catherine Cubbin and colleagues have examined associations between characteristics of teenagers' neighborhoods and their sexual behavior (see article). Although specific predictors vary for females and males, the analyses indicate that young people in neighborhoods marked by socioeconomic disadvantage have modestly elevated odds of sexual initiation; teenagers' contraceptive use shows little relationship to their neighborhood environment. The analysts argue that interventions with "an exclusive focus on behavior and personal responsibility will have a limited effect on sexual initiation"; neighborhood-level contextual factors, such as the concentration of poverty and idle youth, also must be addressed.
• To better understand disparities in STD risk between black and white women, Lisa A. Einwalter and coauthors examined the predictors of gonorrhea and chlamydia among 15-24-year-olds attending Missouri family planning clinics in 2001 (see article). Their findings reveal that for each infection, some factors independently predicted risk for both blacks and whites, but others were predictors only for one group. The authors point out that while national chlamydia screening criteria have been key to detecting infection among sexually active young women, it has been difficult to establish gonorrhea screening criteria; that challenge will remain, they conclude, until racial disparities are better understood.
• Not all sexually experienced teenagers engage in the same risk behaviors, and in a survey of teenage STD clinic clients, Cynthia Rosengard and colleagues found that one distinguishing feature may be the types of partners young people have had (see article). For example, those who had had only main partners, those who had had only casual partners and those who had had both differed in their lifetime number of partners and in the length of their most recent casual relationship. The researchers suggest that interventions tailor messages to the needs of adolescents whose sexual experience has included specific kinds of partners, and that evaluations of interventions assess outcomes by partner type.
• In Indiana, education about HIV and other STDs is mandated, but schools are required to stress abstinence. Nevertheless, William L. Yarber and colleagues report (see article) that the majority of residents participating in a statewide survey agreed that public high schools should provide instruction about condom use for STD prevention; almost all respondents considered condoms at least somewhat effective for STD prevention and agreed that school-based instruction should include only medically accurate information. The promotion of condoms by the media and the federal government also received strong support. If educators and policymakers are listening, Indiana may be able to take steps that will help reduce STD rates among young people.