With this issue, Perspectives on Sexual and Reproductive Health begins its 40th year of publication. We—the field and the journal—have come a long way during these four decades. Perspectives was launched before Title X was in place; the lead article of the first issue (illustrated by the drawing we have reproduced on the cover of this issue) reported on the initial stage of Louisiana’s effort to create “a system to offer high quality modern, medical family planning services” to the state’s “medically indigent” women who wanted and needed them. When that effort got under way, in 1964, the state had no such services, because disseminating family planning information was a felony there.1 Roughly 40 years later, a network of nearly 8,000 publicly funded family planning clinics provides services to some 6.7 million clients nationwide a year.2 And services are no longer restricted to the provision of family planning methods: Many publicly funded clinics provide educational programs for teenagers; screening for cervical cancer, HIV and other STDs; and non–reproductive health services for men.3
Perspectives has been privileged to be a key vehicle for documenting, examining and publicizing these developments and others in the stillexpanding field of sexual and reproductive health. As we begin our 40th year, we look forward to the continuing challenge of providing our broad and growing readership with the information that is essential for the formation of sound policies and effective programs, and for ensuring the sexual and reproductive health of all Americans.
Here is what you will find in this issue:
•Using data from the most recent Guttmacher Abortion Provider Survey, Rachel K. Jones and colleagues show (see article) that the number of abortions performed in the United States declined by 8% between 2000 and 2005, and the abortion rate declined by 9%. The number of abortion providers was fairly stable, largely because of the growing number of providers who offer only medication abortion, and the proportion of counties lacking an provider remained high—close to nine in 10. The authors emphasize the need to “help women and their partners prevent unintended pregnancy,” as well as to enable women to terminate such pregnancies when they occur.
•Sex at a young age with an older partner may be linked to adverse reproductive health outcomes beyond adolescence. In an analysis of data from the National Longitudinal Study of Adolescent Health (see article), Suzanne Ryan and coauthors find that women who have sex before age 16 with a partner at least three years their senior have elevated odds of having a teenage birth and of having a nonmarital birth or acquiring an STD by young adulthood; the combination of having early sex and having an older partner appears to be key to the association with STD risk. For males, early sex is associated with adverse outcomes, but partner age is not a factor.
•Government policies that encourage unmarried adult women to refrain from having sex “appear out of touch with . . . reality,” according to Laura D. Lindberg and Susheela Singh (see article). Lindberg and Singh’s analyses of data from the 2002 National Survey of Family Growth show that the majority of women who are neither married nor cohabiting are sexually active, that single women are more likely than others to have multiple partners in a given year and that half of them are at risk of unintended pregnancy. At best, the authors write, policies that ignore these realities “are unlikely to be effective, and at worst they may have a negative impact on women’s sexual and reproductive health.”
•In a review of the literature spanning 1990–2005 (see article), Douglas Kirby found only 11 studies that assessed programs aimed at increasing contraceptive use or reducing unintended pregnancy among adult women in the United States; he found none that measured the impact of state or federal policies. Given U.S. levels of unintended childbearing, Kirby finds this lack of research “deplorable.” He argues that “a well-developed research plan that rigorously assesses the effects of various approaches to increasing effective contraceptive use among adult women should be an integral part of any long-term effort to reduce unintended pregnancy in this country.”
•Modifying the successful Reducing the Risk pregnancy and STD prevention intervention to meet the needs of youth classified as high sensation seekers or impulsive decision makers did not improve the curriculum’s effectiveness in a quasi-experimental trial in Ohio and Kentucky. As Rick S. Zimmerman and colleagues report (see article), participation in either intervention was associated with short-term improvements in knowledge and with delays in initiating intercourse, but results did not differ between students in the two interventions. The authors’ speculation as to why the modified curriculum had no unique effect may help point the way for further work on meeting the needs of the high-risk youth it had targeted.
1. Beasley JD, View from Louisiana, Family Planning Perspectives, 1969, 1(1): 2–15.
2. Frost J, Frohwirth L and Purcell A, The availability and use of publicly funded family planning clinics: U.S. trends, 1994–2000, Perspectives on Sexual and Reproductive Health, 2004, 36(5):206–215.
3. Lindberg LD et al., Provision of contraceptive and related services by publicly funded family planning clinics, 2003, Perspectives on Sexual and Reproductive Health, 2006, 38(3):139–147.