Every year, millions of women enter U.S. jails and prisons; some of them are pregnant, and many of those pregnancies were not intended. Correctional facilities' abortion policies are known to vary widely, but the actual provision of services is poorly understood. In this issue of Perspectives on Sexual and Reproductive Health (see article), Carolyn B. Sufrin and colleagues present findings from a survey of correctional health providers that suggest that "varied, and sometimes unconstitutional, interpretations of laws and medical standards" constrain incarcerated women's access to abortion care. Among the challenges that incarcerated women may face if they wish to have an abortion are difficulties in making transportation or financial arrangements, facilities' ad hoc responses to abortion requests and the requirement of obtaining a court order.
In a related viewpoint (see article), Diana Kasdan summarizes the legal principles that are relevant for determining the constitutionality of correctional facilities' approaches to abortion provision. She stresses that policy guidelines are needed to help advocates and health professionals identify gaps in services for incarcerated women, and that "correctional facilities across the country should be held to…basic standards for respecting pregnant women's federal constitutional rights." Also in This Issue
• An HIV prevention program that has proven effective in the community-based settings for which it was designed did not work as well when replicated in 10 high schools in the Midwest. Elaine A. Borawski and colleagues (see article) find that students exposed to the Be Proud! Be Responsible! curriculum gained knowledge about risk reduction and confidence that they could take protective measures when having sex. However, over a 12-month follow-up period, these youths did not differ from a control group in terms of levels of sexual activity, condom use, or substance use or other risky behaviors. Nonetheless, the authors maintain that schools are a "logical" place for HIV education to be provided and that it is imperative to "continue to examine ways to optimize the school environment in delivering effective prevention messages."
• Jennifer S. Hirsch and colleagues (see article) explore the social and cultural characteristics associated with risky sexual behavior among Mexican migrant men in Atlanta. They find that while some aspects of masculinity are reflected in men's propensity to engage in extramarital sex, "approaching masculinity purely as a cognitive construct that could be transformed through consciousness-raising strategies" is an inadequate approach to reducing risk. Rather, attention to migrant men's social networks and the places where they spend leisure time should be incorporated into comprehensive prevention efforts.
• Christine Elizabeth Kaestle reports (see article) that young adults—both men and women—experience sexual coercion. Her analyses, based on data from the National Longitudinal Study of Adolescent Health, also show that young adults repeatedly engage in sexual behaviors that they dislike, although women are considerably more likely than men to do so. Kaestle points out that even in fairly well established relationships (the data are from respondents who were in a relationship that had been ongoing for at least three months), young adults may need guidance on how to be sensitive and responsive to partners' desires, as well as on how to express their own preferences regarding sexual activity.
• Two articles in this issue add to the scarce literature on family planning in Russia. Using data from eight rounds of a national study, Francesca Perlman and Martin McKee find (see article) that patterns of contraceptive use changed little between 1994 and 2003: Nonuse was common, and traditional methods were popular throughout the period, while reliance on barrier methods increased, IUD use fell and pill use increased minimally. The study reveals women's personal characteristics that are linked to reliable contraceptive use, but as the authors observe, broader examination of structural and policy-related factors remains an important objective for future research. Meanwhile, Elena Regushevskaya and colleagues explore both contraceptive use and abortion among women in St. Petersburg (page 51). Their analyses uncover some surprising relationships between contraceptive use and women's characteristics, and identify a number of predictors of abortion, which has traditionally been heavily used to limit childbearing in Russia. "Given the current cultural climate," they write, "it is not clear what approach would be best in mounting an effective reproductive health program."