As Perspectives on Sexual and Reproductive Health begins its 42nd year, a new decade is unfolding, and new political and economic landscapes are continuing to take shape. So it seems a good time to give some thought to priorities for the coming years: What issues most need to be addressed in sexual and reproductive health research? We put that question to a number of leading figures in the field, and their answers appear in the special Roundtable section of this issue.
Carolyn Tucker Halpern (see article) notes that despite "numerous calls over many years" to move from treating adolescent sexuality strictly as a problem to placing "commensurate emphasis on positive sexual development," the literature "provides little information about context and the meaning of the behavior to adolescents." Halpern argues for why it is important to approach adolescent sexuality as a developmental process and how best to do so, to help young people make the transition from exploratory sexual activity to healthy sexual lives.
James Trussell and colleagues (see article express their disappointment—no doubt shared by many—that emergency contraceptive pills have not made a significant dent in unintended pregnancy rates. In discussing next steps in efforts to prevent unintended pregnancies, the authors point out that women and researchers often have different notions of what constitutes a "contraceptive emergency." Therefore, one priority is to help women recognize when they need an emergency method, and another is to help them get one in a timely way. But the goal of reducing unintended pregnancy cannot be met only in the context of emergency situations, and the authors suggest strategies for taking on other facets of the problem.
Linda Hock-Long and coauthors (see article) address the question of priorities from the perspective of service providers. "In the coming decade," they write, "whether by chance or by design, the service delivery system is certain to face a multitude of direct care, technological, economic and structural challenges." To meet these challenges, providers need "a basic understanding of a fundamental issue" in service delivery that has not received adequate attention: the dynamics of contraceptive use. The authors call for "systematic and rigorous examination of the patterns of contraceptive use and influences that emerge over a person's reproductive life span and are amenable to intervention."
Gregory D. Zimet (see article) discusses how to maximize individuals' willingness and intention to use emerging biomedical technologies for sexual health promotion—STD vaccines and microbicides, for example. For him, the key is cross-disciplinary research. The "most obvious collaboration," Zimet holds, is between health behavior and biomedical researchers. But he also describes why contributions from such disciplines as medicine, nursing, marketing, anthropology and biostatistics can be "important, even necessary".
Also in This Issue
•In comparisons of two cohorts of women in the 2002 National Survey of Family Growth (see article), Elizabeth Wildsmith and coauthors find evidence that levels of unintended childbearing are rising and that repeated unintended births are common. Black women have a higher level of unintended fertility than whites or Hispanics, and appear to have dramatically rising levels of repeated unintended childbearing. Further investigation of levels and correlates of unintended pregnancy, the authors write, "is vital to efforts to craft effective public policy."
•Julianna Deardorff and colleagues (see article) show that predictors of sexual behavior among Latino youths include three sexual values—the importance youths attach to virginity, the importance they attach to satisfying sexual needs and their comfort with sexual communication. The results suggest that "cultural norms, particularly those related to gender ideologies, influence youths' sexual behavior, even when youths do not perceive these norms as influential."
•Anthony Paik reports (see article) that in a sample of adult men and women in Chicago, the probability of having been nonmonogamous was higher for those who were sexually involved with friends or casual partners than for those in serious relationships. Understanding the link between nonromantic relationships and partner concurrency, Paik concludes, can help individuals assess risks associated with a particular relationship.
•Using longitudinal data from a sample of adolescent women at high risk of pregnancy and STDs, Mary A. Ott and colleagues (see article) identify intrapersonal, relationship and STD-related characteristics associated with the risk of having sex after a period of abstinence. Although the findings differed depending on the length of the abstinence period, they illustrate that to provide appropriate counseling, clinicians may need to ask adolescents "not only whether [they] are sexually active, but when they last had sex."
•Knowing about a partner's risky behavior outside a relationship can help individuals assess the extent to which sex within that relationship puts them at risk. As Susan S. Witte and colleagues report (see article), this knowledge is good but not perfect. In particular, participants in their couple-based study underestimated partners' nonmonogamy. Couple-oriented interventions, the researchers believe, may offer a "safe space" for partners to discuss their risky behaviors.
•In focus groups described by Ellen K. Wilson and coauthors (see article), parents of 10–12-year-olds typically said that talking to children about sex is important and can be successful, but many had not done so. Their reasons for avoiding these discussions suggest ways to help parents have these discussions, according to the authors, including improving parents' understanding of children's sexual development and targeting parents of very young children.