First published online:

| DOI: https://doi.org/10.1363/4400412


After completing a review of 44 high-quality studies on the subject, the UK Academy of Medical Royal Colleges has concluded that having an abortion does not heighten a woman’s risk of having mental health problems.1 The studies, all conducted in developed countries and published in 1990–2001, show that "the most reliable predictor" of mental health problems after an abortion is a history of such problems before the abortion. They also indicate an elevated risk of postabortion mental health problems among women who had negative attitudes toward the procedure, were pressured by their partner to terminate the pregnancy or were going through stressful experiences. Unintended pregnancy, however, was associated with an elevated risk of mental health problems after abortion. "Future practice and research," the investigators comment, "should focus on the mental health needs associated with an unwanted pregnancy, rather than on the resolution of the pregnancy."

1. Academy of Medical Royal Colleges, Induced Abortion and Mental Health: A Systematic Review of the Mental Health Outcomes of Induced Abortion, Including Their Prevalence and Associated Factors, London: National Collaborating Centre for Mental Health, 2011.


Making long-acting reversible contraceptives—IUDs and implants—available to women immediately following an abortion may help increase use of these methods, according to findings based on more than 5,000 women who enrolled in the Contraceptive CHOICE Project in 2007–2009.1 At enrollment, all participants, who were sexually active and seeking reversible contraceptives, received STD testing, contraceptive counseling and free contraceptive supplies. One-third had had a recent abortion; three in five of these women had been offered a contraceptive method on the day of their abortion, and the rest had been offered one a day or more later (mean, 32 days). Some 86% of women who chose a method immediately postabortion opted for an IUD or implant, compared with 66–67% of those whose postabortion choice was delayed or who had not recently had an abortion. In analyses controlling for demographic, socioeconomic and behavioral characteristics, women who received a method immediately after an abortion were significantly more likely than those who had not had an abortion to choose an IUD or implant (relative risks, 3.3 and 1.5, respectively); those who chose a method longer after an abortion had a reduced likelihood of getting an implant (0.6). The researchers comment that the findings "reinforce the importance" of offering women long-acting reversible contraceptives immediately after they have an abortion.

1. Madden T et al., Comparison of contraceptive method chosen by women with and without a recent history of induced abortion, Contraception, 2011, 84(6):571–577.


Can pregnant women control the timing of their deliveries? Using 11 years worth of U.S. birth certificate data, analysts have found that the number of spontaneous births is significantly lower on Halloween than in the seven days leading up to it or following it.1 In contrast, the number of births is significantly higher on Valentine’s Day than on the seven days on either side of that holiday. Given that "cultural representations…are able to influence physical functioning," the researchers suggest that that the negative symbolism of Halloween (with its witches and skeletons) and the positive symbolism of Valentine’s Day (flowers and cherubs) may increase a woman’s will to delay and expedite births, respectively; this desire, in turn, may trigger a hormonal reaction that determines the timing of a birth. On a practical level, the analysts conclude, the findings "indicate the need to adapt obstetric staffing" on these holidays to accommodate the drops and spikes in the number of deliveries.

1. Levy BR, Chung PH and Slade MD, Influence of Valentine’s Day and Halloween on birth timing, Social Science & Medicine, 2011, 73(8):1246–-1248.


Use of a widely prescribed class of antihypertensive drugs during the first trimester of pregnancy has been linked to the risk of birth defects, but the largest investigation to date suggests that any association is actually attributable to the high blood pressure, rather than to the drugs.1 The study, using data on nearly 500,000 women in Northern California and their infants born in 1995–2008, focused on angiotensin converting enzyme (ACE) inhibitors and found that their risk profile was similar to that of other anti-hypertensives. Women who used ACE inhibitors at all during the first trimester or only then had no increased risk of having an infant with a birth defect, regardless of whether they were compared with women who did not have hypertension or with women who had untreated hypertension; any first-trimester use of other blood pressure drugs was positively associated with risk in comparisons involving women with normal blood pressure. Those same comparisons suggested a relationship between use of ACE inhibitors and elevated risks of congenital heart defects and neural tube defects; results for other types of drugs reached statistical significance. Untreated hypertension was independently associated with all outcomes. The study also confirmed an established risk of fetal malformations associated with use of ACE inhibitors in the second and third trimesters.

1. Li D-K et al., Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring: a retrospective cohort study, BMJ, 2011, 343:d5931, doi:10.1136/bmj.d5931, accessed Oct. 20, 2011.


Drinking is associated with the risk of STD infection, and a meta-analysis of randomized controlled studies suggests that intentions to engage in unprotected sex may be a crucial link.1 Pooled data from 12 studies showed a significant, linear association between blood alcohol levels and the intention to have sex without using condoms. The results were essentially the same in separate analyses by gender and by type of sample. (However, the analysts acknowledge that the generalizability of the findings is limited because all of the studies involved samples that were community- or university-based, in which participants were, on average, in their 20s.) According to the researchers, the consistency of their findings indicates that "personality factors" alone do not explain the association between drinking and either unprotected sex or STD incidence. They speculate that the elevated risk of intending to have unprotected sex associated with alcohol consumption is largely due to alcohol’s effect on cognitive function.

1. Rehm J et al., Alcohol consumption and the intention to engage in unprotected sex: systematic review and meta-analysis of experimental studies, Addiction, 2012, 107(1):51–59.


An HIV prevention intervention that was adapted to the linguistic and cultural context of Latinas in Miami appeared to succeed in reducing risky behaviors over a six-month follow-up period.1 In 2008–2009, Latina outreach workers recruited Spanish-speaking Latinas to participate in a randomized controlled trial of the intervention, which was based on a widely used intervention originally developed for black women and was adapted with considerable input from the Latina community. The 125 participants assigned to the intervention attended four sessions, conducted by a Latina health educator, that covered issues including ethnic and cultural pride, the importance of healthy relationships, HIV risk and how experiences related to immigration and acculturation can affect risk; 127 controls attended a single-session general health intervention. Throughout follow-up, intervention participants were more likely than controls to report consistent condom use in the last 90 and the last 30 days (odds ratios, 4.8 and 3.1, respectively), as well as use at last sex (2.8); they were less likely to report never-use (0.5 for both the last 90 and the last 30 days). Compared with controls, they used condoms 56% more often in the last 90 days and 44% more often in the last 30 days, and scored higher on measures related to relationships, self-efficacy and HIV knowledge.

1. Wingood GM et al., Efficacy of a health educator–delivered HIV prevention intervention for Latina women: a randomized controlled trial, American Journal of Public Health, 2011, 101(12):2245–2252.


Black women are more likely than whites to become pregnant as teenagers, but the disparity lessens as adolescence progresses.1 An analysis of data from Cycle 6 of the National Survey of Family Growth reveals that the odds of pregnancy before age 15 are four times as high among blacks as among whites, but the differential (while still significant) is about halved at ages 15–17 and 18–19. Similar trends are apparent when the data are stratified by the level of education of teenagers’ mothers, a marker for socioeconomic status. The analysts note that pregnancy risk appears to be "more generalized" among older than younger adolescents; thus, they conclude that it "may…be related to a developmental process," and they encourage efforts to look at it "through a developmental lens."

1. Upadhya KK and Ellen JM, Social disadvantage as a risk for first pregnancy among adolescent females in the United States, Journal of Adolescent Health, 2011, 49(5):538–541.

In Brief

• The World Health Organization has published the first ever guidelines for evidence-based efforts aimed at preventing and treating STDs among men who have sex with men and transgender individuals. The document is intended for use by public health officials, program managers, nongovernmental organizations, funders, policymakers and advocates. Prevention and Treatment of HIV and Other Sexually Transmitted Infections Among Men Who Have Sex with Men and Transgender People: Recommendations for a Public Health Approach is available for free download at <http://www.who.int/hiv/pub/guidelines/msm_guidelines2011/en/>.

• A report based on preliminary 2010 U.S. birth data is available from the National Center for Health Statistics. The report presents information on four million births and selected maternal and infant health characteristics; it also shows comparative data from 2009. "Births: Preliminary Data for 2010" is part of the National Vital Statistics Reports series and can be downloaded for free at <http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_02.pdf>.

• Noting that "male adolescents’ sexual and reproductive health needs often go unmet in the primary care setting," the Committee on Adolescence of the American Academy of Pediatrics has issued a clinical report to help address those needs. The report examines a wide range of issues and provides recommendations on how pediatricians can meet young males’ needs. [Marcell AV et al., Male adolescent sexual and reproductive health care, Pediatrics, 2011, 128(6):e1658–1676, <http://pediatrics.aappublications.org/content/128/6/e1658.full.html>, accessed Dec. 1, 2011.]