THE LATEST ON INTENDEDNESS
Thirty‐seven percent of births in the United States are to women who had not intended to conceive, and the proportion has been essentially unchanged since 1982, according to a report based on data from multiple cycles of the National Survey of Family Growth.1 As has been the case throughout the period, the level of unintended childbearing differs considerably by women's characteristics. For example, 77% of births to teenagers in 2010 were unintended, compared with 25% of those to women aged 25–44; 31% of births to white women, 43% of those to Hispanics and 54% of those to blacks were unplanned. When women who reported an unintended pregnancy were asked why they had not been using contraceptives at the time they conceived, 36% said that they had not thought they could become pregnant, and 23% replied that they had not really minded the thought of a pregnancy. Less commonly cited reasons were that women had not expected to have sex and that they worried about contraceptive side effects. Data from questions meant to measure intendedness in different ways suggest that the extent to which women wish to get pregnant, are trying to conceive and are happy about a pregnancy "are strongly but not perfectly correlated."
1. Mosher WD, Jones J and Abma JC, Intended and unintended births in the United States: 1982–2010, National Health Statistics Reports, 2012, No. 55.
NOT ENOUGH TESTING GOING ON
The rate of chlamydia testing among pregnant women falls short of federal guidelines, according to results of a study based on data from a large clinical laboratory.1 The Centers for Disease Control and Prevention (CDC) recommends routine chlamydia testing at women's first prenatal visit, as well as gonorrhea testing for women who are at high risk of infection. However, records of 1.3 million women who received prenatal care in 2005–2008 and likely were representative of all pregnant women in the United States revealed that only 59% had had a chlamydia test while pregnant; 57% had had a gonorrhea test. Rates of infection were 4% and 1%, respectively. For women with chlamydia infection, the CDC recommends a retest three weeks after treatment ends; no follow‐up test is recommended for women with gonorrhea. Roughly three‐quarters of women with each infection were retested later in pregnancy—a finding that suggests that many women "remain at risk of having an unidentified infection at the time of delivery."
1. Blatt AJ et al., Chlamydial and gonococcal testing during pregnancy in the United States, American Journal of Obstetrics & Gynecology, 2012, 207(55):e.1–8, <http://dx.doi.org/10.1016/j.ajog.2012.04.027>, accessed July 26, 2012.
WHO GETS POSTPARTUM STDs?
Among a sample of 848 young mothers who enrolled in a longitudinal study while pregnant, 27% acquired an STD during the year after they gave birth, and those who had had an STD while pregnant appeared to be at particular risk.1 The women, who were 14–25 years old when they entered the study, were recruited in 2001–2004 at clinics where they were receiving prenatal care; all those who tested positive for an STD during pregnancy (28% of participants) received treatment from their clinic. The incidence of postpartum STD infection was 43% among women who had had an STD while pregnant, 24% among those who had had one previously and 19% among those who had never had one. Multivariate analysis confirmed that the likelihood of postpartum infection was higher among women who had had an STD during pregnancy than among those with no history of infection (odds ratio, 2.5). The researchers comment that women who acquire STDs while pregnant may not be getting "effective education and prevention messages, despite having regular exposure to health care providers throughout pregnancy."
1. Wheeler R et al., Postpartum sexually transmitted disease: refining our understanding of the population at risk, Sexually Transmitted Diseases, 2012, 39(7):509–513.
THE DEVIL'S IN THE DETAILS
Analyses of data from the biennial national Youth Risk Behavior Survey indicate that between 1991 and 2011, the proportion of high school students who had ever had intercourse declined from 54% to 47%, the proportion who had had four or more partners declined from 19% to 15% and (among those currently sexually active) the proportion who had used a condom at last sex rose from 46% to 60%.1 This overall good news, however, masks the facts that most of the improvements took place in roughly the first half of the 20‐year period; these measures have shown no change since 2001 or 2003. Patterns of change were generally similar for males and females, and for blacks and whites; for Hispanics, the only improvement was an increase in the prevalence of condom use (from 37% to 58%), most of which occurred by 2007.
1. Kann L et al., Trends in HIV‐related risk behaviors among high school students—United States, 1991–2011, Morbidity and Mortality Weekly Report, 2012, 61(29):556–560.
LIFE AFTER DEATH
Most respondents to a 2011 online survey had never heard of posthumous reproduction, but after reading a brief definition, 48% of the 1,049 participants supported harvesting sperm from deceased men, and 43% supported retrieving eggs from deceased women.1 Seven in 10 supporters believed that posthumous gamete retrieval should be permitted only if the individual had consented to it; only a minority considered it acceptable to waive consent in the event of unexpected death. The views of respondents of reproductive age did not differ significantly from those of the overall sample of 18–75‐year‐olds. In multivariate analysis, support for posthumous sperm harvesting was elevated among individuals with at least a college degree, Democrats and those who were trying to conceive; these same groups, as well as respondents younger than 46, had elevated odds of supporting posthumous extraction of eggs.
1. Barton SE et al., Population‐based study of attitudes toward posthumous reproduction, Fertility and Sterility, 2012, <http://dx.doi.org/10.1016/j.fertnstert.2012.05.044>, accessed July 26, 2012.
LONG‐ACTING METHODS GAIN GROUND
Use of long‐acting contraceptive (LARC) methods—IUDs and hormonal implants—seems to be on the upswing in the United States, according to analyses of National Survey of Family Growth data spanning the period 2002–2009.1 Two percent of contraceptive users in 2002, 4% of users in 2007 and 9% in 2009 were relying on these methods. The IUD dominated LARC use in each year; although implant use increased over time, it represented only 1% of all use in 2009. The analysts examined trends by a wide variety of socioeconomic, demographic and health‐related characteristics and found increases in LARC use in almost every subgroup. Given the nation's high unintended pregnancy rates, they comment, the increase in use of these methods "is a promising indicator, especially if this increase marks the beginning of a larger upward trend in LARC use."
1. Finer LB, Jerman J and Kavanaugh ML, Changes in use of long‐acting contraceptive methods in the United States, 2007–2009, Fertility and Sterility, 2012, <http://dx.doi.org/10.1016/j.fertnstert.2012.06.027>, accessed July 26, 2012.
IMPLANT WORKS FOR OVERWEIGHT WOMEN
The effectiveness of the contraceptive implant does not appear to be reduced in overweight or obese women.1 Researchers examined the method's failure rate by women's body mass index because a lack of information has led to "controversy and confusion" about how to counsel overweight and obese women regarding its use. They used data from the Contraceptive CHOICE Project, whose participants received their selected method at no cost and were followed up for 2–3 years. The cumulative failure rate for the implant was less than one per 100 woman‐years of use (about the same as that for the IUD) and did not differ among normal‐weight, overweight and obese women. Despite sampling issues that limit the study's generalizability, the researchers characterize their findings as "particularly salient given the current epidemic of obesity in the US population" and the fact that "obesity complicates pregnancy."
1. Xu H et al., Contraceptive failure rates of etonogestrel subdermal implants in overweight and obese women, Obstetrics & Gynecology, 2012, 120(1):21–26.
MULTIPLE RISKS IF A PARTNER'S BEEN IN JAIL
In a trial of an STD prevention intervention conducted in 2002–2004 among black women aged 15–21, those who reported having had vaginal sex with a partner who had "just been released from a jail, prison or detention center" were at heightened risk for a wide array of risky sexual behaviors and adverse sexual health outcomes.1 At a six‐month follow‐up, 14% of the 653 women included in the analyses said that they had had sex with a recently incarcerated man within the last six months; at 12 months, 9% gave this response. These women had elevated odds of saying that in the last 60 days, they had had vaginal, oral or anal sex (odds ratios, 1.5–5.5); had had sex while they or their partner had been drunk or high (1.6–2.3); and had been emotionally, physically or sexually abused by a boyfriend (3.0–4.1). Compared with other women, they also reported a greater frequency of some of these behaviors, more partners for vaginal or anal sex, less consistent condom use during oral sex, and lower levels of sexual communication and refusal self‐efficacy. Their odds of acquiring chlamydia were nearly twice those of other women. Given high STD rates among incarcerated populations, the investigators urge prevention programs to inform young black women of "potential risks associated with a recently released sex partner."
1. Swartzendruber A et al., Sexually transmitted infections, sexual risk behavior, and intimate partner violence among African American adolescent females with a male sex partner recently released from incarceration, Journal of Adolescent Health, 2012, 51(2):156–163.
PREDICTING CANCER FROM AN HPV TEST
A human papillomavirus (HPV) test may yield a better predictor of cancer risk than a Pap smear, particularly over the long term, according to a study of nearly 20,000 women enrolled in an Oregon HMO who had both tests at enrollment.1 HPV tests picked up significantly more cases of grade 3 cervical intraepithelial neoplasia—abnormal cell growth within the cervix that may lead to cancer—than did Pap tests. And whereas results of both tests predicted precancerous cervical changes within two years, only HPV test results predicted diagnosis 10–18 years after screening. At 28 years, the cumulative incidence of grade 3 cervical intraepithelial neoplasia was 0.9% after a negative HPV test and 1.3% after a negative Pap test. The researchers conclude that while HPV tests might identify women "whose HPV infections will persist and develop into disease," Pap smears may be "useful as a secondary diagnostic test to identify … women at immediate risk."
1. Castle PE et al., Clinical human papillomavirus detection forecasts cervical cancer risk in women over 18 years of follow‐up, Journal of Clinical Oncology, 2012, doi:10.1200/JCO.2011.38.8389, accessed July 31, 2012.