The more similar adolescents and their partners are to each other -- with respect to age, race or ethnicity, and the school they attend -- the more likely they are to use contraceptives, according to "Characteristics of Adolescents' Sexual Partners and Their Association with Use of Condoms and Other Methods." Using data from the 1997 National Longitudinal Study of Adolescent Health, researchers Kathleen Ford, Woosung Sohn and James Lepkowski of the University of Michigan found that 78% of sexually active adolescents report romantic relationships with someone of their race or ethnicity, and 55% with a partner within two years of their age. While contraceptives are used at some point in two-thirds of these relationships, the odds of any contraceptive use are reduced in relationships involving partners who are more than two years older or who do not attend the same school. The authors suggest that a lack of familiarity between adolescents and their partners may be associated with communication problems or different approaches to planning for sexual activity, which lead to lower levels of contraceptive use.
Teens Do Not See Themselves At Risk
Only 17% of students in St. Petersburg, Russia, say that they perceive any personal vulnerability to HIV, yet three in 10 of sexually active students report that they never use condoms, according to "Risk Factors for HIV and Other Sexually Transmitted Diseases Among Adolescents in St. Petersburg, Russia." Yuri Amirkhanian and Jeffrey Kelly of the Center for AIDS Intervention Research, and Dennis Tiunov, a sociologist in St. Petersburg, surveyed students in grades 9-10 at eight high schools in St. Petersburg and found that 91% of the sexually experienced young people reported learning about AIDS before having intercourse. However, of all youths surveyed, 12% believed that having sex with well-known partners protects against AIDS, while 17% believed that condoms are not important if someone trusts his o r her partner. When asked about the meaning of safer sex, only 28% correctly specified condom use. Russia currently has one of the highest sexually transmitted disease (STD) rates for young people of any developed country. The number of HIV infections officially recorded in Russia has been doubling annually, and projections suggest that the number may rise to two million by the end of 2001.
ORAL CONTRACEPTIVES NOW LEGAL IN JAPAN BUT FEARS AND MISCONCEPTIONS HINDER USE
Fewer than 1% of Japanese women of childbearing age obtained a prescription for oral contraceptives in the first year after the pill's 1999 approval by the Japanese Ministry of Health and Welfare, according to "Knowledge of and Attitudes Toward the Pill: Results of a National Survey in Japan." The study by Masako Ono Kihara of the University of California, San Francisco and colleagues, based on a national survey of men and women, looks at attitudes toward and intentions to use the pill. Among those surveyed, eight in 10 were familiar with the pill and knew its purpose. Close to half regarded the pill positively because of its effectiveness in preventing pregnancy, while 79% disliked it because of concern about side effects.
Although 44% of both men and women viewed the pill positively, only 12% intended to use the method or wanted their partner to use it. The authors speculate that this reluctance to use the pill may be due to its high cost ($350-400 annually, not covered by medical insurance), the inconvenience of required physician visits, fear of side effects, physicians' reluctance to prescribe it or other factors. The high levels of condom acceptance and use that existed before legalization of the pill present an opportunity for health care providers to promote continued condom use to keep the rate of HIV and other STD infections low. Given that 23% of survey respondents erroneously believed that the pill prevents HIV infection, and 26% believed it prevents other STD infections, women and men need to be better educated about the inability of the pill to protect against HIV and STD infection.
ACCESS TO FAMILY PLANNING VARIES WIDELY BY COUNTY
One in Three Counties Have One or More Clinics but No Private Ob/Gyn
Limited funding and rising costs have hindered family planning clinic outreach to new geographic areas and hard-to-reach populations, according to "Family Planning Clinic Services in the United States: Patterns and Trends in the Late 1990s." The analysis, by Jennifer Frost and colleagues at The Alan Guttmacher Institute, shows that more than 300,000 women in need of publicly funded family planning care live in counties that do not have a single publicly funded family planning clinic.
Although publicly funded family planning clinics were located in 85% of all counties in 1997, the proportion of women with clinic access was significantly lower in some states than others.
• Fewer than 90% of all women who need government support for contraceptive care in Indiana, Iowa, Nebraska, North Dakota, South Dakota and Virginia live in counties with a publicly funded family planning clinic.
• 20-30% of all women in need of publicly funded family planning care in Arkansas, Iowa, Kentucky, Mississippi, Missouri, Oklahoma, West Virginia and Wyoming live in counties with at least one clinic but no private obstetrician-gynecologist.
The authors note that challenges remain in ensuring that women who wish to avoid unintended pregnancy have access to family planning services. They add that the difficulties are compounded for women with limited resources. As a result of rising health care costs and changes in health care delivery systems, increasing numbers of women are unable to access appropriate services.