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Disparities in Contraceptive Use by Race and Ethnicity Not Explained by Differing Attitudes Toward Contraception

A nationally representative survey of unmarried 18–29-year-olds found that among women at risk of unintended pregnancy, 30% were not currently using any method of contraception; that overall figure includes 45% of black women, 38% of Latinas and 24% of white women who were at risk, according to "Do Racial and Ethnic Differences in Contraceptive Attitudes and Knowledge Explain Disparities in Method Use?" by Corinne H. Rocca and Cynthia C. Harper of the University of California, San Francisco. The National Survey of Reproductive and Contraceptive Knowledge revealed that whites were twice as likely as blacks and Latinas to be using the pill or other hormonal methods, and were less likely to rely on condoms or no method.

The authors examined whether differences in attitudes toward contraception, pregnancy, childbearing and fertility, and in contraceptive knowledge, contributed to these disparities. They found a number of attitudinal differences among racial and ethnic groups. For example, black women and Latinas were more likely than whites to believe that the government encourages contraceptive use to limit minority populations. Additionally, Latinas were more likely than white women to agree that minorities and the poor are used as guinea pigs to test contraceptive methods. However, these differences did not explain disparities in use. Only one attitude was associated with method choice: The greater a woman's skepticism that the government ensures contraceptive safety, the less effective was her current method. However, this belief did not differ by race or ethnicity. A lower level of contraceptive knowledge among Latinas partially explained the difference in method use between this group and whites.

The authors suggest that improving knowledge about effective methods might empower women to use contraceptives more effectively. They acknowledge the potential role of other factors in explaining disparities in contraceptive use, such as differences in access to reproductive health care, insurance coverage and provider counseling, and encourage more research in this area. Additionally, they suggest that targeted patient and public education, particularly among Latinas, might help decrease ethnic disparities.


Sample of Illinois Teens Seeking Abortions Express Mainly Negative Opinions About State Parental Involvement Law

Minors participating in in-depth interviews in Chicago believed that a law requiring teens to tell parents about their decision to have an abortion would diminish minors' reproductive autonomy and potentially expose them to unwanted pressure or interference in their abortion decision, according to "Abortion-Seeking Minors' Views on the Illinois Parental Notification Law: A Qualitative Study," by Erin K. Kavanagh, of the University of Chicago, et al. Study participants were 30 minors seeking abortion, to whom researchers described a 1995 Illinois law (which is not in effect because of legal challenges) mandating parental involvement in minors' abortion decisions. The law would require physicians to give notice to an adult family member or receive a written waiver of notice before performing an abortion on a minor; it also contains a provision allowing minors to seek judicial bypass to waive notification.

Participating teens felt that they should have control over who is told about their private abortion decision. They expressed concern that requiring notification could damage teens' relationships with their parents, and that parents' adverse reactions could result in physical or mental abuse. Additionally, teens expressed concern that some parents might actively prevent a minor from obtaining an abortion and force her to continue her pregnancy. However, many felt that voluntarily seeking support from a trusted adult, but not necessarily a parent, could benefit minors. Teens viewed the judicial bypass option—which would require minors to navigate the court system, travel to the courthouse and discuss their abortion decision with a judge—as a clear obstacle to abortion access. However, if parental notification were required by law, participants suggested that minors would need that option.

The authors suggest that policymakers might better understand the impact of parental notification laws on minors' ability to make reproductive health decisions if teens' voices were heard in the debates concerning these laws.


Across Europe, Parental Knowledge of Teens' Daily Lives Associated with Lower Likelihood of Early Sexual Initiation

An analysis of data from the 2005–2006 Health Behaviors in School-Aged Children survey in nine European countries examines the relationship between sexual initiation before age 16 and parental support and knowledge of female teens' daily activities. The analysis reveals that the level of early initiation of sex varies across Europe, according to "Parents' Support and Knowledge of Their Daughters' Lives, and Females' Early Sexual Initiation in Nine European Countries," by Aubrey Spriggs Madkour, of Tulane University, et al. Nevertheless, parental support was consistently related to early sexual initiation: The greater the support of a teen's mother, father or both, the lower the likelihood that she would initiate sex before age 16. However, when the authors factored in parental knowledge, early sexual initiation was no longer associated with support and was negatively associated with knowledge. According to the authors, one possible explanation for this relationship is that parental support may produce greater parental knowledge of female teens' lives, which in turn could lead to a decreased likelihood of early sex. Another possibility is that parental knowledge is more important than parental support in influencing early sexual initiation. The authors suggest that more research is needed to examine the relationship between these factors, in order to inform programs designed to help parents assist their teens in protecting their reproductive health.


Despite Young People's Widespread Use of Social Media, Some May Prefer Low-Tech Ways To Share Sexual Health Information

Among a sample of 94 low-income, parenting teens and young adults recruited at urban clinics, most reported that they had mobile phones and regularly used them to make calls, send text messages and use social networking sites. Nevertheless, many prefer to have conversations about sexual health in-person, according to "Tweeting About Testing: Do Low-Income, Parenting Adolescents and Young Adults Use New Media Technologies to Communicate About Sexual Health?" by Zai Divecha, of Peer Health Exchange, et al. The authors examined participants' willingness to discuss sexual health issues via new media technologies. They found that participants discussed these issues more often with close friends than with casual friends, and preferred to have the conversations in person (71% with close friends and 68% with casual friends), rather than by phone (52% and 45%) or text (30% and 28%). Few participants were willing to discuss these issues through social networking sites (0–9% and 2–7%).

The 42% of participants who were willing to communicate about sexual health issues through new media technologies differed from those who were not willing to in several ways: Blacks made up the greatest proportion of those who were willing, while Latinos accounted for the majority of others; and participants who were willing to communicate via new media had greater condom self-efficacy, greater STD knowledge and more Facebook friends than those who were not. The authors suggest that new media technology may be better suited to increasing access to information and services than to encouraging conversations about changing attitudes and behaviors. However, they suggest that teens and young adults who are willing to use new media for discussions of sexual health may be ideal leaders in prevention programs, given the higher levels of knowledge indicated in this analysis. As new technology continues to evolve, the authors recommend more research about its role in advancing sexual and reproductive health.


Literature Review Finds That Men Generally Have Positive Attitudes Toward Emergency Contraception, and Many Support Its Use in a Range of Circumstances

A new analysis synthesizes data from 43 studies regarding the knowledge, attitudes and behavior of American men with regard to emergency contraception. According to "What Do We Know About Males and Emergency Contraception? A Synthesis of the Literature," by Arik V. Marcell of Johns Hopkins University et al., the proportion of men who were familiar with emergency contraception ranged from 38% among teens to 65–100% among adults. Small proportions of men reported either that they had discussed the use of emergency contraception with a partner or that their partner had used it, and one in 10 reported that they had ever purchased the product. Most men approved of the use of emergency contraception following a contraceptive failure (74–82%), unprotected sex (59–65%) or rape (85–91%). However, many noted some concern about women's feeling pressured to use it, and believed that the ultimate decision whether to do so is the woman's. Although men had positive attitudes about emergency contraception, the authors suggest that improvements in knowledge of, access to and use of the method are needed.

Additionally, the authors point out that the majority of the studies they found were a decade or more old, and suggest that more current work is needed to examine the relationship between knowledge of and attitudes toward emergency contraception and increased use of the product or subsequent reductions in unintended pregnancy rates.


Women Report Available Contraceptive Methods Do Not Fully Meet Their Needs

A survey of 574 women seeking abortions at six U.S. clinics—women considered to be at high risk of engaging in unprotected sex and experiencing an unintended pregnancy—found that the contraceptive methods currently available largely lack the features that are important to them. According to "Contraceptive Features Preferred by Women at High Risk of Unintended Pregnancy," by Lauren Lessard of the University of California, Los Angeles, et al., the three features deemed most important to women surveyed were effectiveness (prioritized by 84%), lack of side effects (78%) and affordability (76%). In addition, more than two-thirds of women surveyed wanted a method that was easy to access (74%) and to use (74%), and that they had control over (70%) or were responsible for using (69%).

For 91% of women, not a single available contraceptive method had all of the features they deemed most important. The average match for current methods ranged from 67% for the contraceptive ring and sponge to 37% for withdrawal and natural family planning. Oral contraceptives, the reversible method most commonly used by American women, were a 60% match, while male condoms were a 42% match. If the pill were available without a prescription, it would have 71% of the features women prioritized.

The authors suggest that data on women's preferences can be used to design and promote new contraceptive options that meet more of women's needs, thereby increasing their satisfaction with their method choice, and potentially encouraging more consistent use. They postulate that more consistent use could, in turn result, in lower rates of unintended pregnancy.

Also in this issue is a Viewpoint titled "The Public Health Risks of Crisis Pregnancy Centers," by Joanne Rosen of Johns Hopkins Bloomberg School of Public Health.