Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 35, Number 1, January/February 2003
FYI


CAIRO AGREEMENT STANDS, DESPITE U.S. OPPOSITION

At a conference held in Bangkok in December 2002 to develop ways to implement the program of action adopted in Cairo at the 1994 International Conference on Population and Development, Asian and European delegations overwhelmingly rejected U.S. attempts to add language denouncing abortion into the Cairo document.1The Cairo plan promotes reproductive health and the provision of safe abortion services in countries where the procedure is legal; it does not support abortion as a method of family planning. Nonetheless, contending that the terms "reproductive health services" and "reproductive rights" promote abortion, the U.S. delegation pressed the representatives of more than 30 other countries meeting in Bangkok to amend those phrases or delete them from the Cairo document. Representatives of the Bush administration also tried to have a provision expressing "general reservation" about abortion and language promoting abstinence as the healthiest choice for unmarried adolescents inserted into the Cairo document, and pushed for removing references to adolescents from a section on reproductive rights, which it said promoted sexual activity among teenagers. While debate over the U.S. proposals "almost completely consumed" the conference, in the voting at the end of the week, the United States stood alone, and the Cairo document remained unchanged.

1. Dao J, Over U.S. protest, Asian group approves family planning goals, New York Times, Dec. 18, 2002, p. A7.

GOVERNMENT FOR THE PEOPLE

With Japan's total fertility rate below replacement level, women marrying later than they did in the past or not at all, and the population rapidly aging and shrinking, the government has taken innovative steps to avoid demographic disaster.1 The Plus One Plan, launched in September 2002, contains a number of supports intended to encourage married couples to have more than one child. It also includes a request for a ¥3.1 billion matchmaking budget, which will enable local authorities to sponsor parties, cruises and hiking trips for single men and women. Critics of the "bureaucratic matchmaking" proposal point out that in the past, such initiatives have met with little success. Opponents of the Plus One Plan contend that the country's corporate culture, which places the company before the family, undermines the expansions in child care entitlements that are one of the plan's key features.

1. Watts J, Japan opens dating agency to improve birth rate, Lancet, 2002, 369(9347):1755.

IS SEX DEPRESSING?

Massachusetts teenagers surveyed in 1992 were more likely to be stressed or depressed if they were sexually active and did not use contraceptives than if they were not having sex.1 Some 35% of youth in a statewide sample of 2,224 ninth and 12th graders reported having felt depressed or stressed during 10 or more of the preceding 30 days. Initial comparisons revealed that depressive symptoms were associated with young people's age, race, gender, school grades, substance use, sexual activity and contraceptive use, pregnancy experience, and reported frequency of fighting and taking sick days. When all of these factors were controlled for, sexually active youth who never used contraceptives had nearly twice as high odds of reporting depressed mood as those who were not sexually active (odds ratio, 1.8). Among young women, the odds were elevated for those who always used contraceptives (1.5), but more so for those who used inconsistently (1.6); for males, never-use was associated with the risk of stress or depression (1.9). The researchers infer that youth who do not use contraceptives may see themselves as engaging in riskier behavior than others.

1. Brooks TL et al., Association of adolescent risk behaviors with mental health symptoms in high school students, Journal of Adolescent Health, 2002, 31(3):240-246.

WHAT THE BRITISH DON'T KNOW COULD HURT THEM

A third of 18-24-year-old men and women in the United Kingdom believe that HIV is curable, according to results of a survey by the leading HIV/AIDS charity there.1 With the number of HIV diagnoses in their country climbing annually, nearly half of Britons say that they do not know enough about the disease; two-thirds think that school sexuality education programs are inadequate, and two-thirds of young people say that the sexuality education they received in school did not give them sufficient information about the risks associated with unprotected sex. When asked what would worry them about engaging in unprotected sex with a new partner, 52% of those polled expressed concern about HIV, 19% about sexually transmitted infections and 10% about unintended pregnancy; 10% would be unconcerned about the consequences of unprotected sex. Nearly 4,500 Britons received HIV diagnoses in 2001; 60% acquired the virus through heterosexual activity, and 35% through homosexual activity.

1. Terrence Higgins Trust, Twenty years of HIV and people still don't get it, news release, London: Terrence Higgins Trust, Nov. 25, 2002.

ANOTHER EARLY ABORTION OPTION

Many clinicians do not perform surgical abortions during the first six weeks of pregnancy because research in the 1970s documented a higher failure rate at that early stage than later in the first trimester. However, evidence from three Planned Parenthood clinics, where more than 1,000 women had early surgical abortions between January 1998 and August 2000, supports the conclusions of more recent studies that new technologies have improved the safety and effectiveness of such procedures.1 In all, 4% of the 750 women who received follow-up care experienced complications: 2% a failed abortion, and fewer than 1% each a number of other complications. These rates compare favorably with rates reported in the 1970s; moreover, the proportion of women who required further surgical intervention (3%) was lower than or comparable to reported proportions requiring surgical treatment after a medical abortion. The investigators conclude that "advances in technology provide important new choices for women seeking abortion during the earliest weeks of pregnancy," and that surgical options are safe and effective.

1. Paul ME et al., Early surgical abortion: efficacy and safety, American Journal of Obstetrics and Gynecology, 2002, 187(2):407-411.

GOING TO THE CHAPEL

After declining steadily for decades, the number of 15-19-year-olds in the United States who are married rose sharply between 1990 and 2000--from 598,000 to 891,000.1 The proportion of teenagers who are married is small (5%), but it, too, has risen sharply (from 3% in 1990). By contrast, Americans overall are marrying later than they did in the past: The median age at first marriage rose by about one year for both men and women during the 1990s. Part of the trend among teenagers may be explained by high levels of immigration in the last decade: Many teenagers came from developing countries where marriage often occurs at a young age. Roughly two-thirds of married teenagers do not live with their spouse--for example, because one is in jail, is away at college or lives in his or her homeland.

1. Sharp increase in marriages of teenagers found in 90's, New York Times, Nov. 10, 2002, p. 26.

NEED INFORMATION? DON'T ASK THE GOVERNMENT

There was a time when anyone who wanted information on the association between abortion and breast cancer risk (the latest evidence suggests that there is none) or effective ways to reduce teenagers' levels of sexual activity could find that information on government Web sites. But no longer, because the Department of Health and Human Services (DHHS) has removed it.1 The deletion of the information on abortion and breast cancer was prompted by a letter from Rep. Christopher Smith (R-NJ) to HHS Secretary Tommy Thompson contesting the accuracy of the article cited. A spokesperson for DHHS explains the changes by saying that the material is being updated, but legislators and health advocates charge that the department is censoring its Web sites to bring them in line with the administration's moral stance. (A fact sheet on the role of condom use in preventing HIV transmission had been removed from the Centers for Disease Control and Prevention's Web site, but it has been replaced by a modified version, emphasizing the advantages of abstinence. The new fact sheet is available at <http://www.cdc.gov/hiv/pubs/facts/condoms.htm>.)

1. Clymer A, Critics say government deleted Web site material to push abstinence, New York Times, Nov. 26, 2002, p. A18.

NEW CERVICAL CANCER SCREENING GUIDELINES

The American Cancer Society has issued new guidelines on who should be tested for cervical cancer and how frequently.1 The society recommends that screening begin about three years after a woman becomes sexually active or, to ensure that young women who are fearful of admitting to sexual activity are not missed, by age 21. (Previous guidelines had recommended that screening begin by age 18.) If regular Pap tests are used, screening should occur every year; if the newer liquid-based test, every two years. For women aged 30 and older who have had three consecutive normal tests and have no risk factors for cervical cancer, the frequency of screening can be reduced to every 2-3 years; women aged 70 and older who have had three or more normal tests and no abnormal results in 10 years may opt out of further screening. After a hysterectomy including removal of the cervix, a woman need not be tested, but the general guidelines apply following a partial hysterectomy. While the new recommendations aim to prevent overscreening and overtreating women, the society stresses that increasing the frequency of screening among those who have not been tested or have not been tested regularly would produce the greatest improvement in cervical cancer incidence.

1. American Cancer Society, New cervical cancer early detection guidelines released, Nov. 20, 2002, <http://www.cancer.org/docroot/NWS/cntent/ NWS_2_1x_Cervical_Cancer_Early_Detection_Guidelines_Releasedd.asp>, accessed Dec. 18, 2002.

CATHOLIC HOSPITALS OFFER LIMITED ACCESS TO EMERGENCY PILLS

Only 5% of Catholic hospital emergency rooms provide emergency contraceptive pills to any woman who requests them, and 55% do not provide the method under any circumstances, according to results of a survey conducted in August 2002.1 Nearly a quarter (23%) of the nation's 600 Catholic hospitals dispense emergency pills to women who have been raped, although often with restrictions; 6% provide pills at the discretion of the attending physician. Perhaps reflecting confusion over official policy, 11% of respondents did not know whether their facility offers the method. Roughly half (47%) of hospitals that do not dispense emergency contraceptive pills refer women to a facility--generally a hospital--that does. However, two-thirds of referrals are "dead ends": The phone number is incorrect or the facility is closed on weekends, does not provide the method or does not refer for it. In general, emergency room personnel are helpful to callers asking about emergency contraception, but about one in 10 are evasive, suspicious or hostile.

1. Catholics for a Free Choice (CFFC), Second Chance Denied: Emergency Contraception in Catholic Hospital Emergency Rooms, Washington, DC: CFFC, 2002.