Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 37, Number 3, September 2005
FYI


PROTECTIVE FACTORS ARE NOT MULTIPURPOSE

Factors that are associated with teenagers' postponing sexual initiation are not, for the most part, protective against STDs in early adulthood, according to an analysis of data from the National Longitudinal Study of Adolescent Health.1 Six percent of participants in the survey's 2001-2002 wave, who were aged 18-26, tested positive for chlamydia, gonorrhea or trichomoniasis. In multivariate analyses of variables measured in 1996 that are associated with delayed sexual debut, only two were predictive of STD infection: The odds of infection were reduced among respondents whose parents had strongly disapproved of their having sex during adolescence (odds ratio, 0.9) and among those whose grade point average had been above 3.0 (0.8); the associations were significant only for females. STD diagnosis was not associated with feelings of connectedness to family or school, reported importance of religion, attending a parochial school, family mental health, taking a virginity pledge, parental disapproval of contraception, self-reported physical appearance, same-sex attraction, expectations of dying young or time spent doing paid work. The analysts comment that "it may be unrealistic to expect broad protective models" to predict "complex health outcomes."

1. Ford CA et al., Predicting adolescents' longitudinal risk for sexually transmitted infection: results from the National Longitudinal Study of Adolescent Health, Archives of Pediatrics and Adolescent Medicine, 2005, 159(7):657-664.

WHAT'S A PEDIATRICIAN TO DO?

After reviewing the most up-to-date data on teenage sexual activity, contraceptive use, pregnancy and parenthood, the American Academy of Pediatrics Committee on Adolescence has outlined ways in which pediatricians can address their patients' emerging sexual and reproductive health needs.1 These include encouraging young people to postpone sexual initiation; offering confidential, developmentally appropriate services; and ensuring that teenagers know about contraception and know where to obtain birth control methods. The committee also encourages pediatricians to participate in programs geared toward preventing early sexual activity or teenage pregnancy, and to be aware of all available options and resources that young people may need to draw on for comprehensive medical and psychosocial support. According to the committee, the pediatrician's role also extends to providing resources or referrals for services to assist teenage parents with arranging child care, obtaining educational and vocational training, and developing parenting skills.

1. Klein JD and the Committee on Adolescence, Adolescent pregnancy: current trends and issues, Pediatrics, 2005, 116(1):281-286.

FULL MOON: UH-OH?

In labor wards and delivery rooms, where personnel typically are guided by evidence-based approaches to their work, a superstitious belief that a full moon brings a spike in the number of deliveries or delivery complications causes some staff a certain amount of monthly distress. If this belief were grounded in fact, it could have implications for staffing patterns. However, a study of more than 500,000 North Carolina births spanning 62 lunar cycles should bring comfort to health care personnel who approach their work with bated breath every 28 days.1 Using analysis of variance and t tests to compare outcomes across the eight phases of the moon, the researchers found no statistically significant differences in the number of births overall or of births to women who had had more than one pregnancy, in types of delivery or in complications. Nevertheless, with a nod to human nature, they expect that the superstition will endure and that some labor and delivery personnel "will continue to look up and sigh in dread when [they] see the full moon looking back." Maybe not. Keep your fingers crossed.

1. Arliss JM, Kaplan EN and Galvin SL, The effect of the lunar cycle on frequency of births and birth complications, American Journal of Obstetrics and Gynecology, 2005, 192(2):1462-1464.

MUM'S THE WORD? COULD MEAN TROUBLE

Seventeen percent of abortion patients surveyed at a Houston clinic in mid-2004 had not told their partner about the abortion, generally because they did not think the relationship had a future or they did not feel obliged to tell him.1 However, 21% of women who had not disclosed the abortion to their partner reported that he would oppose it, and 8% said that he would hurt them physically if he knew. Furthermore, 24% reported having been physically, emotionally or sexually abused during the last year or since conceiving—twice the proportion among women who had told their partner about the abortion. Higher proportions of women who had not disclosed than of others said that their partner had ever physically or emotionally hurt them (25% vs. 12%), that someone had physically hurt them within the last year (20% vs. 10%) and that they were afraid of their partner (9% vs. 2%). The researchers recommend that abortion providers routinely screen patients for domestic violence and that they "have a high index of suspicion for domestic violence among patients who avoid disclosing the abortion to their partners."

1. Woo J, Fine P and Goetzl L, Abortion disclosure and the association with domestic violence, Obstetrics & Gynecology, 2005, 105(6):1329-1334.

NO STERILIZATION AFTER ALL

Postpartum sterilization is convenient and safe; yet, nearly half of women who requested it while receiving prenatal care at a Chicago hospital in 2002-2003 did not have the operation.1 In analyses controlling for demographic, prenatal and intrapartum factors, the odds that women who requested postpartum sterilization obtained it were significantly reduced among 21-25-year-olds (the youngest group included—odds ratio, 0.6), blacks (0.7), women who made the request during their second trimester (0.5) and women who delivered vaginally (0.2). So, what happens to change the plan? The analysts speculate that whereas some women change their minds, characteristics of the health care system (e.g., Medicaid restrictions or delays in the procedure if surgical resources are needed for more urgent operations) may deter others. "Clearly," the analysts remark, "it will be important to determine which women who did not get their surgery still wanted it." Moreover, they stress that because many women who ask for postpartum sterilization will not get it, all those who request the operation should receive counseling about reversible contraception.

1. Zite N, Wuellner S and Gilliam M, Failure to obtain desired postpartum sterilization: risk and predictors, Obstetrics & Gynecology, 2005, 105(4):794-799.

FINDING EC IS NOT EASY

In phone calls to the emergency departments of all U.S. Catholic hospitals in 2002, a researcher posing as a woman in need of emergency contraception learned that 55% of these facilities do not provide the method, 29% provide it with restrictions and 5% provide it on request.1 Among a nonrandom sample of non-Catholic hospitals the researcher called in 2003, 42% do not provide the method, 37% provide it in some situations and 17% provide it on request. (The remaining hospitals did not or could not answer the question.) Among hospitals that restrict access, 79% of Catholic and 45% of other facilities said that emergency contraception is provided only to women who have been sexually assaulted, 19% and 44% that provision is up to the discretion of the physician on duty, and 2% and 11% that a woman has to take a pregnancy test before obtaining the method. About half of each type of hospital referred the caller elsewhere, but most of these did not know whether the referral facility provides emergency contraception. The majority of referrals (65% of those from Catholic and 80% from non-Catholic hospitals) led to dead ends—wrong numbers, clinics that were closed on weekends or facilities that did not provide the method.

1. Harrison T, Availability of emergency contraception: a survey of hospital emergency department staff, Annals of Emergency Medicine, 2005, 46(2):105-110.

HIV: WHO SHOULD BE TESTED?

The U.S. Preventive Services Task Force now recommends that all pregnant women, rather than just those considered to be at high risk, be screened for HIV infection.1 According to the group, a review of the literature from 1983 to 2004 revealed "good evidence" that available tests "accurately detect HIV infection in pregnant women" and that standard drug therapies "are acceptable to pregnant women and lead to significantly reduced rates of mother-to-child transmission." Furthermore, the task force has concluded that the potential risks associated with antiretroviral therapy are outweighed by the benefits of screening all pregnant women. As for the wider population, the task force recommends that all adolescents and adults with risk factors be screened, but views the benefit of universal screening as "too small relative to potential harms to justify a general recommendation."

1. U.S. Preventive Services Task Force, Screening for human immunodeficiency virus infection, 2005, <http://www.ahrq.gov/clinic/uspstf/uspshivi.htm>, accessed July 8, 2005.

IS METH WORTH THE WORRY?

Although U.S. public health officials and AIDS agencies hammer hard at the link between use of crystal methamphetamine and risky sexual behavior that could lead to HIV transmission, experts in Toronto are not so sure about it.1 In Toronto, where the number of new HIV infections rose sharply until 2002, crystal meth use is in its early stages but has begun to increase rapidly among street youth and gay men. City health officials and the leaders of some AIDS groups consider the evidence of a link too shaky to justify the kinds of large-scale awareness campaigns that are common in major U.S. cities. That stance has ignited a debate that touches on many difficult issues, including how best to direct public resources and how to avoid unduly frightening or stigmatizing particular groups of people. Still, a San Francisco public health official thinks that Toronto is "extremely unlikely" to dodge the effects crystal meth has had on HIV transmission in most urban areas of the United States.

1. Chung A, Is HIV-crystal meth link clear? Toronto Star, July 7, 2005, <http://www.thestar.com>, accessed July 8, 2005.

SLOWLY, A GAP CLOSES

Maternal and child health disparities between the poorest neighborhoods and others in four metropolitan areas narrowed in the 1990s, but key indicators remain far from ideal levels.1 Analysts used vital statistics and census data to compare rates of teenage births, late prenatal care, low birth weight and infant mortality in "high-poverty" neighborhoods (those in which 30% or more of residents were below the poverty line in 1990) and others in Cuyahoga County, Ohio; Denver; Marion County, Indiana; and Oakland. In all four areas, trends from 1990 to 2000 were most favorable in the poorest neighborhoods, but substantial disparities remain. For example, high-poverty neighborhoods in Marion County saw a greater decline than others in the teenage birthrate, but they still had the higher rate at the end of the decade (12 vs. six births per 100 women aged 15-19). Furthermore, in the high-poverty neighborhoods in each metropolitan area, all four rates were considerably higher than the Healthy People 2010 goals. The analysts conjecture that the observed gains were due partly to demographic shifts and partly to the effects of intensive interventions and improved social conditions.

1. Howell EM, Pettit KLS and Kingsley GT, Trends in maternal and infant health in poor urban neighborhoods: good news from the 1990s, but challenges remain, Public Health Reports, 2005, 120(4):409-417.