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Perspectives on Sexual and Reproductive Health FYI HOUSE COMMITTEE JUST SAYS YES TO ABSTINENCE-ONLY EDUCATION By a vote of 32-22, a House committee in April rejected a measure that would have permitted states receiving federal funds for abstinence-only education to use that money for programs that include discussion of contraceptive methods.1 While Democrats argued that limiting information "is no way to solve a serious health problem," Republicans countered that abstinence-only programs teach students about values, character and self-esteem, as well as about the potential risks involved in sexual activity. The committee also voted down an amendment that would have required programs to include only medically accurate information; the measure, introduced by Democrats, was prompted by the belief that abstinence-only programs often overstate the failure rate of condoms. Republican committee members contended that determining what information is medically accurate would be impossible. Results of an evaluation of federally funded abstinence-only programs have yet to be published; an interim report released in April indicates that to date, there are no reliable estimates of their effectiveness in preventing sexual activity, pregnancy or sexually transmitted diseases among teenagers. 1. Associated Press, Panel votes on sexual abstinence, New York Times, Apr. 24, 2002, PREGNANT? ME? NEIN! Of nearly 30,000 women who gave birth in 1995-1996 in the Berlin metropolitan area, 62--or approximately one in 475--did not know until after 20 weeks' gestation that they were pregnant.1 Twenty-five pregnancies were not identified until the woman went into labor; 12 of these resulted in the birth of a viable infant. On the basis of these data, analysts estimate that each year in Germany, 1,600 births occur to women who did not know that they were pregnant until they were at least 20 weeks into the pregnancy; 300 of these births are to women who learn of their pregnancy only when labor begins. The figures for Berlin, which are consistent with data from elsewhere in Germany and in Austria, prompt the analysts to conclude that "the common view that denied pregnancies are exotic and rare events is not valid." 1. Wessel J and Buscher U, Denial of pregnancy: population-based study, BMJ, 2002, 324(7335):458. ON THE FENCE IS NOT A GOOD PLACE TO BE One-fifth of a sample of low-income black teenagers in Alabama were ambivalent about becoming pregnant, and these young women engaged in less protective behavior than their peers who wished to avoid conceiving.1 Women who were ambivalent were significantly more likely than others to say that they had not used any contraceptive method at their last sexual encounter (odds ratio, 3.7), that they had not used a method during all five of their most recent encounters with a steady partner (2.1) and that they did not use a hormonal method (1.9). They also had an elevated likelihood of reporting not having used condoms with their steady partner the last time they had sex (2.0) or at some time during the previous month (2.1). Thus, the researchers suggest that it may be beneficial for programs aimed at preventing pregnancy and sexually transmitted disease to address "existing positive beliefs about, and corresponding desire for, early parenthood." 1. Crosby RA et al., Adolescents' ambivalence about becoming pregnant predicts infrequent contraceptive use: a prospective analysis of nonpregnant African American females, American Journal of Obstetrics and Gynecology, 2002, 186(2):251-252. ONCE BURNED... Swedish women who viewed their first birth as a generally bad experience had fewer subsequent births and waited longer before having their second child than those with more positive feelings about their first birth.1 In all, 617 women who first gave birth in 1989-1992 completed a questionnaire two months later that explored specific aspects of the experience and asked women to indicate their overall assessment of it, using a seven-point scale. Those who gave it a negative rating were about twice as likely as those who scored it more positively to have no more births (38% vs. 17%); they also delayed their next birth for a longer period (median, 4.2 vs. 2.4 years). When a wide range of factors were controlled for simultaneously, the likelihood of having another birth within 8-10 years was elevated for women who had had a positive birth experience (hazard ratio, 1.7), married or cohabiting women (2.6) and women younger than 35 (2.6). In analyses of married or cohabiting women and of young women, the experience at first birth remained a significant predictor of future childbearing. According to the investigators, the findings highlight the need for clinicians providing postpartum or intrapartum care to determine women's assessments of their birth experiences. 1. Gottvall K and Waldenström U, Does a traumatic birth experience have an impact on future reproduction? British Journal of Obstetrics and Gynaecology, 2002, 109(3):254-260. DOCTORS RECEIVE WARNING ABOUT MIFEPRISTONE The maker of mifepristone has sent a letter to doctors, informing them that six women have become seriously ill, and two have died, after undergoing medical abortion using the drug in combination with misoprostol.1 Three women suffered bleeding when ectopic pregnancies, which are not terminated by the drug regimen, ruptured; one of these women died. Another two medical abortion patients developed serious bacterial infections, and one died. The sixth woman, a 21-year-old, suffered a heart attack three days after taking the drug combination. The letter, written in collaboration with the Food and Drug Administration, was intended partly to remind physicians to report any serious adverse events occurring among women who take mifepristone. In particular, it warns doctors to "be mindful of the possibility of an ectopic pregnancy," which is not always possible to diagnose during the pelvic exam typically performed before a woman undergoes an early abortion. Although the drug maker has not revealed the number of women who have abortions using mifepristone, it maintains that the events reported in the letter "represent an extremely small incidence relative to overall usage." Moreover, the manufacturer emphasizes that there is no evidence directly linking use of the drug to these illnesses. 1. Okie S, Physicians sent abortion pill alert, Washington Post, Apr. 18, 2002, p. A2. THE HOW-MANY-MARTINI PREGNANCY? After increasing in the early 1990s, the proportion of pregnant women who reported in a nationwide survey that they consumed any alcohol dropped from 16% to 13% between 1995 and 1999.1 By contrast, the proportion of nonpregnant women of childbearing age reporting any drinking was unchanged (at about 53%) over the same period. The news is not all good, however: Rates of binge drinking (having five or more drinks on one occasion) and frequent drinking (seven or more drinks a week) among pregnant women remained stable, at about 2-3%. (Levels of these behaviors likewise were constant among nonpregnant women--roughly 11-12%). Among pregnant women, those aged 18-30 had reduced odds of drinking at all (odds ratio, 0.6), and those who were employed or unmarried had elevated odds (1.5-2.3). The odds of binge drinking and frequent drinking also were elevated for employed and unmarried women (2.3-3.7). Analysts comment that "all women of childbearing age should be warned about the adverse effects of alcohol use,...and health-care providers should learn effective techniques for screening for, and intervening with, binge and frequent drinkers." 1. Centers for Disease Control and Prevention, Alcohol use among women of childbearing age--United States, 1991-1999, Morbidity and Mortality Weekly Report, 2002, 51(13):273-276. THE PAP GAP Only three in five U.S. women of reproductive age have had a Pap test within the past year, and an analysis of data from the 1995 National Survey of Family Growth reveals that not all women are equally likely to have been tested.1 When background factors and insurance status are controlled for, women with any of five risk factors for cervical cancer (very early initiation of sex, 10 or more lifetime partners, history of pelvic inflammatory disease or sexually transmitted disease, and a partner who has recently had multiple partners) have significantly elevated odds of having had a Pap test within the past year (odds ratio, 1.6); even among these women, however, nearly one-third have not been tested recently. Women aged 20-34 and non-Hispanic black women also have an elevated likelihood of having been tested (1.5-2.0). In a number of subgroups--women with no insurance, women younger than 18, never-married women, those with less than a high school education, those who are poor or low-income, non-Hispanic women of a minority racial group other than black and immigrants--no more than about half of women have been tested recently, and multivariate analyses confirm that their odds of testing are reduced (0.4-0.8). To improve Pap test use, the analysts recommend that educational campaigns "inform women of cervical cancer risk factors and encourage screening and provision of increased support." 1. Hewitt M, Devesa S and Breen N, Papanicolaou test use among reproductive-age women at high risk for cervical cancer: analyses of the 1995 National Survey of Family Growth, American Journal of Public Health, 2002, 92(4):666-669. CONDOM MACHINE HAUTE COUTURE Five Paris subway stations are now equipped with machines selling female condoms, and Paris being Paris, the machines are distinguished by a certain je ne sais quoi: There are pink ones for women and blue ones for men.1 The machines were installed in March as part of President Jacques Chirac's efforts to win women's votes in this spring's election. Not all women were pleased, however, once they found that the price of the female device is triple that of its male counterpart. At least one advocacy group dismissed the introduction of the machines as a publicity stunt on the part of the conservative incumbent. 1. Reuters, France launches its first female-condom machine, Mar. 8, 2002, A DOWNSIDE TO BOYS' SELF-ESTEEM Youngsters' level of self-esteem is an important predictor of sexual initiation, but it has opposite effects among males and females.1 To study how self-esteem influences early sexual activity, researchers collected data from a sample of junior high school students in seventh grade and again 22 months later, and analyzed the responses of the 188 youngsters who had reported being sexually inexperienced in the earlier survey. They measured self-esteem using a standard instrument and categorized respondents as having high or low self-esteem according to the median score for each gender. Results of logistic regression analyses indicated that males with high self-esteem were significantly more likely than their peers with low self- esteem to have initiated intercourse between surveys (odds ratio, 2.4). By contrast, female students with high self-esteem had higher odds of having remained sexually inexperienced than those with low self-esteem (3.0). The researchers comment that while programs aimed at delaying first intercourse are useful, their effectiveness may improve if they address issues of self-esteem. 1. Spencer JM et al., Self-esteem as a predictor of initiation of coitus in early adolescents, Pediatrics, 2002, 109(4):581-584. FYI is compiled and written by Dore Hollander, executive editor of Perspectives on Sexual and Reproductive Health. |
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