Same-sex behavior and sexual minority groups have traditionally received relatively little attention in the sexual and reproductive health literature, and available studies have been limited by their use of nonrepresentative samples and narrow definitions of sexuality. Three studies reported in this issue of Perspectives on Sexual and Reproductive Health, all based on nationally representative samples, take a more nuanced look at experiences and behaviors that could have a profound impact on individuals’ health.
Using data from the 2002 National Survey of Family Growth (NSFG), Janice McCabe and colleagues find that “notable” proportions of men and women aged 15–21 have had consensual same-sex sexual experiences; moreover, the majority of those who have done so do not categorize themselves as homosexual or bisexual, and many claim to be attracted only to people of the opposite gender (page 142). Among other things, the authors comment, these findings “argue for the need to broaden research to examine the diversity of behaviors reported by youth of all sexual attractions and identities.”
Also using data from the 2002 NSFG, William L. Jeffries IV examines an important STD risk factor—number of recent partners—among bisexual men aged 15–44 (page 151). Jeffries, too, considers sexual orientation from the distinct angles of behavior, identity and attraction, and he finds that the outcome depends on the definition: The number of partners men reported for the previous year was positively associated with bisexual behavior, but it was not related to bisexual identity or attraction. The findings, Jeffries observes, support results of earlier research that has suggested the need for STD prevention interventions for bisexual men to focus on men’s behaviors with both men and women, rather than simply on attraction or identity.
In a similar vein, Christine E. Kaestle and Martha W. Waller report (page 158) that among young adults in the 2001–2002 wave of the National Longitudinal Study of Adolescent Health, bisexual identity and attraction—but not behavior—predicted an increased risk of STD infection for women. Additionally, women who reported exclusively same-sex relationships or who considered themselves homosexual had elevated odds of underestimating their STD risk. Among men, none of the measures of sexual minority status was associated with STD risk, and those who were attracted to both genders had reduced odds of underestimating their risk. The authors remark that these findings suggest the need for health care professionals to “provide safer-sex information to all patients.”
Also in This Issue
• On the basis of an examination of 2002 NSFG data (page 164), Marleen M.H.J. van Gelder and colleagues find that men and women who use marijuana or cocaine began having vaginal sex earlier than nonusers and are more likely to engage in a variety of risky sexual behaviors—sex with a nonmonogamous partner, while high on alcohol or drugs, or in exchange for money or drugs. Elevated risks were apparent both in the early reproductive years (15–25) and later. The authors suggest that programs for drug users should aim to prevent not only STDs, but also unintended pregnancies, since prenatal use of illicit drugs can have adverse effects for both mother and child.
• In analyses of statewide data for 2006–2008, Grace Shih et al. find large racial and ethnic disparities in contraceptive method choice among California women aged 18–44 who are at risk of unintended pregnancy (page 173). Notably, foreign-born Asian women were considerably less likely than whites to choose highly effective reversible methods (i.e., hormonals or IUDs) or to be protected by either female or male steril-ization; blacks also reported a relatively low level of reliance on highly effective reversible methods and male sterilization, but were more likely than whites to choose female sterilization. Shih and colleagues speculate as to the causes of these disparities but recommend additional research into possible provider- and user-related factors.
• Meanwhile, a study by Christine Dehlendorf and colleagues (page 181) indicates that even when cost is not a barrier, contraceptive choice varies substantially by race and ethnicity among low-income California women. This study, which examined data from a statewide program that offers participants all federally approved methods free of charge, found, for example, that black women are less likely than whites to get an IUD, but more likely to get barrier methods or emergency contraception. The researchers note that although racial and ethnic disparities in contraceptive use “most likely do not entirely explain” racial and ethnic variation in levels of unintended pregnancy, they “may be one factor.”
• In an update on levels and trends in legal abortion by Gilda Sedgh and colleagues (page 188), statistics and estimates were available for 64 of the 77 countries and major territories worldwide in which legal abortion is generally available. In the 25 countries with complete records—all of them developed countries—abortion rates for 2008 ranged from seven (in Germany and Switzerland) to 30 (in Estonia) abortions per 1,000 women of childbearing age. Between 1996 and 2008, rates declined in about half of the 20 countries with consis-tently reliable information for the whole period, although the pace of decline slowed after 2003. The highest rates were in developing countries with incomplete records.
• The murder of Wichita doctor George Tiller in 2009 brought to an end a unique chapter in the history of abortion provision, as Tiller’s former staff describe the clinic and its mission in Carole Joffe’s special report (page 199). In extensive interviews, staff of the now defunct clinic detailed the compassion with which Tiller cared for women who needed third-trimester abortions, the sense of commitment he instilled in his staff and how clinic personnel went about their work in the face of grinding opposition. As facilities elsewhere in the country slowly extend their services to offer late abortions, Joffe remarks that “it remains to be seen” whether they can avoid the “polarization” that marked Tiller’s clinic.