Why do levels of effective contraceptive use differ among U.S. women from different racial and ethnic groups? Corinne H. Rocca and Cynthia C. Harper hypothesized that differences in attitudes toward contraception, pregnancy and childbearing, and in contraceptive knowledge, may have a role; in this issue of Perspectives on Sexual and Reproductive Health (page 150), they report their findings based on analyses of data from a nationally representative sample of unmarried 18–29-year-olds at risk of unintended pregnancy. Blacks and Latinas, they found, were less likely than whites to use an effective method. These groups also differed from whites on a number of attitudinal measures, but none of these differences was associated with disparities in method use. However, Latinas’ comparatively poor contraceptive knowledge appeared to account for a substantial proportion of the difference in method use. The authors comment that educating young women of all races about contraceptives might help overcome reluctance to use certain methods, but they also emphasize that characteristics of the health care system—for example, differential access to services and insurance coverage—are among the variables that need to be explored as potential contributors to racial and ethnic disparities in use.
Also in This Issue
● State laws mandating parental involvement in minors’ abortion -decisions are intended to ensure young adolescents’ best interests, but many minors themselves see these laws as potentially harmful on a number of fronts. In in-depth interviews with minors in Illinois, Erin K. Kavanagh and colleagues found that such a law (which is on the books but is not enforced) raised concerns about threats to reproductive autonomy and to relationships with parents; about how minors would navigate the process of obtaining a judicial bypass; and about the lengths minors would go to in order to avoid that option (page 159). Some of the 30 minors in the study had positive or ambivalent feelings toward the law; these young people cited benefits of parental involvement, but felt that it should not be mandated. “Policymakers,” the researchers conclude, “should consider minors’ concerns … when weighing the benefits and harms of parental involvement laws.”
● Population-based data from nine European countries reveal that the proportion of females having sex at very early ages—before they are 16—varies considerably, according to Aubrey Spriggs Madkour and coauthors (page 167). Parental support was negatively associated with the odds of early sexual initiation in all nine countries. However, in analyses that added controls for parents’ knowledge of their daughters’ lives, support was not significant, but knowledge was. Madkour and colleagues suggest two possible ways to interpret these findings: Knowledge may mediate the relationship between parental support and early sex, or it may be the stronger correlate. According to the authors, research to further assess these relationships, particularly studies that can determine the sequence of events (which this study could not), might yield “significant implications for public health practice.”
● Despite all of the time that adolescents and young adults spend exchanging news via social media Web sites, social networking may not be an effective approach to STD prevention interventions. In a sample of young parents surveyed by Zai Divecha's team (page 176), those who discussed sexual health with friends did so predominantly in person, over the phone or via text message; few used social networking sites. Participants also reported that they would prefer private communications—texts or -e-mails—as means for receiving sexual health tips. The findings, according to the investigators, “suggest caution as well as promise in adopting new technologies to implement sexual risk reduction interventions.”
● It seems reasonable to assume that by encouraging their partners to use emergency contraception when it is appropriate, men can help their partners avoid unintended pregnancy. However, findings from a literature review by Arik V. Marcell and colleagues (page 184) indicate that the available evidence is insufficient to assess whether this is so. “Further work is needed,” they write, “to understand males’ emergency contraception–related knowledge, attitudes, communication and access, and to examine whether improvements in these characteristics are associated with increased use of the method and reductions in unintended pregnancy rates.” The review also reveals considerable gaps in knowledge about health providers’ perspectives on and practices regarding provision of emergency contraception to men.
● A survey of abortion patients at six clinics across the United States brought to light “a large gap between the contraceptive features women want and the features of currently available methods,” as Lauren N. Lessard and colleagues report (page 194). The investigators asked women to rate the importance of 18 features and found that for the vast majority of women, no method has all of the features considered “extremely important.” The ring and sponge came closest: Each has two-thirds of features women viewed as extremely important. Pills have 60%, but they would have 71% if they were available over the counter. Developing and promoting methods that are well aligned with women's contraceptive preferences, the authors posit, may lead to more consistent and effective use.
● In a viewpoint article (page 201), Joanne D. Rosen outlines what she sees as the public health risks created by crisis pregnancy centers—“organizations that provide counseling and other prenatal services from an antiabortion (prolife) perspective.” By giving women inaccurate or misleading information about abortion and its potential negative consequences, Rosen contends, they impede women's access to abortion, improperly influence women's reproductive health decision-making and contribute to unwanted childbearing. Rosen lays out a number of legal and educational efforts that she believes could help reduce the harmful impact of these centers.