Black-White Differences in Attitudes Related to Pregnancy Among Young Women

In this article, we use newly available data from the Relationship Dynamics and Social Life (RDSL) study to compare a wide range of attitudes related to pregnancy for 961 black and white young women. We also investigate the extent to which race differences are mediated by, or net of, family background, childhood socioeconomic status (SES), adolescent experiences related to pregnancy, and current SES. Compared with white women, black women generally have less positive attitudes toward young nonmarital sex, contraception, and childbearing, and have less desire for sex in the upcoming year. This is largely because black women are more religious than white women and partly because they are more socioeconomically disadvantaged in young adulthood. However, in spite of these less positive attitudes, black women are more likely to expect sex without contraception in the next year and to expect more positive consequences if they were to become pregnant, relative to white women. This is largely because, relative to white women, black women had higher rates of sex without contraception in adolescence and partly because they are more likely to have grown up with a single parent. It is unclear whether attitudes toward contraception and pregnancy preceded or are a consequence of adolescent sex without contraception. Some race differences remain unexplained; net of all potential mediators in our models, black women have less desire for sex in the upcoming year, but they are less willing to refuse to have sex with a partner if they think it would make him angry and they expect more positive personal consequences of a pregnancy, relative to white women. In spite of these differences, black women's desires to achieve and to prevent pregnancy are very similar to white women's desires.

Happiness about unintended pregnancy and its relationship to contraceptive desires among a predominantly Latina cohort

CONTEXT

Women frequently profess happiness about unintended pregnancies; such incongruence is associated with use of less effective contraceptive methods and inconsistent or incorrect method use. Yet, the methods women use may differ from those they desire.

METHODS

Data on 578 women were drawn from a prospective survey of postpartum women aged 18-44 recruited from three hospitals in Texas between 2012 and 2014. Jonckheere-Terpstra tests were used to compare women's feelings about a future pregnancy with their childbearing intentions. Fisher-Freeman-Halton tests compared distributions of contraceptive methods currently used and desired by women who professed happiness about a future unintended pregnancy, as well as distributions of desired methods by women's reported feelings.

RESULTS

The proportion of women who reported happiness about a future pregnancy was 59% among those intending to wait two or three years for another child, 46% among those intending to wait four or more years, and 36% among those intending to have no more children. Among women who professed happiness, a greater proportion desired to use a highly effective contraceptive method than were currently using one (72% vs. 15% among those intending no more children; 55% vs. 23% among those intending to wait at least four years; and 36% vs. 10% among those intending to wait two or three years). Across intention categories, the types of methods desired did not differ by whether women professed happiness or unhappiness.

CONCLUSIONS

Women who profess happiness about a future unintended pregnancy may nonetheless desire highly effective contraceptive methods.

Social network- and community-level influences on contraceptive use: evidence from rural Poland

The diffusion of 'modern' contraceptives-as a proxy for the spread of low-fertility norms-has long interested researchers wishing to understand global fertility decline. A fundamental question is how local cultural norms and other people's behaviour influence the probability of contraceptive use, independent of women's socioeconomic and life-history characteristics. However, few studies have combined data at individual, social network and community levels to simultaneously capture multiple levels of influence. Fewer still have tested if the same predictors matter for different contraceptive types. Here, we use new data from 22 high-fertility communities in Poland to compare predictors of the use of (i) any contraceptives-a proxy for the decision to control fertility-with those of (ii) 'artificial' contraceptives-a subset of more culturally taboo methods. We find that the contraceptive behaviour of friends and family is more influential than are women's own characteristics and that community level characteristics additionally influence contraceptive use. Highly educated neighbours accelerate women's contraceptive use overall, but not their artificial method use. Highly religious neighbours slow women's artificial method use, but not their contraceptive use overall. Our results highlight different dimensions of sociocultural influence on contraceptive diffusion and suggest that these may be more influential than are individual characteristics. A comparative multilevel framework is needed to understand these dynamics.

EMERGENCY CONTRACEPTION: AN OVERVIEW AMONG USERS

BACKGROUND

Emergency contraception Pills (ECP) provides a safe and effective means of post coital treatment and prevents at least 75% of expected pregnancies resulting from unprotected intercourse. The purpose of the study was to assess the awareness regarding emergency contraception and to see the knowledge attitude and preference about emergency contraception.

METHODS

This was a descriptive cross sectional study carried out at Combined Military Hospital (CMH) Khuzdar. A total of 200 married women of reproductive age group who agreed to participate in the study were interviewed using a self-reported comprehensive, structured closed ended questionnaire.

RESULTS

77% of the women were practicing some contraceptive method at the time of study. Most were using condoms for contraception. 16% of all respondents have never used any contraceptive in their life. 70% believe that religion of Islam is not a barrier in family planning. Only 7.5% of the women were aware about ECP.

CONCLUSION

Knowledge about ECP is poor among the women of child bearing age. There is a room for improvement regarding the awareness and use of ECP which can contribute to prevention of unwanted pregnancies.

'Men don't need to know everything': a field trial of a discreet, female-initiated, contraceptive barrier method (FemCap™) among Haitian-American women

Worldwide, women report the need for safe, non-hormonal, woman-initiated methods of family planning. Cervical barriers provide such technology but are under-researched and under-promoted. In the USA, there are few studies of cervical barriers among women at high unmet need for contraception. A feasibility study of the FemCap™ was conducted among US women of Haitian origin. Participants were heterosexual and seeking to avoid pregnancy. At first visit, participants completed baseline assessments, underwent group counselling and were fitted with FemCap™. Women were asked to insert or use the cap at home. The second visit (2-3 weeks) included an interviewer-administered questionnaire and a focus-group discussion. Participants (n  =  20) were Haitian-born (70%), married (55%) and parous (85%). Their mean age was 32.6 years. Seventy percent reported recent unprotected sex. All women inserted the device at home and 9 women used it during intercourse, including 5 without prior partner negotiation. Of 20 women, 11 liked FemCap™ very much or somewhat; 7 considered it 'OK'; 2 disliked it. Best-liked attributes were comfort, discreet wear and reusability. Difficulties with removal abated over time. Qualitative data revealed a high value placed on lack of systemic side effects. Use of FemCap™ was feasible and acceptable, supporting expansion of research, particularly among relevant populations with unmet need.

Development and psychometric testing of the attitude toward potential pregnancy scale

OBJECTIVE

To develop and test a comprehensive tool for measuring women's attitudes toward the possibility of becoming pregnant.

DESIGN

Cross-sectional mixed methods study.

SETTING

Two obstetric/gynecologic (OB/GYN) clinics and one family planning clinic in Baltimore, Maryland.

PARTICIPANTS

One-hundred thirty (130) nonpregnant, primarily African American women (84%) age 18 to 29.

METHODS

Participants completed a computer-based survey as part of a larger retrospective mixed-methods study. The Attitude Toward Potential Pregnancy Scale (APPS) was assessed using exploratory factor analysis and hypothesis testing.

RESULTS

Cronbach's alpha for internal consistency for the APPS was 0.86. Item-total correlations ranged from 0.56 to 0.75. All items loaded on one factor. Support for construct validity was demonstrated using logistic regression, where the odds of being a highly effective contraceptive user decreased by 8% with each one-point increase in score on the APPS (odds ratio = 0.92; confidence interval [0.87, 0.98]).

CONCLUSIONS

This study provides support for reliability and validity of the APPS. The APPS may be a useful tool for understanding pregnancy attitude in future studies and in clinical practice. Further research is needed to assess the usefulness of the scale with other groups of women, its utility in the clinical practice setting, and its potential predictive validity for unintended pregnancy.

Women's empowerment and contraceptive use: the role of independent versus couples' decision-making, from a lower middle income country perspective

INTRODUCTION

There is little available evidence of associations between the various dimensions of women's empowerment and contraceptive use having been examined--and of how these associations are mediated by women's socio-economic and demographic statuses. We assessed these phenomena in Pakistan using a structured-framework approach.

METHODS

We analyzed data on 2,133 women who were either using any form of contraceptive or living with unmet need for contraception. The survey was conducted during May - June 2012, with married women of reproductive age (15-49 years) in three districts of Punjab. The dimensions of empowerment were categorized broadly into: economic decision-making, household decision-making, and women's mobility. Two measures were created for each dimension, and for the overall empowerment: women's independent decisions, and those taken jointly by couples. Contraceptive use was categorized as either female-only or couple methods on the basis of whether a method requires the awareness of, or some support and cooperation from, the husband. Multinomial regression was used, by means of Odds Ratios (OR), to assess associations between empowerment dimensions and female-only and couple contraceptive methods.

RESULTS

Overall, women tend to get higher decision-making power with increased age, higher literacy, a greater number of children, or being in a household that has superior socio-economic status. The measures for couples' decision-making for overall empowerment and for each dimension of it showed positive associations with couple methods as well as with female-only methods. The only exception was the measure of economic empowerment, which was associated only with the couple method.

CONCLUSION

Couples' joint decision-making is a stronger determinant of the use of contraceptive methods than women-only decision-making. This is the case over and above the contribution of women's socio-demographic and economic statuses. Effort needs to be made to educate women and their husbands equally, with particular focus on highly effective contraceptive methods.

Contraceptive use among low-income women living in medically underserved neighborhoods

OBJECTIVE

To describe the rate of contraceptive use and types of contraception used by low-income women.

DESIGN

A descriptive study was used to survey women about their contraceptive use and sexual behaviors 12 months prior to the time of the interview.

PARTICIPANTS AND SETTING

A convenience sample of 110 low-income women living in three urban medically underserved neighborhoods who enrolled in a larger study was included.

METHODS

Univariate and bivariate descriptive analyses were conducted using STATA 10.

RESULTS

Forty-eight (43.6%) of the women were African American, 43 (39.1%) were Hispanic, and 17 (15.5%) were White. The women were age 18 to 55 years (Mean = 31 years). Forty percent of these women who were not pregnant or planning to get pregnant had sex without contraceptives in the past 12 months. The percentage of women who used contraception decreased from 77.3% users in the last 12 months to 63.6% current users. The most common methods used within the last 12 months were condom use by male partner (28.2%), birth control pills (14.6%), contraceptive injection (12.7%), intrauterine device (10.9%), and the patch (1.8%).

CONCLUSIONS

Many of the low-income women from medically underserved neighborhoods did not use contraceptives and of those who used contraceptives, the majority used the least effective methods.

Postpartum contraception utilization among low-income women seeking immunization for infants in Mumbai, India

OBJECTIVE

The objective was to examine postpartum contraception utilization among Indian women seeking immunization for their infants in three low-income communities in Mumbai, India.

STUDY DESIGN

We conducted a cross-sectional questionnaire of low-income postpartum women seeking immunization for their infants at three large urban health centers in Mumbai. Contraceptive utilization data were collected as part of a larger study focused on the impact of postpartum domestic violence on maternal and infant health. Descriptive, bivariate and multivariate analyses were conducted to describe and identify predictors of postpartum contraceptive utilization.

RESULTS

Postpartum women aged 17-45 years (N=1049) completed the survey; 44.5% (n=467) reported resuming sexual relations with their husbands. Among these women, the majority (65.3%; n=305) reported not currently using contraception. In multivariate analyses, women who did not discuss postpartum family planning with their husbands, had not used contraception previous to the recent birth, and had experienced physical violence or forced sex were more likely to not use postpartum contraception (adjusted odds ratios=1.47-1.77). Among the 162 women using contraception, the most common time to initiation of contraception was 5 weeks postpartum, and the most common method used was condoms 77.8% (n=126).

CONCLUSION

Contraception nonuse was common among urban, low-income postpartum women in India. This study highlights the importance of developing interventions to increase use of highly effective contraceptive methods postpartum, and that spousal violence and lack of marital communication may present barriers to postpartum contraception utilization. Infant immunization may represent an opportunity for provision of contraceptives and contraceptive counseling.

IMPLICATIONS

This original research study is a unique contribution to the literature because it presents data regarding the nonuse of postpartum contraception among women seeking immunizations for their infants in urban centers in a developing country. It also reveals barriers to not using postpartum contraception and provides data for future interventions.

Postpartum contraceptive choices among ethnically diverse women in New Mexico

OBJECTIVE

The objective of the study was to determine if postpartum contraceptive choices by primiparous women differ by ethnicity.

STUDY DESIGN

Retrospective nested cohort study analyzing women's characteristics and contraceptive choice.

RESULTS

Of 652 participants, 312 (47.8%) were Hispanic, 287 (44.0%) were non-Hispanic white, and 53 (8.1%) were American Indian (AI). In multivariate analysis, depot medroxyprogesterone acetate (DMPA) and intrauterine device (IUD)/implant choice was related to AI [DMPA: odds ratio (OR) 15.28, confidence interval (CI) 4.49-52.04; IUD/implant: OR 0.46, CI 0.22-0.92] and Hispanic (DMPA: OR 3.44, CI 1.12-10.58) ethnicity.

CONCLUSION

DMPA use was higher among Hispanic and AI women and IUD/implant use lower in AI women compared to non-Hispanic white women.

Reconsidering racial/ethnic differences in sterilization in the United States

OBJECTIVE

Cross-sectional studies have found that low-income and racial/ethnic minority women are more likely to use female sterilization and less likely to rely on a partner's vasectomy than women with higher incomes and whites. However, studies of pregnant and postpartum women report that racial/ethnic minorities, particularly low-income minority women, face greater barriers in obtaining a sterilization than do whites and those with higher incomes. In this paper, we address this apparent contradiction by examining the likelihood a woman gets a sterilization following each delivery, which removes from the comparison any difference in the number of births she has experienced.

STUDY DESIGN

Using the 2006-2010 National Survey of Family Growth, we fit multivariable-adjusted logistic and Cox regression models to estimate odds ratios and hazard ratios for getting a postpartum or interval sterilization, respectively, according to race/ethnicity and insurance status.

RESULTS

Women's chances of obtaining a sterilization varied by both race/ethnicity and insurance. Among women with Medicaid, whites were more likely to use female sterilization than African Americans and Latinas. Privately insured whites were more likely to rely on vasectomy than African Americans and Latinas, but among women with Medicaid-paid deliveries reliance on vasectomy was low for all racial/ethnic groups.

CONCLUSIONS

Low-income racial/ethnic minority women are less likely to undergo sterilization following delivery compared to low-income whites and privately insured women of similar parities. This could result from unique barriers to obtaining permanent contraception and could expose women to the risk of future unintended pregnancies.

IMPLICATIONS

Low-income minorities are less likely to undergo sterilization than low-income whites and privately insured minorities, which may result from barriers to obtaining permanent contraception, and exposes women to unintended pregnancies.

Racial/ethnic disparities in contraceptive use: variation by age and women's reproductive experiences

OBJECTIVE

Disparities in unintended pregnancy in the United States are related, in part, to black and Hispanic women being overall less likely to use effective contraceptive methods. However, the fact that these same groups are more likely to use female sterilization, a highly effective method, suggests there may be variability in disparities in contraceptive use across a woman's life course. We sought to assess the relationship between race/ethnicity and contraceptive use in a nationally representative sample and to approximate a life course perspective by examining effect modification on these disparities by women's age, parity, and history of unintended pregnancy.

STUDY DESIGN

We conducted an analysis of the 2006 through 2010 National Survey of Family Growth to determine the association between race/ethnicity and: (1) use of any method; (2) use of a highly or moderately effective method among women using contraception; and (3) use of a highly effective method among women using contraception. We then performed analyses to assess interactions between race/ethnicity and age, parity, and history of unintended pregnancy.

RESULTS

Our sample included 7214 females aged 15-44 years. Compared to whites, blacks were less likely to use any contraceptive method (adjusted odds ratio, 0.65); and blacks and Hispanics were less likely to use a highly or moderately effective method (adjusted odds ratio, 0.49 and 0.57, respectively). Interaction analyses revealed that racial/ethnic disparities in contraceptive use varied by women's age, with younger women having more prominent disparities.

CONCLUSION

Interventions designed to address disparities in unintended pregnancy should focus on improving contraceptive use among younger women.

Interventions to improve adolescents' contraceptive behaviors in low- and middle-income countries: a review of the evidence base

OBJECTIVE(S)

Many adolescents in developing countries have an unmet need for contraception, which can contribute to poor reproductive health outcomes. Recent literature reviews have not adequately captured effective contraceptive services and interventions for adolescents in low- and middle-income countries (LMICs). This study aims to identify and evaluate the existing evidence base on contraceptive services and interventions for adolescents in LMICs that report an impact on contraceptive behavior outcomes.

STUDY DESIGN

Structured literature review of published and unpublished papers about contraceptive services and interventions for adolescents in LMICs that report an impact on contraceptive behavior outcomes.

RESULTS

We identify common elements used by programs that measured an impact on adolescent contraceptive behaviors and summarize outcomes from 15 studies that met inclusion criteria. Effective programs generally combined numerous program approaches and addressed both user and service provision issues. Overall, few rigorous studies have been conducted in LMICs that measure contraceptive behaviors. Few interventions reach the young, the out of school and other vulnerable groups of adolescents.

CONCLUSION(S)

Though the evidence base is weak, there are promising foundations for adolescent contraceptive interventions in nearly every region of the world. We offer recommendations for programmers and identify gaps in the evidence base to guide future research.

Exploring young adults' contraceptive knowledge and attitudes: disparities by race/ethnicity and age

BACKGROUND

Half of pregnancies in the United States are unintended, with the highest proportions occurring among Blacks, Hispanics, and teenagers. Understanding differences in knowledge and attitudes about contraception by race/ethnicity and age can improve efforts to reduce disparities in unintended pregnancy.

METHODS

This analysis used data from the 897 female respondents in National Survey of Reproductive and Contraceptive Knowledge, a survey exploring young adults' knowledge and attitudes about contraception and pregnancy. Bivariate and multivariate logistic regression analyses were used to assess racial/ethnic and age group differences in knowledge and attitudes about contraceptives.

FINDINGS

Hispanics and teenagers (aged 18-19) had lower awareness of available contraceptive methods, and lower knowledge about individual methods compared with White women and young adults (age 20-29). For example, Hispanics (74%) and teenagers (77%) were less likely to have heard of the intrauterine device (IUD) than were White women (90%) and young adults (90%), and were less likely to know that a woman experiencing side effects could switch brands of oral contraceptive pills (72% of Hispanics vs. 86% of White women; 76% of teenagers vs. 90% of young adults). Hispanics born outside the United States had lower knowledge about contraceptives than U.S.-born Hispanics. For example, foreign-born Hispanics were less likely than U.S.-born Hispanics to have heard of the IUD (59% vs. 82%) or the vaginal ring (55% vs. 95%).

CONCLUSIONS

Lower contraceptive knowledge among teenagers and Hispanics, particularly immigrants, suggests the importance of disseminating family planning information to these women as one means to address disparities in unintended pregnancy.

African American women's safer sexual practices: the influence of ethnic-racial socialisation and body esteem

African American women are disproportionately at risk for sexually transmitted infections (e.g., HIV and gonorrhoea). It is important therefore to explore cultural factors that may influence their sexual practices. The present study examined the relationship between safer sexual practices (i.e., using condoms and inquiring about partner sexual history), participants' ethnic-racial socialisation experiences with maternal and paternal caregivers, and body esteem. Participants were 262, largely middle-class, African American women (ages 18 to 78) from a Midwestern US city who completed an online questionnaire. Results indicated significant differences on measures of safer sexual practice based on relationship status. Regression results suggested that certain paternal cultural practices were negatively related to inquiring about a partner's sexual history. However, body esteem was positively associated with inquiry regarding partner's previous sexual history. Implications for intervention efforts and research are discussed.

Contraceptive method choice and use by married women of reproductive age in two Districts of East Harerge

BACKGROUND

Contraceptive method mix and choice is not uniform across all countries. Literatures have shown that a significant variation exists in contraceptive method mix among regions and countries. In Africa most mothers rely on short-term contraceptives such as pills and injectables or traditional methods while in Asia and Latin America permanent methods mainly male and female sterilizations are commonly used. Though long-term methods of contraception are recommended for its effectiveness and efficiencies in countries like Ethiopia where high fertility rate is a concern, its choice and utilization remains low.

OBJECTIVE

The main objective of the study was to assess factors influencing contraceptive method choice and use among married women of reproductive age in rural Districts of East Harerge Zone of Oromia Region.

METHODS

A community-based cross-sectional study using both quantitative and qualitative methods was conducted among 473 married women of reproductive age in two rural districts of East Harerge Zone. A systematic random sampling method was used to select the study participants from the list of all married women who have been using contraceptives in the project sites. Data was collected using structured and pretested questionnaires. Data entry and analysis was done using EPI Info version 6.04d and SPSS for Windows version 15, respectively. Frequencies and proportions were used for description while odds ratio with 95% CI was used to determine the strength and significance of association between independent and outcome variables. Multiple logistic regression analysis was used to control confounding variables.

RESULTS

A total of 473 currently married women who were using modern contraceptives were interviewed for the survey. About 6 in ten (58.8%) were in the age range of 25-34 years with the mean (+/- SD) age of 29.5 (+/- 5.7) years. About three-fourth (74%) were short-term contraceptive method users while only 26% were long-term contraceptive method users. Duration of family planning use, reasons for contraceptive use and provider's choice of the method were positively associated with long-term contraceptive use by married women of reproductive age in the study area. Qualitative finding showed that religious and cultural perceptions about contraceptives and values the society, particularly men, gives to large family size has negatively influenced contraceptive use.

CONCLUSIONS

Long-term contraceptive method use is influenced by duration and reason for use of the methods and provider 's choice in the study area. Misconceptions about fertility regulations and the value the society gives to large family size do also affect contraceptive use. Beside availing contraceptives of choice, reproductive health/family planning awareness creation targeting religious leaders as well as interventions aimed at respecting women's right of accessing family planning method of their choice has to be strengthened in the study area.

Measurement of unmet need for family planning: longitudinal analysis of the impact of fertility desires on subsequent childbearing behaviors among urban women from Uttar Pradesh, India

BACKGROUND

The measure of unmet need relies on women's reported fertility desires; previous research has demonstrated that fertility desires may be fluid and not firm.

STUDY DESIGN

Our study uses recently collected longitudinal data from four cities in Uttar Pradesh, India, to examine whether women's fertility desires and family planning (FP) use at baseline predict pregnancy/birth experience in the 2-year follow-up period.

RESULTS

Multivariate models demonstrate that women who were using any method of FP and reported an intention to stop childbearing were the least likely to experience a pregnancy/birth in the 2-year follow-up period. The stated desire to delay childbearing, whether or not the woman was using FP, did not distinguish pregnancy/birth experience. Ninety-two percent of pregnancies/births over the follow-up period were considered "wanted then" suggesting post-hoc rationalization of the pregnancy/birth even among those women who reported a desire to stop childbearing 2 years earlier.

CONCLUSIONS

More nuanced assessments of fertility intentions may be needed to adequately gauge latent FP needs. Non-users of FP may be ambivalent about future childbearing and the timing of future births; these women may not have an unmet need for FP as typically defined.

Racial and ethnic differences in men's knowledge and attitudes about contraception

BACKGROUND

Little is known about racial/ethnic differences in men's contraceptive knowledge and attitudes.

STUDY DESIGN

We used multivariable logistic regression to examine racial/ethnic differences in contraceptive knowledge and attitudes among 903 men aged 18-29 in the 2009 National Survey of Reproductive and Contraceptive Knowledge.

RESULTS

Black and Hispanic men were less likely than Whites to have heard of most contraceptive methods, including female and male sterilization, and also had lower knowledge about hormonal and long-acting reversible methods. They were less likely to know that pills are ineffective when 2-3 pills are missed [Blacks: adjusted odds ratio (aOR)=0.42; Hispanics: aOR=0.53] and that fertility was not delayed after stopping the pill (Blacks: aOR=0.52; Hispanics: aOR=0.27). Hispanics were less likely to know that nulliparous women can use the intrauterine device (aOR=0.47). Condom knowledge was similar by race/ethnicity, but Blacks were less likely to view condoms as a hassle than Whites (aOR=0.46).

CONCLUSIONS

Efforts to educate men, especially men of color, about contraceptive methods are needed.

Racial and ethnic differences in U.S. women's choice of reversible contraceptives, 1995-2010

CONTEXT

In the United States, unintended pregnancies disproportionately affect minority populations. Persistent disparities in contraceptive use between black and Hispanic women and white women have been identified, but it is unclear whether racial and ethnic differences in use of the most effective methods have changed.

METHODS

Data on 4,727 women from the 1995 National Survey of Family Growth and 5,775 women from the 2006-2010 cycle were used to examine the association between race and ethnicity and women's choice of reversible contraceptives according to level of method effectiveness. Stepwise multinomial logistic regressions were used to identify changes in this association between cycles. Analyses controlled for demographic, socioeconomic, family, religious, behavioral and geographic characteristics.

RESULTS

The proportion of women using the most effective reversible contraceptive methods increased from 46% in 1995 to 53% in 2006-2010. In 1995, black and Hispanic women's use of the most effective reversible contraceptives did not differ from that of white women. By 2006-2010, however, black women were substantially less likely than white women to use highly effective reversible contraceptive methods rather than no method (relative risk ratio, 0.6). An analysis that combined the two data sets and included a term for the interaction between survey year and race and ethnicity found that relative to white women, black women were less likely in 2006-2010 than in 1995 to use more effective methods rather than no method (0.6).

CONCLUSIONS

Further research is needed to identify factors that may be causing racial and ethnic disparities in contraceptive decisions to widen.

'He lacks his fatherhood': safer conception technologies and the biological imperative for fatherhood among recently-diagnosed Xhosa-speaking men living with HIV in South Africa

This paper explores notions of fatherhood and their linkages to fertility desires and intentions among a treatment-naïve cohort of Xhosa-speaking male key informants living with HIV, aged 20-53 in Cape Town, South Africa. Analysis is based on an initial 27, and 20 follow-up, interviews with men who were part of a study that assessed the acceptability of safer conception and alternative parenting strategies among men and women newly diagnosed with HIV to inform an intervention. Grounded theory analysis revealed themes related to the cultural imperative of biologically-connected fatherhood. Certain safer-conception strategies aimed at minimising the risk of HIV transmission were perceived as threats to paternity. These findings suggest that understanding of social and cultural beliefs related to notions of paternity and fatherhood may inform the implementation of acceptable safer-conception options for HIV-positive men and their infected and uninfected female partners in a high-HIV prevalence, low-resource setting.

Daughter preference and contraceptive-use in matrilineal tribal societies in Meghalaya, India

Although son preference in patrilineal society is an established fact, daughter preference in matrilineal society is not thoroughly examined. Very few studies have been carried out on the issue. This paper attempts to explore the daughter preference and contraceptive-use in matrilineal tribal societies in Meghalaya, India. Data from the National Family Health Survey 1998-1999 have been used in this study because, among the large-scale surveys, only this dataset allows identification of matrilineal sample. Mean, percentage, and standard deviation are computed in the present study. Further, the data have been cross-tabulated, and logistic regression has been run through SPSS (version 15). Among the ever-married matrilineal women, 17% desired more sons than daughters but 18.2% desired more daughters than sons. About 11% of ever-married women could achieve their desired sex composition of children. However, a very striking finding suggests that, even after achieving desired sex composition of children, as high as 61.8% of women were still not using contraception mainly because of programme factors while one-fourth were still depending on temporary methods. The rest 13.2% adopted terminal method of contraception, which calls for immediate attention of planners. With the increase in the number of sons but without daughter, contraceptive-use drastically decreased. The most desired sex composition of children seems to be two daughters and a son. Absence of daughter with increase in the total number of sons increased the desire for additional children. Every woman with two or more sons but without daughter wanted the next child to be a daughter. Thus, there are ample evidences to draw the conclusion that there is, in fact, a daughter preference in the matrilineal tribal societies in Meghalaya, India. Policy-makers may, thus, target the women who have achieved fertility and should ensure that daughter preference does not lead to the negligence to sons.

Physical domestic violence and subsequent contraceptive adoption among women in rural India

This study examines the relationship between male to female physical domestic violence and contraceptive adoption among women in four economically and culturally distinct areas of India. Data from India's 1998-1999 National Family Health Survey-2 and a follow-up survey in 2002-2003 for which the same women in four states were reinterviewed are analyzed. The focus of the analysis is on how baseline exposure to physical domestic violence is associated with the intersurvey adoption of contraception. Women who experience physical violence from their husbands are significantly less likely to adopt contraception in the intersurvey period, although this relationship varies by State. This study builds upon previous work by using an indicator of physical domestic violence exposure that is measured before contraceptive adoption, thus allowing the identification of how exposure to violence shapes the adoption of contraception. The results demonstrate that for women living in Bihar and Jharkhand there is a clear negative relationship between physical domestic violence and a woman's adoption of contraception; this relationship was not found for women in Maharashtra and Tamil Nadu. The results point to the need to include domestic violence screening and referral services into family planning services.