In their own words: romantic relationships and the sexual health of young African American women

OBJECTIVE

We assessed young African American women's understanding of "dual protection" (DP) (i.e., strategies that simultaneously protect against unintended pregnancies and sexually transmitted diseases [STDs]) and how relationship factors influence their use of DP methods.

METHODS

We conducted 10 focus groups with African American women (n=51) aged 15-24 years in Atlanta, Georgia, to identify barriers to and facilitators of their DP use. Focus group participants also completed a brief self-administered questionnaire that assessed demographics and sexual behaviors. We analyzed focus group data by theme: relationships, planning for sex, pregnancy intentions, STD worries, the trade-off between pregnancy and STDs, attitudes toward condoms and contraceptives, and understanding of DP.

RESULTS

From the questionnaire, 51% of participants reported that an STD would be the "worst thing that could happen," and 26% reported that being pregnant would be "terrible." Focus group data suggested that most participants understood what DP was but thought it was not always feasible. Relationship factors (e.g., trust, intimacy, length of relationship, and centrality) affected pregnancy intentions, STD concerns, and use of DP. Social influences (e.g., parents) and pregnancy and STD history also affected attitudes about pregnancy, STDs, and relationships.

CONCLUSIONS

Although participants identified risks associated with sex, a complex web of social and relationship factors influenced the extent to which they engaged in protective behavior. The extent to which relationship factors influence DP may reflect developmental tasks of adolescence and should be considered in any program promoting sexual health among young African American women.

Racial and ethnic variation in unmarried young adults' motivation to avoid pregnancy

CONTEXT

Racial and ethnic differences in unintended fertility are well documented, but mechanisms underlying these differences are poorly understood. To identify the factors that may contribute to such disparities, differences in distal characteristics theoretically linked to unintended fertility-such as the motivation to avoid a pregnancy-need to be identified.

METHODS

Data on sexual and reproductive attitudes and behavior among a sample of 1,573 unmarried men and women aged 18-29 came from the 2009 National Survey of Reproductive and Contraceptive Knowledge. Ordinal logistic regression analysis was conducted to examine two measures of motivation: one cognitive (perceived importance of avoiding pregnancy) and one affective (predicted feelings about experiencing an unplanned pregnancy).

RESULTS

Seventy-seven percent of young adults reported that avoiding pregnancy is very important, and 34% would be very upset if they were to experience an unplanned pregnancy. In multivariate analyses, the cognitive measure of motivation was not associated with race and ethnicity. The affective measure, however, was: Foreign-born Hispanics would be less upset than whites, and blacks would be more upset than whites, if they were to experience an unplanned pregnancy (coefficients, -1.7 and 0.5, respectively).

CONCLUSIONS

Differences in motivation to avoid pregnancy-particularly in predicted emotional responses to an unplanned pregnancy-should be further investigated as a potential factor in Hispanics' relatively high rates of unintended births. Future research should also examine connections between motivation to avoid pregnancy and reproductive behavior.

Evaluation of e-mail contact to conduct follow-up among adolescent women participating in a longitudinal cohort study of contraceptive use

BACKGROUND

The purpose of this study was to determine whether e-mail contact is a viable method for gathering information from adolescent women about contraceptive use.

STUDY DESIGN

Adolescent women initiating contraception followed in a prospective longitudinal cohort study and who had access to the Internet were randomized to the control or intervention arm and were contacted at 3, 6 and 12 months after enrollment. The control arm completed follow-up surveys in-person or by telephone. The intervention arm received Web-based surveys via e-mail.

RESULTS

There were 46 women in each group. Women in both groups were approximately 20 years old, were sexually active minority women, and were in school or employed. While participants in the intervention group initially had lower response rates than those in the control group (59% vs. 91%, respectively), with the addition of traditional follow-up methods, the overall response rates were comparable (94% vs. 91%, respectively).

CONCLUSIONS

E-mail follow-up with Web-based surveys was effective amongst adolescent women at risk for unintended pregnancy. This indicates that e-mail contact could be used as a preliminary follow-up strategy to capture a substantial proportion of participants and that standard follow-up can be used as a second-line approach. A two-pronged approach with initial e-mail contact and traditional follow-up for participants who do not respond may be a viable method when evaluating sensitive areas such as contraceptive use.

Patterns of contraception choice among Hispanic and non-Hispanic female adolescents

BACKGROUND

This study examines contraception choices among Hispanic and non-Hispanic girls, to determine if there are differences when the barrier of cost is removed by facilitating enrollment in a Title X Family Planning Program.

METHODS

Charts of adolescent females aged 13-19 years, seen for the first time at a university hospital clinic from January 1, 2005 to December 31, 2007, were reviewed. Access to contraception was facilitated by enrollment in the Title X Family Planning Program. Patients were categorized as public insurance if they had Medicaid or Child/Family Health Plus or chose to enroll in the Title X program.

RESULTS

Among the 666 eligible patients, 27% were Hispanic, with a mean age of 14.9 years. At least 20% had used one form of contraception before their first clinic visit. About one-third of the youth were enrolled in the Title X Family Planning Program, with no statistical difference between Hispanic and non-Hispanic youth. Three hundred and ninety subjects (58%) chose contraception during their visit. Hispanic subjects, who represented 32% of the group, were more likely to choose condoms and oral contraceptive pills compared to non-Hispanic subjects. The privately insured adolescents chose condoms less often than the publicly insured adolescents, and this was true regardless of ethnicity.

CONCLUSION

There are significant differences in contraception choices between Hispanic and non-Hispanic youth. The Title X Family Planning Program allowed young women to make independent choices. Adolescents may benefit from further improvements in culturally sensitive family planning programs.

Qualitative inquiry into premarital sexual behaviours and contraceptive use among multiethnic young women: implications for education and future research

Background

This study was a qualitative investigation into sexual attitudes and behaviours, and contraceptive use among Malaysian youth, based on constructs from the health belief model, theory of reasoned action, and problem behaviour theory.

Methods

A total of 34 focus group discussions with 185 participants were conducted among the Malay (35%), Chinese (34%), and Indian (31%) young females between November, 2010 and April, 2011. The participants were secondary school students and university undergraduates from Selangor and the Federal Territory of Kuala Lumpur.

Results

The study found a lack of knowledge about sexual issues and contraception among the participants. Many engaged in unprotected sexual intercourse and relied on periodic abstinence, natural methods, and traditional folk pregnancy preventive practices. The findings also revealed numerous categories of factors influencing sexual attitudes and behaviours: ethnic group and religion, level of religiosity, peer pressure and norms, and parental monitoring. With regard to condom use, factors such as embarrassment about condom acquisition, low perceived susceptibility to sexually transmitted infections (STIs), and perceived efficacy of traditional and folk methods of contraception, were uncovered from the discussions.

Conclusion

This study underscores the importance of development of culturally specific interventions that address the identified promoting factors of premarital sex. Behavioral interventions to promote condom use should increase awareness about condom effectiveness against not only unwanted pregnancies but also STIs.

Care of adolescent parents and their children

Teen pregnancy and parenting remain an important public health issue in the United States and the world, and many children live with their adolescent parents alone or as part of an extended family. A significant proportion of teen parents reside with their family of origin, significantly affecting the multigenerational family structure. Repeated births to teen parents are also common. This clinical report updates a previous policy statement on care of the adolescent parent and their children and addresses medical and psychosocial risks specific to this population. Challenges unique to teen parents and their children are reviewed, along with suggestions for the pediatrician on models for intervention and care.

Frustrated demand for sterilization among low-income Latinas in El Paso, Texas

CONTEXT

Sterilization is the most commonly used contraceptive in the United States, yet access to this method is limited for some.

METHODS

A 2006-2008 prospective study of low-income pill users in El Paso, Texas, assessed unmet demand for sterilization among 801 women with at least one child. Multivariable logistic regression analysis identified characteristics associated with wanting sterilization. In 2010, at an 18-month follow-up, women who had wanted sterilization were recontacted; 120 semistructured and seven in-depth interviews were conducted to assess motivations for undergoing the procedure and the barriers faced in trying to obtain it.

RESULTS

At baseline, 56% of women wanted no more children; at nine months, 65% wanted no more children, and of these, 72% wanted sterilization. Only five of the women interviewed at 18 months had undergone sterilization; two said their partners had obtained a vasectomy. Women who had not undergone sterilization were still strongly motivated to do so, mainly because they wanted no more children and were concerned about long-term pill use. Among women's reasons for not having undergone sterilization after their last pregnancy were not having signed the Medicaid consent form in time and having been told that they were too young or there was no funding for the procedure.

CONCLUSIONS

Because access to a full range of contraceptive methods is limited for low-income women, researchers and providers should not assume a woman's current method is her method of choice.

Meeting the need: youth and family planning in sub-Saharan Africa

BACKGROUND

The need for a concerted effort to address the gaps in family planning services for youth in sub-Saharan Africa has been underreported and underexplored.

STUDY DESIGN

Trends in fertility, childbearing, unmet need for family planning options and contraceptive prevalence (CP) among youth are described with data from six African countries with four consecutive Demographic and Health Surveys. Estimates of exposure to risk of pregnancy and number of new contraceptives users needed to maintain and double CP in 2015 are calculated using current CP and projected youth population size in six African countries.

RESULTS

The youth population is expected to range from approximately 3 to 35 million in six African countries by 2015. Accounting for population growth and current estimates of sexual activity among youth, family planning services will need to absorb more than 800,000 and 11.3 million new contraceptive users total to maintain and double CP, respectively, in 2015 in those six African countries alone.

CONCLUSION

Our findings support existing literature that calls for a reorientation of family planning policies and programs, especially improved access to modern contraceptive methods among African youth.

Fertility goal-based counseling increases contraceptive implant and IUD use in HIV-discordant couples in Rwanda and Zambia

BACKGROUND

HIV-discordant heterosexual couples are faced with the dual challenge of preventing sexual HIV transmission and unplanned pregnancies with the attendant risk of perinatal HIV transmission. Our aim was to examine uptake of two long-acting reversible contraceptive (LARC) methods--intrauterine devices (IUD) and hormonal implants--among HIV-discordant couples in Rwanda and Zambia.

STUDY DESIGN

Women were interviewed alone or with their partner during routine cohort study follow-up visits to ascertain fertility goals; those not pregnant, not infertile, not already using LARC, and wishing to limit or delay fertility for ≥3 years were counseled on LARC methods and offered an IUD or implant on-site.

RESULTS

Among 409 fertile HIV-discordant Rwandan women interviewed (126 alone, 283 with partners), 365 (89%) were counseled about LARC methods, and 130 (36%) adopted a method (100 implant, 30 IUD). Of 787 fertile Zambian women interviewed (457 alone, 330 with partners), 528 (67%) received LARC counseling, of whom 177 (34%) adopted a method (139 implant, 38 IUD). In both countries, a woman's younger age was predictive of LARC uptake. LARC users reported fewer episodes of unprotected sex than couples using only condoms.

CONCLUSIONS

Integrated fertility goal-based family planning counseling and access to LARC methods with reinforcement of dual-method use prompted uptake of IUDs and implants and reduced unprotected sex among HIV-discordant couples in two African capital cities.

Hormonal contraceptive use and discontinuation because of dissatisfaction: differences by race and education

The unintended pregnancy rate in the United States remains high, and there are large race and education differences in unintended pregnancy and fertility. These differences make it important to study race and education differences in contraceptive behavior. Using nationally representative data from the 2002 National Survey of Family Growth, this study examines the effects of race and education on the likelihood that women have ever used particular types of hormonal contraception and have ever discontinued hormonal contraception because of dissatisfaction. The results show that blacks and Latinas were more likely to have used injectable contraceptives ("the shot") and less likely to have used oral contraceptives ("the pill") than were white women. Women with less education were more likely than college-educated women to have used the shot but there were no significant education differences in use of the pill. Among women who had ever used hormonal birth control, those with less than a college degree were more likely than college-educated women to discontinue the birth control because of dissatisfaction. However, net of education, this study found no significant racial/ethnic differences in discontinuation. The most commonly stated reason for discontinuation because of dissatisfaction was side effects.

Influence of depressed mood and psychological stress symptoms on perceived oral contraceptive side effects and discontinuation in young minority women

BACKGROUND

We examined the influence of depressed mood and psychological stress on oral contraceptive (OC) side effects and discontinuation.

STUDY DESIGN

We administered standard psychological instruments to 354 young women (13-24 years old) beginning a 6-month OC continuation intervention trial and questions on OC side effects and use at 6 months. Logisitic regression determined the relationships between psychological conditions, perceived OC side effects and continuation rates.

RESULTS

Baseline depressed mood (21%) and stress (19%) and 6-month mood (25%) and weight changes (57%) were relatively common. Only 38% continued OCs at 6 months. Depressed mood [odds ratio (OR) 2.27, confidence interval (CI) 1.25-4.15, p=.007] and stress (OR 2.07, CI 1.12-3.82, p=.02) were associated with perceived OC-related moodiness; depressed mood was associated with perceived weight loss (OR 1.89, CI 1.01-3.55, p=.05). Depressed mood (OR 0.54, CI 0.29-0.99, p=.04), stress (OR 0.48, CI 0.25-0.91, p=.03) and perceived weight change (OR 0.60, CI 0.38-0.94, p=.03) all reduced the likelihood of OC continuation.

CONCLUSION

Young women with adverse psychological symptoms are at risk for perceived OC side effects and discontinuation.

Current contraceptive use in the United States, 2006-2010, and changes in patterns of use since 1995

OBJECTIVE

Use of contraception and the effectiveness of the method used to prevent pregnancy are major factors affecting national pregnancy and birth rates and the ability of women to plan their pregnancies. This report presents national estimates of contraceptive use among women of childbearing age (15-44 years) in 2006-2010. Selected comparisons are made with 1995 data to describe changes in contraceptive use and in method choice over time.

METHODS

Data for 2006-2010 were collected through in-person interviews with 22,682 women and men aged 15-44 years in the household population of the United States. Interviews were conducted by female interviewers in the homes of sampled persons. This report is based primarily on the sample of 12,279 women interviewed in 2006-2010; some tables are supplemented with the sample of 10,847 women interviewed in 1995.

RESULTS

Sixty-two percent of women of reproductive age are currently using contraception. Of women using a contraceptive method in the month of the interview, the most common methods used are the pill (28%, or 10.6 million women) and female sterilization (27%, or 10.2 million women). Use of intrauterine devices as a current method has increased since 1995 (from 0.8% in 1995 to 5.6% in 2006-2010), whereas fewer women report that their partners are using condoms as their current, most effective contraceptive method. Of women at risk of an unintended pregnancy, 11% report not currently using a method of contraception.

Correlates of contraceptive use among Ghanaian women of reproductive age (15-49 years)

Though fertility in Ghana has declined from an average of 8 children per woman over the past three decades to 4 per woman in recent times, the current rate of population growth is still unmatched by the requisite economic growth. Recent evidence suggests that the use of contraceptives have increased marginally despite the considerable decline in fertility rate. This paper revisits the determinants of contraceptive use among Ghanaian women, aged 15-49 using the 2008 GDHS. Empirically, the logistic and multinomial logistic regressions are used. Our results indicate that wealth status, level of education, ownership of health insurance, number of surviving children, marital status, location and geographical area of residence, religion and women autonomy are significant correlates of contraceptive use in Ghana. The finding reveals that, women who take health decisions jointly with their partners are more likely to use modern contraceptives as compared to women who take health decisions alone.

Integrating condom skills into family-centered prevention: efficacy of the Strong African American Families-Teen program

PURPOSE

The Strong African American Families-Teen (SAAF-T) program, a family-centered preventive intervention that included an optional condom skills unit, was evaluated to determine whether it prevented unprotected intercourse and increased condom efficacy among rural African American adolescents. Ancillary analyses were conducted to identify factors that predicted youth attendance of the condom skills unit.

METHODS

Sixteen-year-old African American youths (N = 502) and their primary caregivers were randomly assigned to SAAF-T (n = 252) or an attention control (n = 250) intervention. SAAF-T families participated in a 5-week family skills training program that included an optional condom skills unit. All families completed in-home pretest, posttest, and long-term follow-up interviews during which adolescents reported on their sexual behavior, condom use, and condom efficacy. Because condom use was addressed only in an optional unit that required caregiver consent, we analyzed efficacy using complier average causal effect analyses.

RESULTS

Attendance in both SAAF-T and the attention control intervention averaged 4 of 5 sessions; 70% of SAAF-T youth attended the condom skills unit. Complier average causal effect models indicated that SAAF-T was efficacious in reducing unprotected intercourse and increasing condom efficacy among rural African American high school students. Exploratory analyses indicated that religious caregivers were more likely than nonreligious caregivers to have their youth attend the condom skills unit.

CONCLUSIONS

Results suggest that brief condom skills educational modules in the context of a family-centered program are feasible and reduce risk for sexually transmitted infections and unplanned pregnancies.

Pregnancy in adolescents

Adolescent pregnancy remains a public health issue with significant medical, emotional, and societal consequences for the adolescent mother, her child, and her family. Teenage pregnancies are at higher risk of many adverse outcomes, including preterm delivery, low birth weight, and neonatal and infant mortality. Teen pregnancy and motherhood may have detrimental effects on the teen mother and her child; antenatal and postpartum care need to be adapted to meet the special needs of pregnant adolescents because standard obstetrical environments may not do so. This comprehensive review of adolescent pregnancy will highlight global statistics, factors contributing to adolescent pregnancy, social implications of adolescent pregnancy, obstetrical and neonatal outcomes, and the importance of multidisciplinary antenatal and postnatal care.

Characteristics related to effective contraceptive use among a sample of nonurban Latinos

CONTEXT

A better understanding of effective contraceptive use among Latinos is needed to reduce their high rate of unintended pregnancy. Most research has focused on urban Latinas and has overlooked the relationship context of effective contraceptive use.

METHODS

Interviews were conducted among a sample of 450 Latino women and men aged 18-25 in sexual relationships, who were recruited from community sites in four rural Oregon counties in 2006. Bivariate and multinomial logistic regression analyses were used to examine the associations between effective contraceptive use and -individual, cultural and relationship characteristics.

RESULTS

Half of participants reported effective contraceptive use in their primary relationships: Thirty-six percent consistently used a female method, and 15% consistently used condoms. Acculturation and confidence in one's -ability to practice contraception with a primary partner were associated with female method use rather than no effective use (risk ratios, 0.7 and 1.7, respectively). Participation in sexual decision making was positively associated with condom use rather than no effective method use (2.2) or female method use (1.9); partner involvement in birth control was positively associated with condom use rather than female method use (1.8).

CONCLUSIONS

Variations in effective contraceptive use among nonurban Latinos appear related to relationship characteristics and dynamics. Contraceptive counseling and unintended pregnancy prevention programs that are tailored to reflect relationship contexts and to include male partners where appropriate could improve the quality and cultural relevance of services among nonurban Latinos.

Reframing motherhood through the culture-centered approach: articulations of agency among young Nepalese women

Based upon the culture-centered approach that foregrounds the relevance of interrogating the taken-for-granted assumptions that circulate in the dominant models of health communication on family planning, this article argues that traditional approaches to reproductive health campaigns are concerned with safe motherhood (e.g., fertility, birth spacing, hospital delivery) rather than with the processes through which women construct, negotiate, and maintain meanings of motherhood and health within their cultural contexts. In doing so, this traditional framework leaves out the broader sociocultural, political, and economic contexts of social structures that constrain and enable the possibilities for health in the realm of motherhood. The culture-centered approach notes the erasure of these voices of women from dominant epistemic structures, and seeks to interrupt knowledge production by co-constructing meanings of reproductive health through dialogues with women at the margins. Therefore, in-depth interviews were conducted to centralize experiences of the cultural participants, allowing alternative health meanings to emerge within their local contexts. In particular, highlighting narratives of young Nepalese women living under poverty, we are able to understand how women actively (re)construct meanings of motherhood within their localized cultural spaces.

Racial and ethnic disparities in contraceptive method choice in California

CONTEXT

Unintended pregnancy, an important public health issue, disproportionately affects minority populations. Yet, the independent associations of race, ethnicity and other characteristics with contraceptive choice have not been well studied.

METHODS

Racial and ethnic disparities in contraceptive use among 3,277 women aged 18-44 and at risk for unintended pregnancy were assessed using 2006-2008 data from of the California Women's Health Survey. Sequential logistic regression analyses were used to examine the independent and cumulative associations of racial, ethnic, demographic and socioeconomic characteristics with method choice.

RESULTS

Differences in contraceptive use persisted in analyses controlling for demographic and socioeconomic characteristics. Blacks and foreign-born Asians were less likely than whites to use high-efficacy reversible methods-that is, hormonals or IUDs (odds ratio, 0.5 for each). No differences by race or ethnicity were found specifically for IUD use in the full model. Blacks and U.S.-born Hispanics were more likely than whites to choose female sterilization (1.9 and 1.7, respectively), while foreign-born Asians had reduced odds of such use (0.4). Finally, blacks and foreign-born Asians were less likely than whites to rely on male sterilization (0.3 and 0.1, respectively).

CONCLUSIONS

Socioeconomic factors did not explain the disparities in method choice among racial and ethnic groups. Intervention programs that focus on improving contraceptive choice among black and, particularly, Asian populations need to be developed, as such programs have the potential to reduce the number of unintended pregnancies that occur among these high-risk groups.

Race, ethnicity and differences in contraception among low-income women: methods received by Family PACT Clients, California, 2001-2007

CONTEXT

The extent to which racial and ethnic differences in method choice are associated with financial barriers is unclear. Understanding these associations may provide insight into how to address racial and ethnic disparities in unintended pregnancy.

METHODS

Claims data from the California Family PACT program, which provides free family planning services to low-income residents, were used to determine the proportions of women receiving each type of contraceptive method in 2001-2007. Bivariate and multivariate analyses were performed to identify associations between women's race and ethnicity and the primary contraceptive method they received in 2007.

RESULTS

Compared with white women, blacks and Latinas were less likely to receive oral contraceptives (odds ratios, 0.4 and 0.6, respectively) and the contraceptive ring (0.7 and 0.5), and more likely to receive the injectable (1.6 and 1.4) and the patch (1.6 and 2.3). Black women were less likely than whites to receive the IUD (0.5), but more likely to receive barrier methods and emergency contraceptive pills (2.6); associations were similar, though weaker, for Latinas. Racial and ethnic disparities in receipt of effective methods declined between 2001 and 2005, largely because receipt of the patch (which was introduced in 2002) was higher among minority than white women.

CONCLUSION

Although Family PACT eliminates financial barriers to method choice, the methods women received differed substantially by race and ethnicity in this low-income population. The reduction in racial and ethnic disparities following introduction of the patch suggests that methods with novel characteristics may increase acceptability of contraceptives among minority women.

Familial, cultural and psychosocial influences of use of effective methods of contraception among Mexican-American adolescents and young adults

STUDY OBJECTIVE

To compare culturally relevant factors associated with ever having used an effective method of contraception among a cohort of predominantly Mexican American females.

DESIGN

Face to face interviews were conducted in either English or Spanish. The survey used was developed directly for this study based on qualitative research with this population as well as the existing literature. Women were grouped as either adolescents (ages 13-20) or young adults (ages 21-25) for study purposes.

SETTING

Two community-based outpatient clinics on Chicago's West Side.

PARTICIPANTS

Non-pregnant Latina females between 13-25 years of age.

MAIN OUTCOME MEASURES

Comparison of familial, cultural and psychosocial factors associated with use of effective contraception using bivariate and multivariable analyses.

RESULTS

Final analysis included 267 participants. Multivariable models yielded three factors found to be statistically significant predictors of effective contraception use, but only one was significant for both age groups. Number of children was a strong predictor of effective contraceptive use among both Latina adolescents and young adults (P < 0.001 for adolescents and P = 0.049 for young adults). Partner communication predicted effective contraceptive use among Latina adolescents (P = 0.001). Acculturation level strongly predicted effective contraceptive use among Latina young adults (P < 0.001).

CONCLUSIONS

Findings demonstrate the need to tailor messages to Latina adolescent and young adults to reduce unintended pregnancy. Interventions to improve effective contraceptive use among Latina adolescents should promote effective forms of contraception in conjunction with communication with their partners about birth control. In contrast, efforts to address unintended pregnancy among Latina young adults should be sensitive to degree of acculturation.

Barriers to adoption of family planning among women in Eastern Democratic Republic of Congo

The objectives of this survey were to identify women's level of KAP toward FP; identify possible barriers to using FP; determine pregnancy spacing pattern; and ascertain the level of FP promotion by health workers. This was a 2-weeks cross-sectional survey at all maternity units in Butembo of post-partum women. 572 women were interviewed. FP knowledge was high (76%), perception good (80%). Majority used traditional methods (65%), mostly Calendar method (72%). Barriers to using modern FP included lack of knowledge, fear of side effects, religious considerations and husband opposition. Unmet need for spacing and limiting was high (21 & 31%). For majority (56%), pregnancy spacing met WHO's Healthy Timing and Spacing of Pregnancy recommendations. Promotion of FP was poor (42%). Training of health workers, advocating modern contraception, improving FP services in all public health facilities and promoting FP on each contact of women is highly recommended in this city.

Influence of culture on contraceptive utilization among HIV-positive women in Brazil, Kenya, and South Africa

Contraceptive choice and discontinuation are poorly understood among HIV-positive women, and HIV disease and culture may influence decisions. We assessed factors influencing contraceptive decision-making among HIV-positive women in three countries. This qualitative assessment of 108 HIV-positive women (36/site, selected by age and parity strata) was conducted in Rio de Janeiro, Brazil; Kericho, Kenya; and Soweto, South Africa. Freelist interviews assessed knowledge and attitudes towards contraception and were analyzed enumerating frequency and saliency of mentions. There was intersite consensus around list items but priority and themes varied. Site-specific factors influencing contraceptive choice were male partner wishes and fertility desire (Brazil), side-effects (South Africa), and impact on health and HIV progression (Kenya). Age, parity, and taking antiretroviral therapy (ART) impacted some themes. Contraceptive use among HIV-positive women is substantially influenced by culture and other factors. Counseling efforts should consider individual factors in method selection and offer method variety to accommodate changing needs.

The effect of spousal communication on contraceptive use in Central Terai, Nepal

OBJECTIVE

Family planning has several social and health benefits; it can reduce maternal mortality and the number of unplanned pregnancies, as well as increase educational and economic opportunities. Utilizing quantitative data from an endline household survey (July 2009) and data from focus group discussions, the Centre for Development and Population Activities (CEDPA) seeks to determine whether spousal communication increases contraceptive use among married women of child-bearing age in Nepal's Central Terai region.

METHODS

Quantitative household survey and qualitative focus group discussions.

RESULTS

Women who discuss family planning with their husbands (OR=7.254), perceive husband approval on family planning (OR=5.558) and have born a son (OR=2.239) are more likely to use a modern contraceptive method. Qualitative data show that several other considerations can be motivating factors for contraceptive uptake.

CONCLUSION

While results do not explain the direction of causality, it is clear that spousal discussion and partner approval are significant in a woman's decision to use modern contraceptives in the Central Terai region of Nepal.

PRACTICE IMPLICATIONS

More research needs to be conducted on the effect of spousal communication and contraceptive use, in particular, the role of frequency, quality, and content of spousal communication, as well as individual motivations.

Reactions of heterosexual African American men to women's condom negotiation strategies

This study describes responses of 172 single heterosexual African American men, ages 18 to 35, to condom negotiation attempts. Strategies used included reward, coercive, legitimate, expert, referent, and informational strategies, based on Raven's (1992) influence model. The purpose was (a) to identify strategies influencing participant acquiescence to request and (b) to identify predictors of participant compliance/refusal to comply with negotiation attempts. Participants viewed six videotape segments showing an actress, portrayed in silhouette, speaking to the viewer as a "steady partner." After each segment, participants completed measures of request compliance, positive and negative affect, and attributions concerning the model and themselves. No significant differences were found in men's ratings across all vignettes. However, differences in response existed across subgroups of individuals, suggesting that, although the strategy used had little impact on participant response, the act of suggesting condom use produced responses that differed across participant subgroups. Subgroups differed on levels of AIDS risk knowledge, sexually transmitted disease history, and experience with sexual coercion. Also, the "least willing to use" subgroup was highest in anger-rejection and least likely to make attributions of caring for partner. Effective negotiation of condom use with a male sexual partner may not be determined as much by specific strategy used as by partner characteristics.

Re-framing microbicide acceptability: findings from the MDP301 trial

Microbicides are most usually conceptualised within a disease prevention framework and studies usually define acceptability in terms of product characteristics, willingness to use and risk reduction. This starting point has led to assumptions about microbicides which, rather than being challenged by empirical studies, have tended to foreclose the data and subsequent conceptual models. Few studies take an emic ('insider') perspective or attempt to understand how microbicides fit into the broader context of women's and men's everyday lives. As part of the integrated social science component of the MDP301 Phase III microbicide trial, in-depth interviews were conducted with female trial participants in South Africa, Zambia, Tanzania and Uganda. Women's experiences of the gel challenge several assumptions that have commonly been reiterated about microbicides. Our analysis suggests that current definitions and conceptual frameworks do not adequately account for the range of meanings that women attribute to gel. Even within the context of a clinical trial, it is possible to obtain a richer, ethnographic and cross-cultural concept of acceptability based on women's practice and emic interpretations. We now need to move beyond limited notions of acceptability and consider how microbicides fit into a more holistic picture of women's and men's sexuality and sexual health.