Adolescents' views of and preferences for sexual and reproductive health services in Burkina Faso, Ghana, Malawi and Uganda

Adolescents' views of and preferences for sexual and reproductive health services highlight promising directions and persistent challenges in preventing pregnancy and HIV and treating sexually-transmitted infections (STIs) in this population. Results from nationally-representative surveys of 12-19 year-olds in Burkina Faso, Ghana, Malawi and Uganda in 2004 show that contraceptive and STI services and HIV testing are still under-utilized. A substantial proportion of sexually-active adolescents do not know of any source to obtain contraception or get STI treatment, and social-psychological reasons (e.g., embarrassment or fear) and financial cost remain common barriers to getting services. Adolescents' preferences are overwhelmingly for public clinics, with strongly positive perceptions of confidentiality, accessibility and cost. Some gender and country differences exist, yet overall females and males' views are similar. Results highlight the need to inform youth about sources, increase availability of government health facilities and improve youth's access to them, especially by reducing social barriers.

Contraceptive practice of the tribal women in tea garden area of North Bengal

A total of 860 tribal tea garden women in the Jalpaiguri district were surveyed by means of detailed questionnaires to obtain information of their contraceptive knowledge and practices and also to see the literacy rate among themselves. Analysis was done of their literacy level, family planning awareness, access to information and communication, methods of contraception adopted and utilisation of healthcare facilities. Majority (85%) of the tea garden women including all the age groups were illiterate. The overall contraceptive prevalence was 40.2% but most of the current users (22.6%) subjected to tubal sterilisation for family planning, couples were not enthusiastic about using the reversible methods; 59.7% women had lack of adequate information regarding various contraceptives. Contraceptive practice, as birth spacing method, needs to be given tremendous emphasis in order to improve the reproductive health of the tribal women. Education, information, choices and rights for decision-making only can achieve this.

Attitudes and behaviours of young Indigenous people in Townsville concerning relationships, sex and contraception: the "U Mob Yarn Up" project

OBJECTIVE

To gain some understanding of the attitudes and behaviours of Indigenous young people in Townsville concerning relationships, contraception and safe sex.

DESIGN

Cross-sectional study using a computer-assisted self-administered survey and single-sex focus group discussions designed by a Young Mums' Group operating on participatory action principles and acting as peer interviewers.

PARTICIPANTS AND SETTING

171 Indigenous students in Years 9-11 at three high schools and 15 residents of a homeless youth shelter in Townsville, Queensland, 27 April - 8 December 2004.

MAIN OUTCOME MEASURES

Self-reported attitudes and behaviour about relationships, sexual intercourse and contraception.

RESULTS

84/183 participants (45.9%) reported past sexual intercourse, with 56.1% commencing intercourse at age 13-14 years. The likelihood of having had sex increased with being male (P=0.001), increasing age, increased perceived sexual activity of peer group (both P=0.000), and drinking alcohol at least weekly (P=0.015). Young women were more likely to report unwanted sexual touching (P=0.031), and less likely to report enjoying sexual intercourse (P=0.001). The main qualitative themes concerned females' reputations, coercion, and denial of female desire. Only 49/80 participants (61.3%) reported always using condoms. The main reasons for not using contraception were "just not thinking about it", shame, and problems with access. Despite having reasonable knowledge about contraception, most lacked the confidence and negotiation skills to communicate with partners about condom use.

CONCLUSIONS

Like teenagers elsewhere, Indigenous teenagers in Townsville are becoming sexually active at a young age, and not practising safe sex reliably. The need to protect their reputations puts young women at risk by not being prepared for safe sex by carrying condoms.

Why women want children: defining the meaning of desire for children and the construction of an index

Many people view procreation as a purpose in life, justifying this idea by pointing towards a woman's natural biological characteristics. However, much of the literature supporting this position is void of studies that examine African-American women's desire for children. Therefore, the primary aims of this article are: 1) to review the literature on parenthood motivation; and 2) to describe the development, validation and reliability of the Modified Index of Parenthood Motivation. Within the first sample of 31 Black women, who served to confirm the Modified Index of Parenthood Motivation (MIPM), Wesley reported a reliability alpha coefficient of .765 for the MIPM. The second sample showed an alpha coefficient of.792, among a sample of 98 Black women of childbearing age. The MIPM offers investigators an opportunity to examine desire for children among women of African descent. Further research is needed to understand the impact of desire for children better among women with chronic illnesses such as HIV.

Willingness to use microbicides is affected by the importance of product characteristics, use parameters, and protective properties

BACKGROUND

Along with efficacy, a microbicide's acceptability will be integral to its impact on the pandemic. Understanding Product Characteristics that users find most acceptable and determining who will use which type of product are key to optimizing use effectiveness.

OBJECTIVES

To evaluate psychometrically the Important Microbicide Characteristics (IMC) instrument and examine its relationship to willingness to use microbicides.

RESULTS

Exploratory and confirmatory factor analyses revealed 2 IMC subscales (Cronbach's coefficient alpha: Product Characteristics subscale (alpha = 0.84) and Protective Properties subscale (alpha = 0.89)). Significant differences on Product Characteristics subscale scores were found for history of douching (P = 0.002) and employment status (P = 0.001). Whether a woman used a method to prevent pregnancy or sexually transmitted disease (STD) in the last 3 months (P < 0.001) and whether she used a condom during the last vaginal sex episode (P < 0.001) were significantly related to her rating of the importance of microbicides being contraceptive. Product Characteristics (r = 0.21) and Protective Properties (r = 0.27) subscale scores and whether a microbicide had contraceptive properties (r = 0.24) were all significantly associated (P < 0.001) with willingness to use microbicides.

CONCLUSIONS

Formulation and use characteristics and product function(s) affect willingness to use microbicides and should continue to be addressed in product development. The IMC instrument serves as a template for future studies of candidate microbicides.

Relationship of STD-related shame and stigma to female adolescents' condom-protected intercourse

PURPOSE

Shame and stigma associated with sexually transmitted diseases (STDs) are barriers to adolescents seeking prompt and appropriate diagnosis and treatment. However, little is known about how these constructs are related to STD-protective behaviors, such as condom-protected intercourse. Thus, we prospectively examined the relationship between shame and stigma and condom use in adolescent females.

METHODS

There were 192 African American females age 17.4 +/- 1.7 years (range 15-21 years) recruited for the study from local teen-oriented health clinics. At baseline, participants completed demographic and psychosocial measures (including STD-related shame and stigma), and chart- or laboratory-confirmed history of STDs was obtained. At 6 months follow-up, rate of condom-protected intercourse in past 14 days was assessed. Participants' baseline shame and stigma scores, prior history of STDs, and select demographic and theoretically important psychosocial variables were entered into a hierarchical linear regression model to predict condom-protected intercourse in the 14 days prior to the 6-month follow-up assessment.

RESULTS

After controlling for variables identified in bivariate correlations, STD-related shame was significantly predictive of condom-protected intercourse in the 14 days prior to follow-up, with higher shame predicting higher rates of condom-protected intercourse.

CONCLUSIONS

Future prevention efforts attempting to reduce adolescents' risks for STDs and HIV may benefit from addressing STD-related shame and stigma in addition to explicitly linking health-promoting behavior changes (condom use) to a decreased likelihood of future infection with STDs.

Correlates of women's cancer screening and contraceptive knowledge among female emergency department patients

Background

Lack of knowledge regarding preventive health services for women might impede campaigns to expand these services in the emergency department setting. For 18–55-year-old English-speaking women visiting an urban emergency department, we aimed to: (1) Ascertain their knowledge regarding the applicability, purpose, and recommended intervals of three women's cancer screening and three contraceptive methods; and (2) Determine if patient age, race/ethnicity, medical insurance status, and current or recent usage of these methods are associated with greater or lesser knowledge about them.

Methods

Emergency department-based survey on recent or current usage and knowledge about Pap smears, breast self-examinations, mammograms, condoms, birth control, and emergency contraception. Analyses included calculation of summary statistics and creation of multivariable logistic regression models.

Results

Of 1,100 patients eligible for the study, 69.9% agreed to participate. Most of the participants were < age 35, white, single (never married and no partner), Catholic, and had private medical insurance. Participant's recent or current usage of a particular cancer screening or contraceptive method varied by type of method: Pap smear within the past year (69.1%), breast self-exam within the past month (45.5%), mammogram within the past year (65.7% for women age 45–55), condom usage during every episode of sexual intercourse (15.4%), current usage of birth control pills (17.8%), and ever use of emergency contraception (9.3%). The participants correctly answered 87.9% of all survey questions about condoms, 82.5% about birth control pills, 78.5% about breast self-exams, 52.9% about Pap smears, 35.4% about mammograms, and 25.0% about emergency contraception. In multivariable logistic regression models, survey participants who had private medical insurance and those who recently or currently used a given screening or contraceptive method had a greater odds of correctly answering all questions about each cancer screening or contraceptive method.

Conclusion

Although these female ED patients demonstrated strong knowledge on some women's cancer screening and contraceptive methods, there were several areas of knowledge deficit. Women without private medical insurance and those who have not used a particular cancer screening or contraceptive method demonstrated less knowledge. Reduced knowledge about women's cancer screening and contraceptive methods should be considered during clinical encounters and when instituting or evaluating emergency department-based initiatives that assess the need for these methods.

Sex, love and gender norms: sexual life and experience of a group of young people in Ho Chi Minh City, Vietnam

This paper discusses the impacts of gender norms on the sexual life and experience of a group of young Vietnamese people. It is based on a qualitative study on sexuality and abortion among young people in Ho Chi Minh City, Vietnam. There were two general attitudes towards premarital sex. One view supported young people in a serious, loving relationship engaging in sex before marriage; the other opposed premarital sex because it affected the reputation of girls and their families. These general attitudes were similar to the views on virginity: one group believed strongly in girls maintaining their virginity and the other group emphasised love, emotion and trust, not virginity, as the most important criteria for marriage. Among women there were more supporters than opponents of the traditional view of premarital sex and virginity. Premarital sex was more acceptable for young people in a serious, loving relationship with certain commitment to marriage. Young men considered sex a way to express their love and to become more intimate. Women's view was that premarital sex only occurred within a serious, loving relationship or when there was a serious commitment to marriage. It is clear that young people's sexual life is shaped and constrained by gender norms through political interventions, sexual education and moral judgements. Under the pressure of these norms, young people face many difficulties in order to fulfill a safe and satisfying sexual life.

Awareness and determinants of family planning practice in Jimma, Ethiopia

BACKGROUND

The continuing growth of the world population has become an urgent global problem. Ethiopia, like most countries in sub-Saharan Africa, is experiencing rapid population growth. Currently, the country's population is growing at a rate of 3%, one of the highest rates in the world and if it continues unabated, the population will have doubled in 23 years, preventing any gain in the national development effort.

AIM

To determine the level and determinants of family planning awareness and practice in one Ethiopian town.

METHODOLOGY

A quantitative study using a descriptive survey design was conducted in Jimma University Hospital.

DISCUSSION

The findings revealed that the knowledge and practice of modern contraception methods was low. Most women's contraceptive knowledge and practice was influenced by socio-cultural norms such as male/husband dominance and opposition to contraception, and low social status of women. A lack of formal education for women was identified as a key factor in preventing change in the patterns of contraceptive knowledge and use by women in this part of Ethiopia.

CONCLUSION

The support and encouragement for women and men to enter and complete formal education is essential in bringing about a cultural and social change in attitude towards the economic and social value of family planning. This study and others suggest that education can address the imbalance in decision making about contraception and the role of women in society generally.

Unwanted pregnancy and associated factors among Nigerian women

CONTEXT

Many Nigerian women experience unwanted pregnancies. To prevent associated health problems, it is important to understand the factors related to unwanted pregnancy in Nigeria.

METHODS

A community-based survey of 2,978 women aged 15-49 was conducted in eight Nigerian states. Univariate analyses and multivariate logistic regression analyses were used to determine the incidence of unwanted pregnancy, the incidence of seeking an abortion among women with unwanted pregnancies and the factors associated with unwanted pregnancy and abortion-seeking behavior. Additional analyses examined the prevalence of contraceptive use and women's reasons for seeking to terminate unwanted pregnancies and for not practicing contraception at the time their unwanted pregnancies were conceived.

RESULTS

Twenty-eight percent of respondents reported ever having had an unwanted pregnancy; of those, half reported having attempted to end their last unwanted pregnancy. Forty-three percent of women who sought an abortion did so because they were not married, were too young or were still in school. Of the women who were not practicing contraception when they had the unwanted pregnancy, 44% said that they were unaware of family planning, and 22% that they either did not have access to contraceptive services, services were too expensive or they were afraid of side effects. At the time of the survey, 27% of all respondents were at risk of an unwanted pregnancy. Almost half were unaware of contraceptive methods.

CONCLUSIONS

Nigerian women often turn to abortion to avoid unwanted births. The provision of family planning counseling and information could substantially reduce the incidence of unwanted pregnancy and induced abortion in Nigeria.

Male involvement in reproductive health among scheduled tribe: experience from Khairwars of central India

INTRODUCTION

Indian tribal men's lack of participation in reproductive health not only damages their own health, but also contributes to the reproductive ill health of their female partners and children. In India the involvement of men in such matters is a new concept. There is a paucity of data particularly on Scheduled tribesmen's knowledge and the extent of their participation in reproductive health. This inhibits planning. The present study aims to understand the involvement of Scheduled tribesmen in reproductive health and the barriers to their involvement by generating a database from the Khairwar tribe of Central India.

METHODS

A door-to-door survey on knowledge, attitude and practice relating to aspects of reproductive health was conducted by canvassing a pre-designed interview schedule among 15-40 year old, currently married Khairwar males in the Sidhi district of Madhya Pradesh, India.

RESULTS

As far as reproductive morbidity is concerned, only 17% of the respondents had heard of HIV/AIDS, and most had no proper knowledge of its transmission. Although 74% of the respondents had heard about reproductive tract infections, the majority of them were unaware of the mechanism of transmission and seriousness of the problem. The duel role of condoms, both as a method of family planning and a protective measure against sexually transmitted infections, was also unknown to them. Approximately 59% of the males were aware of family planning but only 13% were using any method (mostly female sterilization) at the time of survey. Their view on the ideal number of children (3.56) exceeded the actual number of children born and living. High infant and child mortality influenced their preference for higher fertility. Very few among them (29%) had knowledge of antenatal care. They expressed faulty knowledge, myths and unhelpful attitudes towards sexual health matters.

CONCLUSION

The study revealed the male Scheduled tribe population's lack of knowledge and misinformation regarding male sexual health issues, the gender inequality in Indian society, and a lack of male-oriented reproductive health services, all of which deter men from sharing the responsibility.

Noncontracepting behavior in women at risk for unintended pregnancy: what's religion got to do with it?

PURPOSE

In the United States, 49% of all pregnancies are unintended. Part of this high rate has been attributed to the negative effects of higher levels of personal and community-level religiosity in this country. To explore the impacts of individual-level religiosity on unintended pregnancy, we used 2002 National Survey of Family Growth (NSFG) data to model the relationship between religion and noncontracepting behavior, a crucial precursor to unintended pregnancies.

METHODS

We tested logistic models with current and childhood religious affiliation as primary exposures and recent noncontracepting behavior as the outcome, controlling for demographic covariates, religious service importance, and attendance frequency.

RESULTS

An estimated 32.7 million women are at risk for unintended pregnancy, 14 % of whom use no contraception. Proportions of noncontraceptors were 15.5 % among Catholics, 10.3% among mainstream Protestants, and 15.0% among fundamentalist Protestants. In multivariate modeling, religion was significantly related to not contracepting in teens, but noncontributory for women from 20 to 44 years of age. Variables associated with contraceptive behavior included marital status, age, education, and income.

CONCLUSIONS

Among women, current and childhood religious affiliations modify odds ratio for noncontracepting behavior only among teenage girls. For adults, odds ratio vary widely by marital status, education, and income, but not by religious affiliation.

THE RELATION OF SON PREFERENCE AND RELIGION TO INDUCED ABORTION: THE CASE OF SOUTH KOREA

This paper explores the factors that influence the practice of induced abortion in a very low fertility society, with particular emphasis on son preference and three distinct religions: Confucianism, Buddhism and Christianity. Using multivariate logistic regression models fitted by the generalized estimating equation (GEE) method, this paper analysed the data collected by the 2000 Korea National Fertility and Family Health Survey of 6348 married women aged 15–49 years with a total of 1217 pregnancy outcomes. The results showed that the likelihood of induced abortions in women with two or more children, compared with those with one child, was significantly influenced by the sex composition of the previous children: odds ratio (OR)=12·71 (95% CI=5·49, 29·42) for women with only son(s), and OR=3·91 (95% CI=1·67, 9·14) for women with only daughter(s). At parity two, women with two sons were much more likely to have induced abortions than women with two daughters (OR=5·88, 95% CI=2·70, 12·85). Although Buddhist women were not significantly different from Confucian women in induced abortion practice, Christian women were much less likely than Confucian women to have an induced abortion (OR=0·39, 95% CI=0·18, 0·88 for women with only sons and OR=0·44, 95% CI=0·24, 0·81 for women with two children). This suggests that even in this very low fertility society, son preference and religious affiliation are significant predictors of women’s practice of induced abortion.

Swazi men's contraceptive knowledge, attitudes, and practices

This study investigated Swazi men's contraceptive knowledge, attitudes, and practices. Thirty adolescent men, aged from 16 to 18, and 86 adult men from urban and rural areas participated in focus group interviews. Adult Swazi men indicated that men were the sole decision makers about sexual and reproductive issues. The number and gender of children remains socially significant in Swaziland. Adolescent men expressed contradictory notions in expecting girls to refuse unprotected sex but maintaining that men were the sole decision makers about sexual matters. They agreed that women should commence childbearing activities at the age of 21 or later. This finding holds some promise for enabling more Swazi women to use contraceptives at least until they have completed their schooling. Contraceptive services were not readily accessible to men in Swaziland.

Women's stories of abortion in southern Gabon, Africa

The purpose of this study was to explore the reasons women in rural, southern Gabon, Africa, chose to terminate their pregnancies, the methods used to induce abortions, and postabortion effects experienced by these women. Abortion is illegal in this country. A descriptive qualitative design guided the methodology for this study. Five women with a history of induced abortion were interviewed in-depth for their abortion story. Reasons cited for an abortion included lack of financial and partner support. Abortion methods included oral, rectal, and vaginal concoctions of leaves, bark, and water and over-the-counter medications, including misoprostol. Affects were physical, spiritual, and relational. Health care professionals need to provide women with guidance for appropriate contraceptive usage. Abortion after-care of women with physical and spiritual needs is important. Future research is suggested on the use of misoprostol in Gabon to understand its affects on women's reproductive health.

Social ecological predictors of repeat adolescent pregnancy

CONTEXT

Women with multiple pregnancies in adolescence may experience medical, psychological and social complications. Improved understanding of the individual-, dyad-, family-, peer/community- and social system-level risk factors for repeat pregnancy may lead to the development of more effective prevention strategies for adolescent mothers in a variety of settings.

METHODS

Between 1993 and 1996, white, black and Mexican American adolescent mothers at a labor and delivery unit in Texas were interviewed after delivery and completed written surveys prospectively for up to 48 months. Logistic regression analyses were used to determine predictors of repeat pregnancy within 24 months, using social ecological theory as a guide.

RESULTS

Forty-two percent of adolescent mothers experienced a repeat pregnancy within 24 months; 73% of these delivered a second child. Individual-level predictors were planning to have another baby within five years (odds ratio, 1.6) and not using long-acting contraceptives within three months of delivery (2.4). Dyad-level predictors were not being in a relationship with the father of the first child three months after delivery (2.0), being more than three years younger than the first child's father (1.6) and experiencing intimate partner violence within three months after delivery (1.9). Peer/community-level predictors were not being in school three months postpartum (1.8) and having many friends who were adolescent parents (1.5).

CONCLUSION

Adolescent mothers are at high risk for a rapid subsequent pregnancy. Interventions that address the complex and multifaceted aspects of the lives of adolescent mothers are needed to prevent repeat pregnancy.

Identifying barriers to emergency contraception use among young women from various sociocultural groups in British Columbia, Canada

CONTEXT

Despite advances related to the provision of emergency contraception in Canada, particularly the granting of independent prescriptive authority to pharmacists in 2000, little is known about the ways in which women perceive potential barriers to using it.

METHODS

In 2004, an ethnically diverse sample of 52 women living in Greater Vancouver participated in interviews that were analyzed for an assessment of women's knowledge, attitudes and experiences related to emergency contraception, with particular attention to the ways in which ethnicity affected their stories.

RESULTS

Participants generally misperceived emergency contraception as an abortifacient, and often mistakenly thought that it has long-term effects on health and fertility. Knowledge gaps regarding reproductive physiology impeded clear understanding of when it is most effective. Participants also reported receiving subtle and sometimes overtly stigmatizing messages from providers when they sought emergency contraception. Asian and South Asian women were particularly concerned about negative interactions with providers; for example, they feared that female providers from their sociocultural community might recognize, chastise or gossip about them. Institutional policies (e.g., a Catholic hospital's refusal to provide the method), coupled with low awareness of pharmacists' prescriptive authority, also created barriers to use.

CONCLUSIONS

Women's ability to benefit from emergency contraception is hampered by lack of knowledge and conservative cultural or social mores. Serious contextual and structural shifts are required before woman-centered approaches to provision of the method become the norm.

'A shot of his own': the acceptability of a male hormonal contraceptive in Indonesia

Male hormonal contraception has been shown to confer reversible infertility for at least one year; however, while clinical trials refine hormonal regimens, their acceptability, cultural meanings, and implications for study of men's sexualities remain under examined. This paper presents findings from interviews conducted with men and their female partners in a male hormonal contraception clinical trial in Jakarta and Palembang, Indonesia, and describes the ideas expressed about this new contraceptive technology. Fourteen men and their partners in Jakarta and ten men and their partners in Palembang were interviewed about their motivations to participate in the trial and their perceptions of the injection's physical, psychological and social effects. Concerns such as excess fertility and attendant economic liability shaped one quarter of motivations reported by men, while many women highlighted how a male method could help them prevent pregnancy without physical complications. Intimacy and sexual relations between couples were key themes within interpretations of contraceptive acceptability. Taken together, the narratives presented in this study call attention to the need for more nuanced analyses of contraceptive acceptability, as well as to the importance of studies of new male contraceptives for the understanding of masculinities.

Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use

OBJECTIVES

We explored the relative contributions of declining sexual activity and improved contraceptive use to the recent decline in adolescent pregnancy rates in the United States.

METHODS

We used data from 1995 and 2002 for women 15 to 19 years of age to develop 2 indexes: the contraceptive risk index, summarizing the overall effectiveness of contraceptive use among sexually active adolescents (including nonuse), and the overall pregnancy risk index, calculated according to the contraceptive risk index score and the percentage of individuals reporting sexual activity.

RESULTS

The contraceptive risk index declined 34% overall and 46% among adolescents aged 15 to 17 years. Improvements in contraceptive use included increases in the use of condoms, birth control pills, withdrawal, and multiple methods and a decline in nonuse. The overall pregnancy risk index declined 38%, with 86% of the decline attributable to improved contraceptive use. Among adolescents aged 15 to 17 years, 77% of the decline in pregnancy risk was attributable to improved contraceptive use.

CONCLUSIONS

The decline in US adolescent pregnancy rates appears to be following the patterns observed in other developed countries, where improved contraceptive use has been the primary determinant of declining rates.

A gendered study of young adult contraceptive use at one university in KwaZulu-Natal

This study explores contraceptive use among young adult male and female students (aged 18-25) who visit the campus clinic at a university in KwaZulu-Natal. Both a descriptive survey and face to face interviews were used for data collection. In this study, it is affirmed that gender stratification, societal attitudes, and misconceptions about contraceptive use play an important role in the attitudes of young adults, male and female towards contraception and its use. Evidence of this is the high use of condoms amongst both male and female students' compared with other available methods. Among female students this was highly attributed to personal convenience and comfort with condom use as an unmarried young woman. It was clear from the data collected that respondents themselves attached some stigma to being associated with the use of contraceptive pills or having to visit the clinic regularly for injections as young unmarried women. Male respondents affirmed the use of the condom, although this was hardly with the view of taking reproductive/contraceptive responsibility, but rather, it was attributed to the function of the condom as a safe sex method that offered protection against sexually transmitted diseases and infections. Also evident from the study was the fact that male respondents felt more comfortable with their sexual functioning than the female respondents. This was easily attributed to the role of societal gender stratification in an individual's life.

Circumstances of pregnancy: low income women in Georgia describe the difference between planned and unplanned pregnancies

INTRODUCTION AND BACKGROUND

The United States has a higher rate of unintended pregnancies than many other developed countries despite the availability of effective contraception. Using Azjen's Theory of Planned Behavior and Luker's Theory of Contraceptive Risk Taking this qualitative study explores the reasons for the high rate of unintended pregnancy among low income women in Georgia.

METHODS

Six focus groups (N=39) were conducted at county health department clinics. Women were recruited at the clinics to participate in a discussion of Pregnancy and Motherhood. All English or Spanish speaking women between the ages of 18 and 49 were eligible for participation.

RESULTS

Three dimensions of pregnancy planning emerged-the decision to have a child, taking specific behaviors to increase the likelihood of conception, and making plans to care for a child. Planned pregnancies may occur when a couple or a woman decides that they are ready to have a child, but also occur in less stable situations that pose risks for the family and the child. Unplanned pregnancies may be welcomed or be unwanted depending on the circumstances. Women perceive advantages and disadvantages to planned and unplanned pregnancies.

DISCUSSION

There are major differences between the definition and values of planned and unplanned pregnancies promoted by public health practitioners and those of the women in our study. This suggests the need for research on the circumstances in which pregnancies occur, as well as targeted interventions and policies that help women and men define and achieve the circumstances in which they would like to bear and rear children.

Factors Associated with Effective Contraceptive Use Among a Sample of Latina Women

Unintended pregnancy disproportionately affects Latina women. One factor contributing to unintended pregnancy among Latinas is the low rate of contraceptive use. This study examined correlates of effective contraceptive use among a sample of Latina women (n=202) at increased risk for HIV. In addition to traditional intrapersonal variables (i.e., perceived risk of pregnancy, motivation to avoid pregnancy), the present study examined the role of the male partner and relationship factors (i.e., relationship commitment, duration, pregnancy prevention decision-making) on contraceptive use. Participants were recruited from clinics and community locations in East Los Angeles and administered a 60-minute in-person interview. Multivariate logistic regression was used to compare women who consistently used effective contraceptives (36%) to women using no method or an ineffective method. Women in relationships of 1 to 2 years were nearly 3 times more likely to use an effective contraceptive compared to women in relationships of less than 1 year (odds ratio (OR)=2.7, 95% CI 1.1, 6.7). Women were more than twice as likely to use an effective method if they reported a high level of involvement in decision-making about whether to use contraception (OR=2.3, 95% CI 1.1, 4.7) or had discussed contraception with their partner (OR=2.4, 95% CI 1.03, 5.6). This study provides additional information about the importance of male partners and relationship factors in contraceptive use among Latina women. Efforts to prevent unintended pregnancy need to address the role of relationship factors in the sexual risk and protective behaviors of Latinas.

Early childbearing in Nicaragua: a continuing challenge

(1) Among Nicaraguan women 20-24 years old, six in 10 had entered a union and almost half had had a child before their 20th birthday. (2) A quarter of all births in Nicaragua--35,000 per year--are to 15-19-year-olds. (3) Rural women, who have less education, on average, than their urban counterparts, are more likely than city dwellers to enter a union and become mothers during adolescence. (4) The proportion of 20-24-year-olds who had a child during adolescence is more than twice as high among the poorest as among those in the highest socioeconomic category. (5) Nearly half--45%--of births to adolescent women are unplanned, a level that varies little by women's urban-rural residence and their educational achievement. (6) Among all sexually active women aged 15-19 (in union and not in union), 86% do not want a child in the next two years, and 36% have an unmet need for effective contraception. Unmet need for family planning is equally high in urban and rural areas. (7) The strong link between low educational attainment and early motherhood suggests that improving educational opportunities for girls is a promising way of reducing high levels of adolescent childbearing in Nicaragua.

Early childbearing in Guatemala: a continuing challenge

(1) Guatemala has the third highest adolescent birthrate in Central America-114 births for every 1,000 women aged 15-19 each year. (2) Only two-fifths of 20-24-year-old women have completed primary school. The proportion is one in four in rural areas and one in 10 among indigenous women. (3) One-half of young women enter into a union (formal or consensual) before their 20th birthday. Three-quarters of those with no schooling do so, compared with one-quarter of those with a primary education or more. (4) Forty-four percent of 20-24-year-olds were mothers by age 20; the proportion is highest among young women with no education (68%) and among indigenous women (54%). (5) The great majority of 15-19-year-old women in union-83%, with little variation by residence or ethnicity-do not want to have a child in the next two years. However, only 18% are using an effective contraceptive. (6) Although 70% of 15-24-year-olds who recently gave birth made at least one prenatal care visit, roughly half of the least educated and of indigenous women made none. Moreover, only half of 15-24-year-old mothers had professional medical care at their most recent delivery; the proportion is even lower among the least educated and indigenous women (one-quarter).