FAMILY PLANNING PERSPECTIVES, 2001, Vol. 33, No. 1
Public or private providers? U.S. women's use of reproductive health services.
Context: U.S. women receive contraceptive and reproductive health services from a wide range of publicly funded and private providers. Information on trends in and on patterns of service use can help policymakers and program planners assess the adequacy of current services and plan for future improvements.
Methods: Women who reported in the 1995 National Survey of Family Growth that they had obtained any contraceptive or other reproductive health service in the past year were classified by their primary source of care, and the services they received, their characteristics and their primary source of care were analyzed. Logistic regression was used to test which factors predict women's use of publicly subsidized family planning clinics and of specific types of services.
Results: The percentage of women of reproductive age who obtained family planning services increased slightly between 1988 and 1995, primarily among women aged 30 and older. Nearly one in four women who received any contraceptive care visited a publicly funded family planning clinic, as did one in three who received contraceptive counselling or sexually transmitted disease (STD) testing and treatment. Women whose primary source of reproductive care was a publicly funded family planning clinic received a wider range of services than women who visited private providers; moreover, the former were significantly more likely to report obtaining contraceptive care or STD-related care, even after the effects of their background characteristics were controlled. Young, unmarried, minority, less-educated and poor women were more likely than others to depend on publicly subsidized family planning clinics. Source of health insurance was one of the most important predictors of the use of public family planning clinics: Medicaid recipients and uninsured women were 3-4 times as likely as women with private insurance to obtain clinic care.
Conclusions: Publicly funded family planning clinics are an important source of contraceptive and other reproductive health care, providing millions of U.S. women with a wide range of services. Since women's need for reproductive care and for publicly subsidized care is not likely to diminish, clinics may be financially challenged in their efforts to continue delivering this broad package of services to growing numbers of uninsured or disenfranchised women.
(UNITED STATES, FAMILY PLANNING PROGRAMMES, CONTRACEPTION, SEXUALLY TRANSMITTED DISEASES, IEC, MEDICAL CARE, YOUTH, POOR, UNMARRIED PERSONS, METHODOLOGY, REGRESSION ANALYSIS).
English - pp. 4-12.
J. J. Frost, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
***
HARPER, Cynthia; BALISTRERI, Elizabeth; BOGGESS, Jane; LEON, Kathleen; DARNEY, Philip.
Provision of hormonal contraceptives without a mandatory pelvic examination: The first stop demonstration project.
Context: First Stop, an 18-month demonstration project that operated in 1996-1997, was designed to offer low-income adult women in California hormonal contraceptives without requiring a pelvic examination.
Methods: An evaluation was undertaken to assess the contraceptives adopted by First Stop clients, compare health risks of these women with risks among women using traditional family planning clinics and assess clients' satisfaction. Data on 2,065 First Stop clients and 1,507 women attending traditional clinics were collected through several self- and clinician-administered instruments, including questionnaires, a telephone survey and medical chart abstractions.
Results: After the initial First Stop visit, 38% of women adopted a more effective method than they had used at last sex, 47% remained with the same method, 12% switched to a less-effective method and 3% accepted no method. Of clients who were referred for additional medical care, 73% followed through on their referrals. Compared with clients at traditional clinics, First Stop clients were less likely to have a regular source of health care, but more likely to have made a health care visit in the past year. Most First Stop clients valued the project's services; 76% said it was important to be able to receive pills or injections without a pelvic examination.
Conclusions: Programs that provide hormonal contraceptives without requiring a pelvic examination can expand low-income women's access to these methods and improve the chances that they will obtain other reproductive health services.
(UNITED STATES, CITIES, FEMALE CONTRACEPTION, HORMONAL CONTRACEPTIVES, CONTRACEPTIVE USAGE, RISK, POPULATION AT RISK, POOR, MEDICAL CARE, FAMILY PLANNING PROGRAMMES).
English - pp. 13-18.
C. Harper, E. Balistreri, K. Leon, P. Darney, Center for Reproductive Health Research and Policy, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, U.S.A.; J. Boggess is chief, Office of Family Planning, California Department of Health Services, Sacramento, CA, U.S.A.
***
RANJIT, Nalini; BANKOLE, Akinrinola; DARROCH, Jacqueline E.; SINGH, Susheela.
Contraceptive failure in the first two years of use: Differences across socioeconomic subgroups.
Context: While differences in levels of contraceptive use across socioeconomic subgroups of women have narrowed greatly over time, large disparities remain in rates of unintended pregnancy. One reason is variations in the effectiveness with which women and their partners use contraceptive methods.
Methods: Data on contraceptive use and accidental pregnancy from the 1988 and 1995 National Surveys of Family Growth were corrected for abortion underreporting and pooled for analysis. Use-failure rates were estimated for reversible methods during the first year, second year and first two years of use, for subgroups of women of various characteristics.
Results: The average failure rate for all reversible methods, adjusted for abortion underreporting, declines from 13% to 8% from the first year of method use to the second year. First-year failure rates are highest among women using spermicides, withdrawal and periodic abstinence (on average, 23-28% in the first year), and lowest for women relying on long-acting methods and oral contraceptives (4-8%). On average, they exceed 10% for all users except women aged 30-44, married women and women in the highest poverty-status category. The chance of accidental pregnancy does not differ significantly between method users younger than 18 and those aged 18-19.
Conclusion: Both user and method characteristics determine whether contraceptive users will be able to avoid unintended pregnancy. Family planning providers should help clients to identify methods that they are most likely to use successfully, and counsel them on how to be consistent users and to avoid behaviors that contribute to method failure.
(UNITED STATES, CONTRACEPTION FAILURES, CONTRACEPTIVE USAGE, USE- EFFECTIVENESS, UNWANTED PREGNANCY, BEHAVIOURAL METHODS, CONTRACEPTIVE AGENTS, SOCIO-ECONOMIC GROUPS, SOCIO-ECONOMIC STATUS, FAMILY PLANNING PROGRAMMES).
English - pp. 19-27.
N. Ranjit, A. Bankole, J. E. Darroch, S. Singh, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
***
MINNIS, Alexandra M.; PADIAN, Nancy S.
Choice of female-controlled barrier methods among young women and their male sexual partners.
Context: Little is known about the factors associated with the choice of female-controlled, over-the-counter barrier contraceptive methods among women and their male sexual partners.
Methods: Predictors of method choice were assessed following an educational presentation on contraceptive use and risk reduction among 510 sexually active females aged 15-30 who were recruited in the San Francisco Bay Area. In addition, the primary partners of 160 of these women participated in the survey.
Results: Twenty-two percent of women who enrolled in the study alone, 25% of those who enrolled with their main partner and 18% of these male partners chose female-controlled, over-the-counter barrier methods alone. The strongest predictor of this choice was current use of a hormonal contraceptive both for women who participated in the study on their own (odds ratio, 2.1) and for those who enrolled their partner in the study (odds ratio, 6.3). Female-controlled methods were also chosen significantly more often by teenagers than by older women; for example, among those who enrolled with a male partner, the odds ratio for selection of a female-controlled barrier method by women younger than 18 was 6.0. Among women who enrolled without a partner, those who had had multiple partners in the previous six months and those who were current users of male condoms were less likely to choose female-controlled methods (odds ratios, 0.7 and 0.5, respectively).
Conclusions: Although the majority of participants did not choose female-controlled, over-the-counter barrier methods without also choosing male condoms, such female-controlled methods appear to offer an acceptable alternative for prevention of sexually transmitted infections. They may be a particularly attractive option for individuals using hormonal contraceptives and for teenage women.
(UNITED STATES, CITIES, CONTRACEPTION, BARRIER METHODS, CONDOM, CHOICE, CONTRACEPTIVE USAGE, HORMONAL CONTRACEPTIVES, MATE, SEX ROLES, WOMEN'S ROLE).
English - pp. 2834.
A. M. Minnis, Department of Epidemiology, School of Public Health, University of California, Berkeley, U.S.A.; N. S. Padian, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, U.S.A.
***
GODECKER, Amy L.; THOMSON, Elizabeth; BUMPASS, Larry L.
Union status, marital history and female contraceptive sterilization in the United States.
Context: Much of what is known about the choice of sterilization as a contraceptive method is based on data from married women or couples. Because of increasing rates of cohabitation, divorce and repartnering, however, the relationship context in which sterilization decisions are made has changed.
Methods: The 1995 National Survey of Family Growth includes the complete birth and union histories of 10,277 white, black and Hispanic women. The distribution of union status and marital history at the time of tubal sterilization was estimated for these three racial and ethnic groups among the 799 women who had had a tubal ligation in 1990-1995 before age 40. Cox proportional hazard regression models were used to estimate the effects of union status and marital history on the risk of tubal sterilization. The analysis controlled for the woman's age, parity, race and ethnicity, education, region, experience of an unwanted birth and calendar period.
Results: Among women who obtained a tubal sterilization, most whites (79%) and Hispanics (66%) were married when they had the operation, compared with only 36% of black women. At the time of their sterilization, 46% of black women had never been married. Among all women, regardless of race and ethnicity and net of all controls, the probability of tubal sterilization is about 25% lower for single, never-married women than for cohabiting or married women. Cohabitation does not reduce the likelihood in comparison to marriage, however. Higher rates of tubal sterilization among Hispanic women are accounted for by their higher parity at each age; differences in parity or marriage by race only partially account for the relatively higher rates of tubal sterilization among black women.
Conclusions: Because women currently spend greater proportions of their lives outside of marriage or in less-stable cohabiting partnerships than they did in the past, they are increasingly likely to make the decision to seek sterilization on their own. As a result, the gender gap in contraceptive sterilization will likely increase. The possibility of partnership change is an important consideration in choosing sterilization as a contraceptive method.
(UNITED STATES, MARRIAGE, CONSENSUAL UNION, FEMALE CONTRACEPTION, FEMALE STERILIZATION, TUBAL OCCLUSION, MODELS, PROPORTIONAL HAZARD MODELS, EDUCATION, ETHNICITY, PARITY).
English - pp. 35-41 & 49.
A. L. Godecker, E. Thomson, L. L. Bumpass, Department of Sociology, University of Wisconsin-Madison, U.S.A.
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FAMILY PLANNING PERSPECTIVES, 2001, Vol. 33, No. 2
BLAKE, Susan M.; SIMKIN, Linda; LEDSKY, Rebecca; PERKINS, Cheryl; CALABRESE, Joseph M.
Effects of a parent-child communications intervention on young adolescents' risk for early onset of sexual intercourse.
Context: The quality of parent-child communications about sex and sexuality appears to be a strong determinant of adolescents' sexual behavior. Evaluations of interventions aimed at improving such communications can help identify strategies for preventing early onset of sexual behavior.
Methods: A school-based abstinence-only curriculum was implemented among 351 middle school students, who were randomly assigned to receive either the classroom instruction alone or the classroom instruction enhanced by five homework assignments designed to be completed by the students and their parents. An experimental design involving pretest and posttest surveys was used to assess the relative efficacy of the curriculum delivered with and without the parent-child homework assignments.
Results: In analyses of covariance controlling for baseline scores, immediately after the intervention, adolescents who received the enhanced curriculum reported greater self-efficacy for refusing high-risk behaviors than did those who received the classroom instruction only (mean scores, 16.8 vs. 15.8). They also reported less intention to have sex before finishing high school (0.4 vs. 0.5), and more frequent parent-child communications about prevention (1.6 vs. 1.0) and sexual consequences (1.6 vs. 1.1). In all significant comparisons, the direction of the findings favored adolescents who received the enhanced curriculum. Dose-response relationships supported the findings.
Conclusions: Parent-child homework assignments designed to reinforce and support school-based prevention curricula can have an immediate impact on several key determinants of sexual behavior among middle school adolescents.
(UNITED STATES, CITIES, ADOLESCENTS, SEXUAL BEHAVIOUR, RISK, RISK EXPOSURE, SEX EDUCATION, INTERPERSONAL COMMUNICATION, METHODOLOGY, EXPERIMENTATION).
English - pp. 52-61.
S. M. Blake, Department of Prevention and Community Health, The George Washington University Medical School, School of Public Health and Health Services, Washington, DC, U.S.A.; L. Simkin and R. Ledsky, Academy for Educational Development (AED), New York, U.S.A.; C. Perkins and J. M. Calabrese, Prevention Partners, Rochester, NY, U.S.A.
***
KIRBY, Douglas; COYLE, Karin; GOULD, Jeffrey B.
Manifestations of poverty and birthrates among young teenagers in California Zip Code areas.
Context: Given that many communities are implementing community-wide initiatives to reduce teenage pregnancy or childbearing, it is important to understand the effects of a community's characteristics on adolescent birthrates.
Methodology: Data from the 1990 census and from California birth certificates were obtained for zip codes in California. Regression analyses were conducted on data from zip code areas with at least 200 females aged 15-17 between 1991 and 1996, to predict the effects of race and ethnicity, marital status, education, employment, income and poverty, and housing on birthrates among young teenagers.
Results: In bivariate analyses, the proportion of families living below poverty level within a zip code was highly related to the birthrate among young teenagers in that zip code (r=.80, p<.001). In multivariate analyses, which controlled for some of the correlates of family poverty level, the proportion of families living below poverty level remained by far the most important predictor of the birthrate among young teenagers (b=1.54), followed by the proportion of adults aged 25 or older who have a college education (b=-0.80). Race and ethnicity were only weakly related to birthrate. In all three racial and ethnic groups, poverty and education were significantly related to birthrate, but the effect of college education was greater among Hispanics (b=-2.98) than among either non-Hispanic whites (b=-0.53) or blacks (b=-1.12). Male employment and unemployment and female unemployment were highly related to the birthrate among young teenagers in some racial or ethnic groups, but not in others.
Conclusions: Multiple manifestations of poverty, including poverty itself, low levels of education and employment, and high levels of unemployment, may have a large impact upon birthrates among young teenagers. Addressing some of these issues could substantially reduce childbearing among young adolescents.
(UNITED STATES, CITIES, ADMINISTRATIVE DISTRICTS, ADOLESCENTS, ADOLESCENT PREGNANCY, BIRTH RATE, POVERTY, LEVELS OF EDUCATION, ETHNIC GROUPS, EMPLOYMENT, METHODOLOGY, REGRESSION ANALYSIS).
English - pp. 63-69.
D. Kirby and K. Coyle, ETR Associates, Santa Cruz, CA, U.S.A.; J. B. Gould, Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, U.S.A.
***
OTTERBLAD OLAUSSON, Petra; HAGLUND, Bengt; RINGBÄCK WEITOFT, Gunilla; CNATTINGIUS, Sven.
Teenage childbearing and long-term socioeconomic consequences: A case study in Sweden.
Context: Whether long-term socioeconomic problems experienced by many teenage mothers are a reflection of preexisting disadvantage or are consequences of teenage motherhood per se remains unclear.
Methods: National data on all women born in Sweden from 1941 to 1970 who were younger than age 30 when they first gave birth (N=888,044) were analyzed. The outcome measures, assessed during adulthood, were employment status, socioeconomic status, educational attainment, single motherhood, family size, receipt of disability pension and dependence on welfare. Multiple logistic regression techniques were used to adjust for maternal birth cohort and for socioeconomic background of the woman's family.
Results: Compared with Swedish women who first gave birth at ages 20-24, those who were teenage mothers had significantly increased odds of each unfavorable socioeconomic outcome in later life, even after the data were adjusted for family socioeconomic situation and maternal birth cohort. For example, teenage motherhood was positively associated with low educational attainment (odds ratios of 1.7-1.9, depending on the specific age during adolescence when the woman gave birth), with single living arrangements (odds ratios, 1.5-2.3), with high parity (odds ratios, 2.6-6.0), with collecting a disability pension (odds ratios, 1.6-1.9) and with welfare dependency (odds ratios, 1.9-2.6). These trends were usually linear, with the highest odds ratios corresponding to women who had had their first child at the youngest age.
Conclusions: A longitudinal analysis of record-linkage data from Sweden supports the view that childbearing during adolescence poses a risk for socioeconomic disadvantage in later life--even for adolescents from relatively comfortable backgrounds and for those who studied beyond elementary school.
(SWEDEN, ADOLESCENT PREGNANCY, SOCIAL CONSEQUENCES, ECONOMIC IMPLICATIONS, SOCIO-ECONOMIC DIFFERENTIALS, LEVELS OF EDUCATION, EMPLOYMENT, FAMILY SIZE, SOCIO-ECONOMIC STATUS, DEPENDENCY).
English - pp. 70-74.
P. Otterblad Olausson and S. Cnattingius, Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden; B. Haglund and G. Ringbäck Weitoft, Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden.
***
EAST, Patricia L.; KIERNAN, Elizabeth A.
Risks among youths who have multiple sisters who were adolescent parents.
Context: Past research has revealed that having a sister who gave birth as a teenager is associated with increases in young people's likelihood of engaging in risky sexual behavior. To date, however, no study has determined if having several sisters who were adolescent mothers further raises youths' chances of engaging in risky activities.
Methods: Data were collected from 1,510 predominantly Hispanic and black 11-17-year-olds in a California program for youths who have at least one pregnant or parenting sister. Correlational analyses, analyses of variance and regression analyses were conducted to assess the effects of having multiple teenage parenting sisters on a variety of outcomes that are known risk factors for teenage pregnancy.
Results: Twenty-four percent of participants had two or more sisters who had given birth as teenagers. The likelihood of having multiple adolescent parenting sisters was greatest in large families, but was unrelated to youths' other background characteristics. In analyses controlling for background factors, females with many parenting sisters had increased levels of behavioral problems (school problems, drug or alcohol use, and delinquent behavior) and an elevated likelihood of being sexually experienced. Having lived with two or more parenting sisters (as opposed to having lived with only one) was related to more permissive sexual and childbearing attitudes among young women and to earlier first intercourse among young men. Males with a sister who gave birth at a young age had elevated levels of delinquent behavior and promiscuous sexual behavior.
Conclusions: As the number of teenage parenting sisters rises, youths'--particularly females'--risk of pregnancy involvement increases beyond the level associated with having only one teenage parenting sister. Screening for the number, living situation and age at first birth of parenting sisters is likely to be useful for programs seeking to identify youths at high risk of an early pregnancy.
(UNITED STATES, CITIES, ADOLESCENT PREGNANCY, FAMILY ENVIRONMENT, SISTERS, YOUTH, RISK, POPULATION AT RISK, SOCIAL PROBLEMS, SEXUAL PERMISSIVENESS, PREMARITAL SEX BEHAVIOUR).
English - pp. 75-80.
P. L. East and E. A. Kiernan, Department of Pediatrics, University of California, San Diego, U.S.A.
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BENSON GOLD, Rachel; SONFIELD, Adam.
Reproductive health services for adolescents under the state children's health insurance program.
Context: The federal government enacted the State Children's Health Insurance Program (CHIP) in 1997 to provide insurance coverage to uninsured, low-income children up to age 19. Individual states' decisions when designing their CHIP efforts will in large part determine the extent to which the program will help the nation's nearly three million low-income uninsured adolescents get needed reproductive health services.
Methods: CHIP administrators in all states and the District of Columbia were sent a survey concerning reproductive health services for adolescents aged 13-18 provided under their state's CHIP effort. The questionnaire asked about services covered, information provided to adolescents, confidentiality, outreach and enrollment activities, managed care and performance measures.
Results: Of the 46 respondents to the survey, 29 states and the District of Columbia included a Medicaid component to their CHIP effort, and 28 states included a state-designed component. Overall, states provided relatively comprehensive coverage of reproductive health services, with all 58 CHIP programs covering routine gynaecologic care, screening for sexually transmitted diseases and pregnancy testing. Fifty-four covered the full range of the most commonly used prescription contraceptive methods, although only 43 covered emergency contraception. Twenty of 58 CHIP programs required that adolescents be provided with information about coverage for the full range of reproductive health services, and 18 required that information be provided about accessing care. Seventeen programs reported guarantees of confidentiality before and after receipt of reproductive health care. In 26 programs, enrollees in managed care were guaranteed access to contraceptive services through out-of-network providers. Twenty-six states and the District of Columbia reported targeting outreach activities specifically to adolescents, and 41 states and the District of Columbia stated that they provide outreach materials at middle schools, high schools and community-based organizations serving teenagers.
Conclusions: Despite their nearly comprehensive coverage of reproductive health services, programs were inconsistent in guaranteeing the information, confidentiality and flexibility in choosing providers that is critical to adolescents' ability to access care. In addition, many states failed to creatively use strategies to target uninsured adolescents for enrollment, although new initiatives are under way to correct this problem.
(UNITED STATES, ADOLESCENTS, FAMILY PLANNING PROGRAMMES, HEALTH SERVICES, SOCIAL SECURITY, FAMILY PLANNING EDUCATION, MEDICAL CARE, IEC, COMPARATIVE ANALYSIS).
English - pp. 81-87.
R. Benson Gold and A. Sonfield, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
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FAMILY PLANNING PERSPECTIVES, 2001, Vol. 33, No. 3
FORD, Kathleen; SOHN, Woosung; LEPKOWSKI, James.
Characteristics of adolescents' sexual partners and their association with use of condoms and other contraceptive methods.
Context: While a number of studies have examined the association between individuals' characteristics and their contraceptive use, few studies have examined the influence of partners' characteristics on individuals' contraceptive use.
Methods: Using nationally representative data from the National Longitudinal Study of Adolescent Health, multiple logistic analyses were conducted to identify associations between the demographic characteristics of adolescents' heterosexual partners and adolescents' use of condoms or other contraceptive methods.
Results: The partners of white and black adolescents were likely to be similar to them, while the partners of Latino adolescents and of adolescents of "other" race or ethnicity were more likely to be of a different racial or ethnic group. Differences in age between adolescents and their partners were notable in all racial and ethnic groups. As adolescents age, the characteristics of their partners become more heterogeneous. The less similar adolescents and their partners are to one another--whether because of a difference in age, grade or school--the less likely adolescents are to use condoms and other contraceptive methods.
Conclusions: Many adolescents have relationships with partners whose characteristics differ from theirs and with whom they are less likely to use condoms or other contraceptive methods. This behavior is more common as adolescents grow older. To provide appropriate counselling, sexuality educators and family planning providers need to consider the ways in which adolescents' relationships change as they age and discuss with them the dynamics of relationships involving partners who differ in age or other characteristics.
(UNITED STATES, ADOLESCENTS, CONTRACEPTIVE USAGE, CONTRACEPTIVE METHODS, CONDOM, PREFERENCES, MATE, HETEROGAMY, SEXUAL BEHAVIOUR, SEXUAL RELATIONSHIPS, METHODLOGY, REGRESSION ANALYSIS).
English - pp. 100-105 & 132.
K. Ford, Department of Epidemiology, School of Public Health, W. Sohn, School of Dentistry, and J. Lepkowski, Institute for Social Research, University of Michigan, Ann Arbor, MI, U.S.A.
***
AMIRKHANIAN, Yuri A.; TIUNOV, Dennis V.; KELLY, Jeffrey A.
Risk factors for HIV and other sexually transmitted diseases among adolescents in St. Petersburg, Russia.
Context: Over the past several years, there have been sharp increases in the prevalence of HIV and other sexually transmitted diseases (STDs) among young people in Russia. Very little is known about Russian adolescents' behaviors and attitudes that might influence their risk of acquiring these infections.
Methods: A 1995 survey of 533 students aged 15-17 attending eight St. Petersburg high schools assessed their sexual risk practices, AIDS-specific attitudes and beliefs, sexual relationship patterns and preferences, and social characteristics.
Results: Overall, 39% of students were sexually experienced, and these young people had had, on average, 3.4 sexual partners. Only 29% of sexually experienced students said they consistently used condoms, and 29% said they never did. Unprotected vaginal intercourse was the predominant and preferred sexual practice; it also was the practice that most often occurred with students' last sexual partner. In all, 28% of students defined "safer sex" as condom use. Many young people believed that AIDS is a threat only to members of particular "risk groups"; relatively few believed that they could get AIDS (17%) or said that AIDS information had influenced their sexual behavior (29% of those who were sexually experienced). Females were more likely than males to prefer having an exclusive partner, and males were more likely to prefer having casual partners.
Conclusions: Educational and behavioral interventions are urgently needed to help young people in Russia avoid HIV and other STDs. Risk and social characteristics identified in this study can help to guide the development and tailoring of risk reduction interventions.
(RUSSIA, CITIES, ADOLESCENTS, AIDS, SEXUALLY TRANSMITTED DISEASES, RISK EXPOSURE, POPULATION AT RISK, SEXUAL RELATIONSHIPS, SEXUAL BEHAVIOUR, MATE SELECTION, CONTRACEPTIVE USAGE, CONDOM, ATTITUDE, PREFERENCES).
English - pp. 106-112.
Y. A. Amirkhanian and J. A. Kelly, Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, U.S.A.
***
FROST, Jennifer J.; RANJIT, Nalini; MANZELLA, Kathleen; DARROCH, Jacqueline E.; AUDAM, Suzette.
Family planning clinic services in the United States: Patterns and trends in the late 1990s.
Context: Publicly funded family planning clinics are a vital source of contraceptive and reproductive health care for millions of U.S. women. It is important periodically to assess the number and type of clinics and the number of contraceptive clients they serve.
Methods: Service data were requested for agencies and clinics providing publicly funded family planning services in the United States in 1997. The numbers of agencies, clinics and female contraceptive clients were tabulated according to various characteristics and were compared with similar data for 1994. Finally, county data were tabulated according to the presence of family planning clinics and private physicians likely to provide family planning care and according to the number of female contraceptive clients served compared with the number of women needing publicly funded care.
Results: In 1997, 3,117 agencies offered publicly funded contraceptive services at 7,206 clinic sites. Forty percent of clinics were run by health departments, 21% by community health centers, 13% by Planned Parenthood affiliates and 26% by hospitals or other agencies. Overall, 59% of clinics received Title X funding. Agencies operated an average of 2.3 clinics, and clinics served an average of 910 contraceptive clients per year. Altogether, clinics provided contraceptive services to 6.6 million women--approximately two of every five women estimated to need publicly funded contraceptive care. The total number of providers and the total number of women served remained stable between 1994 and 1997; at the local level, however, clinic turnover was high. Some 85% of all U.S. counties had one or more publicly funded family planning clinics; 36% had one or more clinics, but no private obstetrician-gynaecologist.
Conclusions: Publicly funded family planning clinics are distributed widely throughout the United States and continue to provide contraceptive care to millions of U.S. women. Clinics are sometimes the only source of specialized family planning care available to women in rural counties. However, the high rate of clinic turnover and the lack of significant growth in clinic numbers suggest that limited funding and rising costs have hindered the further expansion and outreach of the clinic network to new geographic areas and hard-to-reach populations.
(UNITED STATES, FAMILY PLANNING PROGRAMMES, FAMILY PLANNING POLICY, FAMILY PLANNING CENTRES, HEALTH CENTRES, HEALTH SERVICES, FINANCING, RURAL AREAS).
English - pp. 113-122.
J. J. Frost, N. Ranjit, K. Manzella, J. E. Darroch, S. Audam, The Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
***
KIHARA, Masako Ono, KRAMER, Jane S.; BAIN, Deborah; KIHARA, Masahiro; MANDEL, Jeff.
Knowledge of and attitudes toward the pill: Results of a national survey in Japan.
Context: After decades of debate, the oral contraceptive pill was legalized in Japan in June 1999. Because the pill had been unavailable up until then, little is known about the public's knowledge about, attitudes toward and intentions to use the pill.
Methods: In a nationwide probability sample, 630 women and men were interviewed in their homes in March 1999. Respondents were asked a range of questions to gauge their knowledge about and attitudes toward the pill.
Results: Most respondents (79%) could identify both the name and purpose of the birth control pill. Roughly the same proportion of respondents held an overall positive impression (44%) as held a negative impression (42%) of the pill, and 14% were undecided about the method. The pill's high level of effectiveness in pregnancy prevention was the most common reason for having a favorable impression of it (47%). Women were more concerned about side effects than were men, and they also knew more about the pill's potential side effects than did men. Only 12% of respondents said they intended to use the pill if it were approved. Roughly one-quarter (23-26%) did not correctly identify the pill's inability to protect against HIV and other sexually transmitted diseases (STDs).
Conclusions: Legalization of oral contraceptives in Japan has led to an urgent need to educate both men and women on the inability of the pill to protect against STDs, including HIV. Policymakers and providers need to recognize the importance of encouraging dual method use in Japan.
(JAPAN, ORAL CONTRACEPTIVES, ATTITUDE, KNOWLEDGE OF CONTRACEPTIVES, USE-EFFECTIVENESS, ADVERSE EFFECTS, AIDS, SEXUALLY TRANSMITTED DISEASES, RISK EXPOSURE, FAMILY PLANNING EDUCATION).
English - pp. 123-127.
M. O. Kihara, D. Bain, J. Mandel, Center for AIDS Prevention Studies (CAPS), J. S. Kramer, Institute for Health Policy Studies and Department of Obstetrics and Gynecology, University of California, San Francisco, U.S.A.; M. Kihara, Department of International Health, Kyoto University School of Public Health, Japan.
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