When and Why Do Young People in the United Kingdom First Use Sexual Health Services?

CONTEXT: Many young people think about and take steps to obtain adequate protection only after having sexual intercourse for the first time. Consequently, they are at increased risk of unintended pregnancy and sexually transmitted infections.
METHODS: Between June and August 1999, a self-administered questionnaire was distributed to attendees at UK youth-targeted sexual health services to investigate when and why they first use a sexual health service, reasons for delaying use, and sexual behavior and contraceptive practice before first use.
RESULTS: Of the 747 respondents, 29% had used a sexual health service before ever having sex, most commonly "to be prepared." In contrast, 61% of respondents had used a service after sexual debut; some of these had obtained condoms elsewhere (25% of women and 33% of men who gave a reason for delay) or had not known about services or their location (11-19%). Among the women, 20-24% had been embarrassed or scared, or concerned about confidentiality or age; 32% had visited a provider because they had had unprotected sex. Sixty-three percent of men who had delayed using a service reported that the ability to obtain free condoms had prompted their first visit. Only 43% of respondents who postponed service use had practiced contraception consistently before visiting a provider.
CONCLUSIONS: Young people need to be realistic about the possibility of having sex. Service use could be increased by providing more youth-specific services and by improving publicity and links between the youth, education and health sectors to dispel fears and myths about services.     

Young adults' contraceptive knowledge, norms and attitudes: associations with risk of unintended pregnancy

CONTEXT: Women aged 18–29 have higher rates of unintended pregnancy than any other age‐group. Information is needed to understand what characteristics are associated with risky contraceptive use practices among this population and to develop new strategies for reducing these women's risk of unintended pregnancy. METHODS: Data related to unintended pregnancy risk were collected from a nationally representative sample of 1,800 unmarried women and men aged 18–29 surveyed by telephone in 2009. Among those at risk of unintended pregnancy, multiple logistic regression was used to assess associations between contraceptive knowledge, norms and attitudes and selected risky contraceptive behaviors. RESULTS: More than half of young men and a quarter of young women received low scores on contraceptive knowledge, and six in 10 underestimated the effectiveness of oral contraceptives. Among women, for each correct response on a contraceptive knowledge scale, the odds of expecting to have unprotected sex in the next three months decreased by 9%, of currently using a hormonal or long‐acting reversible method increased by 17%, and of using no method decreased by 17%. Fear of side effects, norms and attitudes that favor nonmarital pregnancy or undervalue the importance of contraception, pregnancy ambivalence and mistrust of government's role in promoting contraception were also associated with one or more risky contraceptive use behaviors. CONCLUSIONS: Programs to increase young adults’ knowledge about contraceptive methods and use are urgently needed. Given the demonstrated link between method knowledge and contraceptive behaviors, such programs may be useful in addressing risky behavior in this population.     

Factors affecting contraceptive use in women seeking pregnancy tests: Missouri, 1997

CONTEXT: If the national health objective of reducing unintended pregnancy is to be met, a better understanding is needed of barriers to women's acquisition and use of contraceptives. METHODS: A sample of 311 Missouri women who were seeking pregnancy tests in public health department clinics in 1997 and who said their potential pregnancy was unintended were asked about potential barriers to family planning. Factors affecting contraceptive use among these women were examined by frequency of use, insurance status, education and race. RESULTS: In general, the women mostly disagreed that particular factors were potential barriers to contraceptive use. For only one item--worry over the potential side effects of the hormonal injectable contraceptive--did a majority agree or strongly agree that it was a barrier to method use in the previous six months. Women who used a contraceptive infrequently were more likely than frequent users to identify 33 factors in nine areas as being potential barriers to contraceptive use. These ranged from factors involving access to services and condom-specific issues to cost-related concerns, social norms, pregnancy denial, embarrassment over discussing or obtaining birth control, worry about side effects and experience with forced sex, among others. Perceived barriers differed somewhat by insurance status in the areas of access, embarrassment, side effects and forced sex. For example, women with no insurance coverage reported a higher level of agreement that transportation problems had hindered their access to a clinic than did women with private insurance. Level of education affected agreement only in the area of side effects, with more-educated women expressing greater concern about side effects than less-educated women. The respondent's race affected agreement in six areas: access, social norms, pregnancy denial, embarrassment, forced sex and other miscellaneous concerns, such as condom use and relationship issues. CONCLUSION: Better education and improved access to and delivery of services might address several factors affecting contraceptive use that are associated with unintended pregnancy. Some barriers, however, such as those related to self-efficacy, self-esteem and fatalistic attitudes about pregnancy, would be much harder for family planning providers to resolve.     

Measuring contraceptive use patterns among teenage and adult women

CONTEXT: Measures of contraceptive use at one point in time do not account for its changing nature. A measure that addresses the pattern of method use over time may better predict the cumulative risk of unintended pregnancy. METHODS: Women at risk of unintended pregnancy were selected from the 1995 National Survey of Family Growth, and their contraceptive use patterns were compared across age-groups. Survival analysis was used to validate women's long-term use pattern as an indicator of pregnancy risk, and multivariate regression analyses were used to explore potential covariates of current patterns of contraceptive use. RESULTS: More than two-thirds of women aged 15-19 report long-term uninterrupted contraceptive use, but they are more likely to report sporadic use and less likely to report uninterrupted use of a very effective method than are women aged 25-34. Compared with women aged 25-34, women aged 20-24 have higher rates of sporadic use and lower rates of effective uninterrupted use. Among teenagers, nonusers are 12 times as likely as uninterrupted effective users to experience an unintended pregnancy within 12 months at risk. Women in less stable relationships, those having more infrequent intercourse and women who have recently experienced nonvoluntary intercourse for the first time are more likely than others to have a high-risk contraceptive pattern. Women aged 17 and younger whose current partner is more than three years older are significantly less likely to practice contraception than are their peers whose partner is closer in age. CONCLUSIONS: Long-term contraceptive use pattern is a valid predictor of unintended pregnancy risk. Policies aimed at reducing unintended pregnancies should target women who do not practice contraception and those who are sporadic users. Women in unstable relationships, those having infrequent sex and women who experience sexual coercion need access to methods, such as emergency contraception, that can be used sporadically or after unprotected intercourse.     

Influences of sex,age and education on attitudes towards gender inequitable norms and practices in South Sudan

Prolonged conflict in South Sudan exacerbated gender disparities and inequities. This study assessed differences in attitudes towards gender inequitable norms and practices by sex, age and education to inform programming. Applying community-based participatory research methodology, 680 adult respondents, selected by quota sampling, were interviewed in seven South Sudanese communities from 2009 to 2011. The verbally administered survey assessed attitudes using the Gender Equitable Men scale. Data were stratified by sex, age and education. Of 680 respondents, 352 were female, 326 were male and two did not report their sex. The majority of respondents agreed with gender inequitable household roles, but the majority disagreed with gender inequitable practices (i.e., early marriage, forced marriage and inequitable education of girls). Respondents who reported no education were more likely than those who reported any education to agree with gender inequitable practices (all p < 0.03) except for forced marriage (p = 0.07), and few significant differences were observed when these responses were stratified by sex and by age. The study reveals agreement with gender inequitable norms in the household but an overall disagreement with gender inequitable practices in sampled communities. The findings support that education of both women and men may promote gender equitable norms and practices.     

A survey of risk behaviors for unintended pregnancy and human immunodeficiency virus among youth attending voluntary counseling and testing (VCT) services in nine centers in urban Haiti and Tanzania

Little is known about the behavioral risks for both human immunodeficiency virus (HIV) and unintended pregnancy among sexually active youth attending voluntary counseling and testing (VCT) in developing countries, and whether youth engaging in risky sexual behaviors perceive themselves to be at risk for HIV. Data are from two cross-sectional studies with youth VCT clients in four facilities in Dar es Salaam, Tanzania and five facilities in Port-au-Prince, Haiti. We measured risky behavior for HIV and unintended pregnancy and perceptions of risk among VCT clients who reported ever having had sex. The majority of sexually active clients, 69% of men and 62% of women in Haiti and 65% of men and 60% of women in Tanzania, reported recent risky behaviors for HIV. Clients also reported risk behaviors for unintended pregnancy: 15% of men and 53% of women in Haiti and 21% of men and 29% of women in Tanzania. The majority of clients with risk behaviors in Tanzania, but not in Haiti, perceived themselves at risk. Strategies to meet youth VCT clients' broader reproductive health needs and avoid any missed opportunities should be tested.     

Predictors of Early Initiation of Vaginal and Oral Sex Among Urban Young Adults in Baltimore, Maryland

Over the past three decades, most research on adolescent sexual behavior has focused on vaginal intercourse and related behaviors, including contraception and unintended pregnancy. In this study, we describe the prevalence and correlates of vaginal, oral, and anal sex in an epidemiologically defined population in Baltimore, Maryland. Young adults (ages 18–24), who had been enrolled in a behavioral intervention trial during elementary school, were interviewed by telephone between 1998 and 2002 to assess their sexual behavior. Of 1679 respondents interviewed, 70.8% were Black and 55% were women. Overall, 93% of the young adults reported vaginal intercourse, 78% reported receiving oral sex, 57% reported performing oral sex, and 10% reported receptive anal intercourse. Among men, 27% reported insertive anal intercourse. Blacks initiated vaginal intercourse at an earlier age than Whites; White women performed oral sex earlier than Black women. Significant interactions were observed between age of first vaginal partner and both gender and race/ethnicity. Blacks with older partners initiated sex at an earlier age than both Blacks with a partner the same age or younger and Whites. We also observed a relationship between older female sex partners and earlier vaginal sex initiation among men. We conclude that older sex partners play an important role in sexual initiation among young adults. In light of the rates of oral and anal sex, sexual education and intervention programs should address the risk for unintended consequences of these behaviors.     

Congruence across Sexual Orientation Dimensions and Risk for Unintended Pregnancy among Adult U.S. Women

ObjectivesTo date, no studies have investigated whether sexual minority women (SMW) are more likely to experience unintended pregnancies compared with their heterosexual peers. The aim of this study was to explore whether adult SMW were more likely to have unintended pregnancies compared with heterosexual women, to examine the role of identity–attraction congruence in unintended pregnancy risk, and to evaluate possible mediators.MethodsData on pregnancies to women ages 18 to 44 were drawn from the 2006 through 2013 National Survey of Family Growth (n = 25,403). Weighted logistic regression models estimated the likelihood of reporting an unintended (rather than intended) pregnancy by identity–attraction congruence and the extent to which this association was mediated by sexual experiences with men, including age at first sex and number of sexual partners. Supplementary analyses addressed the issue of abortion underreporting.ResultsPregnancies to SMW were more likely to be unintended compared with pregnancies to heterosexual women (adjusted odds ratio, 1.26; 95% confidence interval, 1.08–1.46). This was driven by the elevated risk experienced by heterosexual-identified women with same-sex attractions, specifically (adjusted odds ratio, 1.28; 95% confidence interval, 1.08–1.51). Greater unintended pregnancy risk among these women was mediated by a greater number of male sex partners compared with heterosexual women.ConclusionsUnintended pregnancy risk among SMW has historically received little attention from scholars and clinicians. Future research should explore the specific conditions that put heterosexual-identified women with same sex attractions at increased risk for unintended pregnancy. Clinicians should consider these dynamics when screening patients for contraceptive counseling.     

Testing for HIV infection among heterosexual,bisexual and gay men

Abstract: This paper answers the questions: who is and is not tested for human immunodeficiency virus (HIV) antibodies, why, where are they tested, and what do they find difficult about the testing process? The data came from two samples of sexually active heterosexual, bisexual and gay men in Perth (N = 545). Bisexual and gay men were much more likely to be tested than heterosexual men, although the commonest reason for testing for all three groups was risky sex. The three groups differed on reasons for not having the HIV antibody test: heterosexual men most commonly claimed that they were not at risk; bisexual men explained that they had been meaning to go but kept putting it off; and gay men primarily feared a positive test result and lacked trust in the confidential treatment of results. Gay men were more likely to trust their regular doctors than were heterosexual and bisexual men who had more trust in state health clinics. Waiting for test results was the most difficult part of the testing process for all respondents. Few respondents agreed that employers and the police should be notified by a doctor of an antibody-positive test result; nearly all agreed that those who had contracted HIV should be notified; notification of surgeons received moderate support. Knowing one's HIV infection status appears to be strongly associated with safer sex practices, and therefore the HIV antibody test could be promoted as part of a preventive health care program.     

人工流产女青年性行为和避孕现状研究

目的:了解北京市人工流产女青年的性行为和避孕现状,探讨人工流产、特别是重复流产的影响因素。方法:采用自填式问卷的方法,对北京市1 008名自愿要求人工流产、在1980年8月1日之后出生的女青年进行现状调查。结果:研究对象首次性行为的平均年龄为(20.70±1.95)岁,54%的人在20岁之前就开始了性生活;首次人工流产的平均年龄为(21.96±1.81)岁,首次流产在20岁之前的占17.0%;将近25%的人曾与2名及以上的男性发生过性关系;人流女青年本次怀孕的原因,60.2%是因为没有避孕,39.7%由于避孕失败;没有避孕的主要原因是"在没有准备好避孕药具的情况下同房"(41.5%)和"知道避孕方法但不想用"(39.7%);避孕失败的主要原因是全安期和体外射精(39.0%)、避孕套(32.7%)和紧急避孕(18.5%);过去3个月中,最常用的避孕方法为避孕套(75.5%)、全安期和体外射精(11.0%)、紧急避孕(8.2%);在避孕套使用者中,只有9.3%能坚持每次同房都用;77.2%的人认为口服避孕药对身体不好;32.4%的研究对象有重复流产。单因素分析发现,文化程度低、未婚同居、首次性生活和首次流产的年龄小、多性伴和不能坚持、正确使用避孕措施是重复流产的影响因素。结论:女青年首次性行为开始早、多性伴比例高、避孕药具使用率低或使用低效的避孕方法是非意愿妊娠和人工流产的主要原因,且重复流产现象比较严重;同时,流动人口在人流女青年中占了相当大的比例。因此,应当对未婚人群和流动人口女青年进行人工流产的危害以及避孕知识的宣传教育,提高现代科学的避孕药具使用率,避免不必要的意外妊娠和人工流产。     

Who is Using Emergency Contraception? Awareness and Use of Emergency Contraception Among California Women and Teens

INTRODUCTION: Emergency contraception (EC) reduces women's risk for pregnancy after unprotected intercourse, and women's awareness of the method is increasingly important for expanding access. However, knowledge of EC alone does not predict use, and few population data exist to describe EC use among those aware of the method. METHODS: Using data from the 2003 California Health Interview Survey, we measured EC awareness among 11,392 women ages 15-44, and EC use among 7,178 respondents who were aware of EC and at risk for pregnancy. Using chi(2) analyses and multivariable logistic regression, we examined population characteristics that epidemiologically predict EC awareness and use, including age, race/ethnicity, income, health insurance status, usual source of health care, immigration status, languages spoken at home, and urban versus rural residence. RESULTS: Nearly 76% of respondents had heard of EC, but awareness was lower among teens, women of color, poor women, women with publicly funded health insurance, those without a usual source of care, immigrants, non-English-language speakers, and rural residents. Among women aware of EC, about 4% reported having used the method in the previous year; young age, low income, attending a community/government clinic for care or not having a source of care, and living in an urban area significantly increased the odds for using EC. CONCLUSIONS: Among California women in 2003, awareness and use of EC remained low. However, similar rates of use were reported among racial, ethnic, and linguistic subgroups. Those most likely to report use of the method included population groups at high risk for unintended pregnancy.     

Reasons for unprotected intercourse: analysis of the PRAMS survey

OBJECTIVES: This study was conducted to identify reasons why women had unprotected intercourse that led to an unintended pregnancy. METHODS: As part of the Pregnancy Risk Assessment Monitoring System (PRAMS) survey, women with a recent unintended viable pregnancy were asked after the birth why they had not used birth control. RESULTS: Of 7856 respondents, 33% felt they could not get pregnant at the time of conception, 30% did not really mind if they got pregnant, 22% stated their partner did not want to use contraception, 16% cited side effects, 10% felt they or their partner were sterile, 10% cited access problems and 18% selected "other." Latent class analysis showed seven patterns of response, each identifying strongly with a single reason. CONCLUSIONS: Almost half of women with viable unintended pregnancies ending in a birth felt they could not/would not get pregnant at the time of conception. Most women identified with a single reason for having unprotected intercourse.     

Intimate Partner Violence Among Economically Disadvantaged Young Adult Women: Associations With Adolescent Risk-Taking and Pregnancy Experiences

CONTEXT: Intimate partner violence negatively impacts the health of substantial proportions of young women in economically disadvantaged communities, where sexual initiation, aggressive behaviors, unintended pregnancies and childbearing are common among adolescents. It is therefore important to assess how adolescent risk behaviors and pregnancy experiences are linked to such violence during young adulthood.
METHODS: Data from 526 participants in the Reach for Health Longitudinal Study who were surveyed during middle school (in 1995–1996 and 1996–1997) and at ages 22–25 (in 2005–2007) provided information on adolescent risk behaviors and pregnancy experiences, as well as experiences of intimate partner violence during young adulthood. Bivariate and multivariate analyses were conducted to identify correlates of intimate partner violence involvement.
RESULTS: As young adults, 29% of women reported having been victims of intimate partner violence in the past 12 months; 21% reported having perpetrated such violence. In multivariate analyses, victimization and perpetration in the last year are positively associated with aggressive behavior in middle school (odds ratios, 1.9 and 2.5, respectively), lifetime number of sex partners (1.3 for both) and having a history of unintended pregnancy or pregnancy problems (1.3 for both). Perpetration also is associated with early sexual initiation (0.5) and living with a partner (1.8).
CONCLUSIONS: It is important to consider women's pregnancy histories in programs aimed at preventing the adverse outcomes of relationship violence and in screening for partner violence in sexual and reproductive health services. Early intervention may help women develop the skills needed for resolving conflicts with peers and partners.     

Experiences of unmarried young abortion-seekers in Bihar and Jharkhand,India

While several studies have documented the prevalence of unprotected pre-marital sex among young people in India, little work has explored one of its likely consequences, unintended pregnancy and abortion. This paper examines the experiences of 26 unmarried young abortion-seekers (aged 15–24) interviewed in depth as part of a larger study of unmarried abortion-seekers at clinics run by an NGO in Bihar and Jharkhand. Findings reveal that recognition of the unintended pregnancy was delayed for many and many who suspected so further delayed acknowledging it. Once recognised, most confided in the partner and, for the most part, partners were supportive; a significant minority, including those who had experienced forced sex, did not have partner support and delayed the abortion until the second trimester of pregnancy. Family support was absent in most cases; where provided, it was largely to protect the family reputation. Finally, unsuccessful attempts to terminate the pregnancy were made by several young women, often with the help of partners or family member. Findings call for programmes for young women and men, their potential partners, parents and families and the health system that will collectively enable unmarried young women to obtain safe abortions in a supportive environment.     

AIDS high-risk and precautionary behaviour in young african adults: A Zimbabwean perspective

Increases in condom use among hetero-sexual active individuals are crucial to containing the spread of AIDS. A random sample of respondents (N =2,201) completed measures of sexual behaviour, HIV-related risk reduction, attitudes toward condom use and their experiences with deception when dating covering the previous two months and psychological measures theoreticaily pertinent to AIDS risk. Thirty-five percent of the sample reported engaping in unprotected anal intercourse, the abysmal high risk behaviour most strongly associated with transmission of human immunodeficiency virus (HIV) infection. In addition, these data confirm the findings of previous research that majority of women had been lied to by a dating partner. However, it was also noted that sexually experienced men often told a lie in order to have sex and were more dishonest in dating. While women demonstrated greater anxiety/worry and concerns about all STDS, including HIV, because they know they are more vulnerable. These data support the views that personality and psychological adjustment are important predictors of risk reduction for HIV infection in sexually active young adults. HIV education and innovative prevention programmes need to focus more on culturally relevant interventions to achieve safer sex practices and on grassroot social processes that will sustain behaviour changes and consistently support risk reduction maintenance toward safer sex.     

Experiences of unmarried young abortion-seekers in Bihar and Jharkhand, India

While several studies have documented the prevalence of unprotected pre-marital sex among young people in India, little work has explored one of its likely consequences, unintended pregnancy and abortion. This paper examines the experiences of 26 unmarried young abortion-seekers (aged 15-24) interviewed in depth as part of a larger study of unmarried abortion-seekers at clinics run by an NGO in Bihar and Jharkhand. Findings reveal that recognition of the unintended pregnancy was delayed for many and many who suspected so further delayed acknowledging it. Once recognised, most confided in the partner and, for the most part, partners were supportive; a significant minority, including those who had experienced forced sex, did not have partner support and delayed the abortion until the second trimester of pregnancy. Family support was absent in most cases; where provided, it was largely to protect the family reputation. Finally, unsuccessful attempts to terminate the pregnancy were made by several young women, often with the help of partners or family member. Findings call for programmes for young women and men, their potential partners, parents and families and the health system that will collectively enable unmarried young women to obtain safe abortions in a supportive environment.     

Sexual practices,identities and health among women who have sex with women in Lesotho – a mixed-methods study

Despite the high prevalence of HIV and STIs among women in Africa and the growing literature on HIV and STIs among women who have sex with women, research on the sexual health of women who have sex with women in Africa is scant. This study used mixed methods to describe sexual identity, practices and health among women who have sex with women in Lesotho. Most respondents (48%) described themselves as lesbian, 29% as bisexual and 23% as heterosexual. Almost half (45%) had disclosed their same-sex attraction to family, but only 25% had done so with healthcare workers. A total of 8% reported having HIV. Self-reported HIV was associated with having three or more male partners, having male and female partners at the same time and having a history of STIs. Gender norms, the criminalisation of homosexuality, varied knowledge of, and access to, safer-sex strategies, and mixed experiences of HIV/STI testing and sexual healthcare provided social and structural contexts for HIV- and STI-related vulnerability.     

Contraceptive Use and Abortion Among Women Of Reproductive Age in St. Petersburg, Russia

CONTEXT: Although the characteristics associated with contraceptive use among Russian women have been studied, no large-scale research has been conducted on women's use of different contraceptive methods and abortion.
METHODS: A random sample of 1,147 women aged 18–44 completed questionnaires at local women's clinics in St. Petersburg in 2003–2004. Chi-square tests were used to examine differences in selected characteristics among age-groups, and logistic regression was used to assess associations between these characteristics and the use of contraceptive methods at last intercourse and abortion history.
RESULTS: Among women at risk of unintended pregnancy, six in 10 had used reliable contraceptives (the pill, the IUD or condoms) at last intercourse; 42% had used condoms. Women in the middle income level were more likely than women with lower income to have used the pill (odds ratio, 2.1); cohabiting women and those who had had children had lowered odds of using condoms (0.6 and 0.3–0.5, respectively). More than half of those surveyed reported having had an abortion. Characteristics associated with increased odds of having had an abortion included being 25 or older (2.2–3.5), cohabiting (2.9), having high income (1.7), having experienced first intercourse before turning 18 (2.2) and having used no contraceptive method at first sex (1.5). The factor that was most strongly associated with abortion was a woman's number of births (4.9–5.7).
CONCLUSIONS: Educational programs that promote the consistent use of condoms, especially among young women, and family planning programs that reduce financial barriers to contraceptive use, are critically needed in Russia.     

Sexual practices, risk perception and knowledge of sexually transmitted disease risk among lesbian and bisexual women

CONTEXT: Sexually transmitted diseases (STDs) can be spread between female sex partners, probably through the exchange of cervicovaginal fluid and direct mucosal contact. Additionally, lesbians have a high prevalence of bacterial vaginosis, which may represent an STD in this population. However, few data on sexual practices or perceived STD risk among lesbians are available to guide development of interventions aimed at reducing the risk. METHODS: To inform the development of a safer-sex intervention for women who have sex with women, focus group discussions were conducted with 23 lesbian and bisexual women aged 18-29. Topics included sexual practices, STD transmission and prevention, and knowledge about bacterial vaginosis. RESULTS: Although six participants had had bacterial vaginosis and three an STD, women reported little use of preventive measures with female partners (washing hands, using rubber gloves and cleaning sex toys). Participants said that vaginal penetrative practices using sex toys and fingers or hands are common, and that partners frequently share sex toys during a sexual encounter, generally without condoms. Knowledge of potential for STD transmission between women, and of bacterial vaginosis, was limited. Participants viewed use of barrier methods (gloves or condoms) as acceptable, provided that there is a reason (usually STD-focused) to use them and that they are promoted in the context of sexual health and pleasure. CONCLUSIONS: Safer-sex messages aimed at lesbian and bisexual women should emphasize the plausibility of STD transmission between women, personal responsibility and care for partners' well-being; should target common sexual practices; and should promote healthy sexuality.