YOUNG LATINAS AND ABORTION: THE ROLE OF CULTURAL FACTORS,REPRODUCTIVE BEHAVIOR,AND ALTERNATIVE ROLES TO MOTHERHOOD

Latina women have often been portrayed as holding strong traditional family values leading to a greater propensity for rejection of contraception and abortion. Increasingly, the literature has consistently shown that Latina women use contraception effectively when available; however, much less is known about the prevalence of abortion and the factors related to its use in this population. In this article we examine Latinas' use of abortion and identify factors affecting its use among 1,207 ever-pregnant Latina women age 14-24 recruited at two federally-funded family planning clinics in the Los Angeles metropolitan area. Only a small proportion of the young women in our sample (7.5%) had ever had an induced abortion. In multivariate analysis the variables significantly associated with past abortion included less traditional attitudes about women's roles, higher gravidity, shorter periods of sexual activity, and a higher number of lifetime sexual partners. We conclude that use of abortion among Latinas is driven by role orientation and reproductive variables.     

广东省城市流动人口年轻女性避孕现况调查

目的 :调查广东省城市流动人口年轻女性避孕现况及需求 ,探讨加强该人群避孕意识、降低人工流产率的有效措施。方法 :采用个人问卷调查和小组访谈方式调查了 2 0 0 6名 15～ 35岁流动人口女性。结果 :有婚前性行为者占 2 3 4 % ,其中有人工流产史者占 6 6 8% ,75 7%是由于未采用避孕措施造成的。未婚人工流产者性行为中无避孕措施的高达 93.9%。 2 0 0 6人中避孕知识答卷得分≥6 0分占 35 9% ,<6 0分占 6 4 1% ,其中 0分占 7 6 % ;有人工流产史者避孕知识得分≥ 6 0分占18 7% ,<6 0分占 81 3%。能说出 3种以上避孕药具及正确使用方法的仅占 8 0 %。能正确描述紧急避孕方法者占 12 % ;听说过紧急避孕但不能正确描述者占 34 0 % ;不知道紧急避孕者占 5 3 9%。结论 :流动人口年轻女性避孕生殖健康知识贫乏 ,婚前性行为普遍 ,无防护性行为率高。     

Abortion services for sex workers in Uganda: successful strategies in an urban clinic

Sex workers' need for safe abortion services in Uganda is greater than that of the population of women of reproductive age because of their number of sexual contacts, the inconsistent use of contraception and their increased risk of forced sex, rape or other forms of physical and sexual violence. We sought to understand sex workers' experiences with induced abortion services or post-abortion care (PAC) at an urban clinic in Uganda. We conducted nine in-depth interviews with sex workers. All in-depth interviews were audiotaped, transcribed, translated, computer recorded and coded for analysis. We identified several important programmatic considerations for safe abortion services for sex workers. Most important is creating community-level interventions in which women can speak openly about abortion, creating a support network among sex workers, training peer educators, and making available a community outreach educator and community outreach workshops on abortion. At the health facility, it is important for service providers to treat sex workers with care and respect, allow sex workers to be accompanied to the health facility and guarantee confidentiality. These programmatic elements help sex workers to access safe abortion services and should be tried with all women of reproductive age to improve women's access to safe abortion in Uganda.     

Consistent and Inconsistent Contraception Among Young Women: Insights from Qualitative Interviews

Qualitative interviews with young women attending community colleges were used to address why women who do not desire pregnancy vary in how consistently they use contraception. Based on our analysis of the women's sexual histories, we argue that five factors are key to promoting or discouraging consistent use of contraception: efficacy (women's ability to put an intention to contracept into practice), the actions and attitudes of male partners, being in a long‐term relationship, whether women experience side effects, and misinformation or erroneous reasoning about pregnancy risk. Variations in how these factors combine at different times in women's lives explain much about their patterns of contraceptive consistency.     

(Not) talking about sex: couple reports of sexual discussion and expression in Bangalore,India

Adolescent marriage is common in India, placing young women at risk of HIV, early pregnancy and poor birth outcomes. Young women's capacity to express their sexual desires is central to negotiating safe and mutually consensual sexuality. Men, too, play an important role in shaping women's sexual and reproductive health outcomes, but little research has examined how men influence women's sexual expression. Using paired husband and wife data, this paper reports on a preliminary investigation into the patterns of and concurrence between women's sexual expression and their husbands' attitudes about it, as well as the influence of men's approval of their wives' sexual expression on women's actual expression of sexual desire. The results suggest that, among this sample, men are more open to sexual expression than their wives and that, for women, expressing desire not to have sex is far more common than expressing desire to have sex. Further, men's approval of sexual expression from wives appears to positively influence women's actual expression. These findings suggest that men may be resources for women to draw upon as they negotiate sexuality in adolescence and early adulthood.     

深圳外来务工青年生育健康状况调查与分析

目的了解深圳16～24岁不同性别进城务工青年的性与生育健康知信行状况及影响因素。方法采用自编结构式匿名问卷对深圳市2013例16～24岁进城务工青年进行自填式问卷调查。结果男性与女性进城务工青年的性与生育健康知识水平均较低,尤其流产相关知识,男性得分中位数仅25．0分;认为只要双方愿意就可以发生婚前性行为男女性比例分别为13．1％和16．0％;面对恋人性要求,坚持不发生性行为男女性的比例分别为20．6％和45．6％,差异有统计学意义;42．2％的调查对象自我报告发生过性行为,男性为41．5％,女性为42．7％,差异无统计学意义;不同性别外来务工青年发生婚前性行为的共同影响因素为年龄、文化程度和对避孕的态度;女性青年发生婚前性行为还与对婚前性行为的看法、对恋人性要求的处理方式有关。结论为外来务工青年提供性与生育健康教育及服务时应考虑性别差异。     

广州市未婚流动人口人工流产状况及影响因素分析

目的:了解广州市未婚流动人口人工流产状况及其影响因素。方法:采用随机整群抽样方法进行抽样,应用统一的“外来务工未婚女性生殖健康需求与服务调查问卷”,对调查对象进行现场问卷调查。结果:共调查1872名未婚女性流动人口,有过婚前性行为者233名,发生率为12.4%。69人至少有过1次人工流产,人工流产率为29·9%。在实施过人工流产的人群中,32人(46.3%)的妊娠月份超过2个月,21人(30.4%)选择在家中或私人诊所实施手术。人工流产的发生与调查对象的文化程度、收入情况,对人工流产危害的认识,避孕情况及其了解避孕方法的种类有关。结论:未婚流动人口人工流产的发生率较高,与其认知水平和避孕行为密切相关,为流动人口提供及时有效的生殖健康教育和服务将有助于提高其生殖健康认知水平和行为能力,降低人工流产率及其危害。     

Pregnancy prevention,reproductive health risk and morality: a perspective from public-sector women's clinics in St. Petersburg,Russia

The use of reliable contraception in Russia remains lower and rates of induced abortion higher than in Western Europe, even though reliable contraception has been accessible for nearly two decades now. Due to the organisation of women's health services in Russian cities, gynaecologists can have a major influence on women's contraceptive choices, but little is known about their attitudes and practices in terms of contraception promotion. This study draws on qualitative observation and interview data of gynaecologists in public-sector women's clinics in St. Petersburg, Russia's second largest city in order to investigate their perceptions of various birth control methods and contraception counselling. Also in focus are clinical counselling practices. The results reveal that gynaecologists in St. Petersburg had up-to-date knowledge of the latest contraception methods and that they were willing to promote their use. They took an active role in counselling, although the coverage was not full. The depth of counselling varied considerably and counselling practices were mainly paternalistic. Yet, in about a third of the observed cases, patient preferences were incorporated into clinical decision-making. The gynaecologists perceived reliable contraception essentially as a means of fostering future fertility and avoiding harmful health consequences of induced abortions. Using reliable contraception was equated with being a responsible and morally respectable woman. The results suggest that links between health, risk and morality are vividly present in contraception counselling in St. Petersburg, and that reliable contraception has become a powerful source of new moral demands for individual women to foster their reproductive function.     

How does religious affiliation affect women's attitudes toward reproductive health policy? Implications for the Affordable Care Act

BackgroundSupreme Court cases challenging the Affordable Care Act (ACA) mandate for employer-provided reproductive health care have focused on religiously based opposition to coverage. Little is known about women's perspectives on such reproductive health policies.Study designData were drawn from the Women's Health Care Experiences and Preferences survey, a randomly selected, nationally representative sample of 1078 US women aged 18–55 years. We examined associations between religious affiliation and attitudes toward employer-provided insurance coverage of contraception and abortion services as well as the exclusion of religious institutions from this coverage. We used chi-square and multivariable logistic regression for analysis.ResultsRespondents self-identified as Baptist (18%), Protestant (Other Mainline, 17%), Catholic (17%), Other Christian (20%), Religious, Non-Christian (7%) or No Affiliation (21%). Religious affiliation was associated with proportions of agreement for contraception (p=.03), abortion (p<.01) and religious exclusion (p<.01) policies. In multivariable models, differences in the odds of agreement varied across religious affiliations and frequency of service attendance. For example, compared to non-affiliated women, Baptists and Other Nondenominational Christians (but not Catholics) had lower odds of agreement with employer coverage of contraception (OR 0.63, 95% CI 0.4–0.1 and OR 0.57, CI 0.4–0.9, respectively); women who attended services weekly or more than weekly had lower odds of agreement (OR 0.53, 95% CI 0.3–0.8 and OR 0.33, CI 0.2–0.6, respectively), compared to less frequent attenders.ConclusionsRecent religiously motivated legal challenges to employer-provided reproductive health care coverage may not represent the attitudes of many religious women.ImplicationsRecent challenges to the ACA contraceptive mandate appear to equate religious belief with opposition to employer-sponsored reproductive health coverage, but women's views are more complex.     

Abortion as agentive action: reproductive agency among young women seeking post-abortion care in Uganda

Abstract

Unsafe abortion in Africa continues to be a major contributor to the global maternal mortality which affects young women in particular. In Uganda, where abortion is legally restricted and stigmatised, unsafe abortion is a major public health issue. We explored reproductive agency in relation to unsafe abortion among young women seeking post-abortion care. Through in-depth interviews we found that reproductive agency was constrained by gender norms and power imbalances and strongly influenced by stigma. Lack of resources and the need for secrecy resulted in harmful abortion practices and delayed care-seeking. Women did not claim ownership of the abortion decision, but the underlying meaning in the narratives positioned abortion as an agentive action aiming to regain control over one′s body and future. Women′s experiences shaped contraceptive intentions and discourse, creating a window of opportunity that was often missed. This study provides unique insight into how young women negotiate and enact reproductive agency in Uganda. Health systems need to strengthen their efforts to meet young women’s sexual and reproductive health needs and protect their rights. Enabling young women’s agency through access to safe abortion and contraception is paramount.     

'Without a plan' but 'keeping on track': views on contraception, pregnancy and abortion in Mexico City

Despite increased use of modern contraception among Mexican women, there has been a significant increase in abortions. Little is known about the experiences behind these trends. This study examines decision-making around contraception, pregnancy, childbearing and abortion. We carried out 26 in-depth interviews with 23- to 35-year-old females and males in Mexico City. Interviewees described reproductive planning 'without a plan' and sporadic contraceptive use. Linking of reproductive preferences and contraceptive use occurred only after raising a child for a few years or after experiencing an abortion. Interviewees described side effects of hormonal contraceptives and the intrauterine device (IUD) and problems with condoms. Only 8% of participants disagreed with abortion completely. Those with mixed views opposed abortion for pregnancies resulting from lack of responsibility or due to personal problems or concerns about one's future. However, these more controversial reasons were the primary motivations for terminating pregnancies. Females and males expressed that females made most decisions related to contraception, pregnancy and abortion. Further research could explore the reasons behind reproductive planning 'without a plan', 'on and off' contraceptive use and abortion beliefs and experiences that are somewhat contradictory.     

Latina adolescents' perceptions of their male partners' influences on childbearing: findings from a qualitative study in California

Teenage births among Latina women living in the USA remain higher than any other racial/ethnic group. This study explored the role that male partners play in the occurrence of pregnancy and their influence on teenage mothers' future plans in a sample of women pregnant with their first child. Qualitative analysis revealed that partners played a significant role in the use of contraception, timing and desire for pregnancy and young women's post-pregnancy plans for education, work and childrearing. Men's older age, concerns about contraceptive use and fertility, reluctance to use condoms, and readiness for parenthood put their partners at increased risk for pregnancy. More acculturated men were supportive of young women's educational goals in many cases, whereas less acculturated males subscribed to more rigid gender roles which required that their partners remain at home after the birth of their child. These findings have important implications for programmes that seek to reduce teenage pregnancy in the US Latino population.     

Meanings of Being Pregnant and Having Decided on Abortion: Young Swedish Women's Experiences

In-depth interviews about the experience of being pregnant and having decided on abortion were conducted with 10 young Swedish women. A phenomenological-hermeneutic study disclosed a complex life world summarised as “I'm happy about my fertility but I choose not to give life now.” Four themes were revealed: encountering an unexpected understanding of oneself and one's fertility, desiring to be understood by trusted others, trying out different positions in relation to pregnancy and abortion, and approaching planned adult motherhood. The results indicate that addressing young women's concerns about fertility might be important in reproductive care.     

Sexual experience and use of contraception among young adults in Latin America.

Although a formal public health surveillance system has not yet been established in Latin America to document the attitudes of young people toward sex education, sexual activity, and contraception and their behaviors in these areas, representative data are available from 12 household-based Young Adult Reproductive Health Surveys conducted in seven countries since 1985. The surveys indicate that the rate of sexual experience before marriage or consensual union for males is much higher than that for females, and first sexual experience occurs at a younger age for males than for females. However, from 34% to 90% of females 20-24 years of age report having had premarital sexual relations. No more than 41% of females and 31% of males report that they or their partner used contraception at first sexual experience. Less than one-third of both young men and young women could identify the most fertile period during the menstrual cycle. The results of such surveys have provided program officials and policymakers with data to plan, implement, and evaluate interventions targeted for young adults.     

Connecting Knowledge about Abortion and Sexual and Reproductive Health to Belief about Abortion Restrictions: Findings from an Online Survey

BackgroundThe objective of this research was to examine individuals' knowledge about abortion in the context of their knowledge about other sexual and reproductive health (SRH) issues, including contraception, abortion, pregnancy, and birth.MethodsDuring August 2012, we administered an online questionnaire to a randomly selected sample of 639 men and women of reproductive age (18–44 years) in the United States.FindingsRespondents reported the highest levels of perceived knowledge about SRH in general (81%), followed by pregnancy and birth (53%), contraception (48%), and abortion (35%); knowledge of specific items within each of these areas paralleled this pattern. Respondents who believe that abortion should be allowed in at least some circumstances were more likely to be correct regarding the safety and consequences of contraception and abortion. Characteristics associated with higher levels of knowledge regarding abortion-related issues included having higher levels of knowledge about non–abortion-related SRH issues and having less restrictive abortion beliefs.ConclusionsWomen and men are not well-informed about the relative safety and consequences of SRH-related experiences. Many overestimate their knowledge, and personal beliefs about abortion restrictions may influence their knowledge about the safety and consequences of abortion and contraception. Providers of SRH services should provide comprehensive evidence-based information about the risks and consequences of SRH matters during consultations, particularly in the case of abortion providers serving women who hold more restrictive abortion beliefs.     

Young Latinas and abortion: the role of cultural factors,reproductive behavior,and alternative roles to motherhood

Latina women have often been portrayed as holding strong traditional family values leading to a greater propensity for rejection of contraception and abortion. Increasingly, the literature has consistently shown that Latina women use contraception effectively when available; however, much less is known about the prevalence of abortion and the factors related to its use in this population. In this article we examine Latinas' use of abortion and identify factors affecting its use among 1,207 ever-pregnant Latina women age 14-24 recruited at two federally-funded family planning clinics in the Los Angeles metropolitan area. Only a small proportion of the young women in our sample (7.5%) had ever had an induced abortion. In multivariate analysis the variables significantly associated with past abortion included less traditional attitudes about women's roles, higher gravidity, shorter periods of sexual activity, and a higher number of lifetime sexual partners. We conclude that use of abortion among Latinas is driven by role orientation and reproductive variables.     

‘It hurts,but I don't have a choice,I'm not working and I'm sick’: decisions and experiences regarding abortion of women living with HIV in Cape Town,South Africa

Research was conducted with 36 women living with HIV in Cape Town, South Africa, regarding their decision-making about, and experiences with, abortion of unwanted pregnancies in the public health sector. Abortion intentions and decisions were explored by investigating influencing factors; knowledge of abortion policy and public health sector services; and abortion perceptions and experiences. Findings reveal that many women face censure both for becoming pregnant and terminating a pregnancy, including by family, partners, community members and healthcare providers. Data suggest that abortion may be more stigmatised than HIV despite South Africa's liberal abortion law. Generally, however, study participants were satisfied with the abortion care received. Most would advise women living with HIV to think carefully about abortion, but to make a decision in their own best interests, including only seeking care early in pregnancy from an accredited clinic. Study implications include a need to integrate information and counselling on safe legal abortion within sexual and reproductive health services, especially in efforts to integrate sexual and reproductive health into HIV care, and to forge greater linkages between HIV and abortion services more generally to ensure continuity in follow-up of care for women.     

Understanding women's experiences with medical abortion: In-depth interviews with women in two Indian clinics

Abstract

We explored women's perspectives on using medical abortion, including their reasons for selecting the method, their experiences with it and their thoughts regarding demedicalisation of part or all of the process. Sixty-three women from two urban clinics in India were interviewed within four weeks of abortion completion using a semi-structured in-depth interview guide. While women appreciated the non-invasiveness of medical abortion, other factors influencing method selection were family support and distance from the facility. The degree of medicalisation that women wanted or felt was necessary also depended on the way expectations were set by their providers. Confirmation of abortion completion was a source of anxiety for many women and led to unnecessary interventions in a few cases. Ultimately, experiences depended more on women's expectations about the method, and on the level of emotional and logistic support they received rather than on inherent characteristics of the method. These findings emphasise the circumstances under which women make reproductive choices and underscore the need to tailor service delivery to meet women's needs. Women-centred counselling and care that takes into consideration individual circumstances are needed.     

不同性别务工青少年生殖健康状况分析

目的 了解15～24岁不同性别进城务工青少年的性与生殖健康知信行状况及影响因素.方法 采用自编结构式匿名问卷对山东省济南市1 075名15～24岁进城务工青少年进行自填式问卷调查.结果 男性与女性进城务工青少年的性与生殖健康知识水平均较低,尤其流产相关知识,男性得分中位数仅25.0分;35.0%的男性认为只要双方愿意就可以发生婚前性行为,高于女性的16.1%;面对恋人性要求,男性坚持不发生性行为的比例(18.1%)远低于女性(53.1%),差异有统计学意义(χ2=141.704,P<0.001);30.7%的调查对象自我报告发生过性行为,其中男性为40.1%,女性为23.7%,差异有统计学意义(χ2=29.385,P<0.001);不同性别进城务工青少年发生婚前性行为的共同影响因素为年龄、文化程度、对避孕的态度;女性还与对婚前性行为的看法、对恋人性要求的处理方式有关.结论 为进城务工青少年提供性与生殖健康教育及服务时应考虑性别差异.