Race and Reproductive Politics: An Editorial

In Race, Reproductive Politics and Reproductive Healthcare in the Contemporary United States, an editorial published in Contraception, authors Carole Joffe and Willie Parker discuss how the United States, a country marked by extreme stratification on both racial and economic grounds, has had a history of both targeting the birth rates of people of color while also fueling deep political divisions about the provision of reproductive healh services – particularly abortion and contraception.

The authors discuss their dismay at the contemporary state of reproductive politics in the United States, particularly the manipulation of racial themes by opponents of abortion and birth control.  However, they reference the “mixed legacy” of the United States history and acknowledge the complexity of alandscape “containing both liberatory and coercive possibilities, and always with particular implications for people of color in a white-dominated society.” Ultimately, the authors warn against the “manipulation of the history of race and reproduction by those involved in the [recent anti-abortion] billboard campaigns” and similar efforts which obscure “the contemporary facts of life faced by the most vulnerable black women.”

The authors note that the current climate has galvanized a countermovement of health activists  and they see hope for women’s reproductive rights. At the same time, the authors conclude that “the stakes in this “war” are inevitably the highest for the most vulnerable in our society; Parker calls on fellow health care providers “to trust women to make the good and tough decisions about when and whether to expand their families” and assure them the resources to do so.

Adolescent Initiation of Sexual Activity

In Sexual Timetables for Oral-Genital, Vaginal and Anal Intercourse: Sociodemographic Comparisons in a Nationally Representative Sample of Adolescents, published in The American Journal of Public Health, authors Carolyn Tucker Halpern and Abigail Haydon documented the relative timing and prevalence of three types of intercourse: oral-genital, vaginal, and anal, examining whether these timetables varied by sociodemographic factors.

The authors utilized data from National Longitudinal Study of Adolescent Health respondents to generate prevalence estimates for adolescents who reached age 18 years by 2001, examining sociodemographic correlates of sexual patterns.

Authors found that 1 in 5 adolescents did not engage in any of the aforementioned sexual behaviors by age 18 years, while over two thirds reported vaginal or oral-genital sexual activity.  Roughly half of respondents experienced both.  Only 10 percent of individuals reported having had an anal intercourse experience.  Authors concluded that most of the examined sociodemographic characteristics were uniquely associated with prevalence and sexual timing.

Disparities in Reproductive Care Among Urban and Rural Women

In Primary Care Physician’s Perceptions of Barriers To Preventive Reproductive Health Care in Rural Communities [PDF], published in Perspectives on Sexual and Reproductive Health, authors Cynthia H. Chuang, et al, sought to investigate the disparities in reproductive health care between urban and rural women.

Findings suggest that expanding access to preventive reproductive health services in rural areas may not be sufficient to improve use of contraceptive services and preconception care.  Raising public awareness of the importance of pregnancy planning and good preconception health is needed.

In 2010, authors conducted semistructured interviews with 19 rural primary care physicians in central Pennsylvania regarding their experiences in two domains of preventive reproductive health—contraceptive care and preconception care. Physicians perceived that they had a greater role in providing contraceptive care than did nonrural physicians and that contraceptives were widely accessible to patients in their communities; however, the scope of contraceptive services that were provided by each individual provider varied greatly.  Physicians also perceived rural community norms of unintended pregnancies, large families, and indifference toward career and educational goals for young women as the biggest barriers to both contraceptive and preconception care, as these issues predicted a lack of interest in family planning.

Study findings point to the importance of encouraging primary care physicians to take a more proactive role in promoting preventive reproductive health care.  This could be accomplished through continuing education programs and skills-building workshops to increase both provider knowledge about client self-efficacy for reproductive health counseling.

HIV Testing in Variety of Clinical Settings

In Supporting the Integration of HIV Testing into Primary Care Settings, published in The American Journal of Public Health, authors Janet J. Myers, et al, examined the efforts of the US network of AIDS Education and Training Centers (AETCs) to increase HIV testing capacity across a variety of clinical settings.

Authors utilized quantitative process data from 8 regional AETCs from 2008 and 2009, along with qualitative program descriptions to demonstrate how AETC education helped providers integrate HIV testing into routine clinical care with the goals of being able to diagnosis an infection as early as possible and providing treatment.

When compared with other AETC training, results indicated that HIV testing training was generally longer and utilized a broader variety of strategies to educate more providers per training.  It was also found that educational trainings did provide a platform for providers to master comprehension of their primary care responsibility to address public health concerns through HIV testing.  These AETC efforts illustrate not only how integration of the principles of primary care and public health can be promoted through professional training, but how integral these skills are to comprehensive and well-rounded clinical care practice.

Oral Contraception Linked to Women’s Wage Gains

In The Opt-In Revolution? Contraception and the Gender Gap in Wages, by Bailey et al., published in the National Bureau of Economic Research, reports that from 1979 to 1989, median wage and salary earnings of full-time, working women increased from approximately 60% of men’s earnings to 69% of men’s earnings.  This marked a striking departure from the stability of women’s relative pay during the 1970s, narrowing the wage gap during the 1980s.  Authors utilized data from the National Longitudinal Survey of Young Women, which includes interviews starting in 1968 with 5,159 women ages 14 through 24, with 21 follow-up interviews.

Authors examined state-level variation within birth cohorts for early legal access (ELA) to the pill, and although the timing of ELA implementation differed significantly from state to state, every state gave physicians the ability to prescribe the pill to unmarried women younger than age 21 without parental consent.  The researchers used respondents’ legal state of residence at age 21 to determine whether they would have had ELA.  Authors then utilized the 1970 National Fertility Survey, which includes data on ever-married women’s pill use during the 1960s, in order to specifically look at pill use among women who were married by 1970 and those who were ages 18 through 21 before 1970.

Researchers determined that although the hourly and annual wages of women who had ELA were lower in their early 20s than the earnings of women who did not have ELA, “their wage and salary earnings grew more rapidly than their counterparts as they aged.”  Specifically, the researchers found that women ages 20 through 24 with ELA earned 3% less hourly and 9% less annually, compared with their peers. Read more of this post

How Educated are Medical Providers on Medical Abortion?

In Knowledge of Medication Abortion Among Adolescent Medical Providers, published in The Journal of Adolescent Health, authors Mandy S. Coles, et al, sought to understand whether providers caring for adolescents have the knowledge to counsel accurately on medication abortion, a suitable option for many teenagers seeking to terminate a pregnancy.

An online survey related to medication abortion was administered to U.S. providers in the Society for Adolescent Health and Medicine.  Authors evaluated the knowledge of medication abortion by reported adolescent medicine fellowship training, and to compare responses to specific knowledge questions by medication abortion counseling.  They also examined the relationship between providers’ self-assessed and actual knowledge.

Authors surveyed 797 total providers.  About 25% of respondents incorrectly believed that medication abortion was not very safe, 40% misidentified that it was < 95% effective, and 32% did not select the correct maximum recommended gestational age (7–9 weeks).  However, providers had difficulty identifying that serious complications of medication abortion are rare, and those who counseled on medication abortion had more accurate information in all knowledge categories, except for expected outcomes.  Medication abortion knowledge did not differ by adolescent medicine fellowship completion. In total, only thirty two percent of those surveyed were identified as having “very good knowledge.”

The authors concluded that knowledge regarding medication abortion safety, effectiveness, expected outcomes, and complications is suboptimal even among adolescent medicine fellowship trained physicians.  In order to ensure pregnant teenagers receive accurate counseling on all options, adolescent medicine providers need better education on medication abortion.

U.S. Second Trimester Abortions: Who Is Most Likely To Have Them?

In Who Has Second Trimester Abortions in the United States? [PDF] published in Contraception, authors Rachel K. Jones and Lawrence B. Finer looked at a national sample of 9493 women who obtained abortions in 2008.  They examined and compared the demographic characteristics of women having abortions at 13 or more weeks since their last menstrual period (LMP) and women having abortions at 13–15 weeks since their LMP.

The authors found that 10.3% of abortions in the United States were 13 weeks LMP or later, including 4.0% at 16+ weeks, and that the individuals most likely to have abortions at 13 weeks or later included black women, women with less education, those using health insurance to pay for the procedure and those who had experienced three or more disruptive events in the last year.  Individuals who were more likely to have an abortion at 16 weeks or later included black women, higher income women and those paying with health insurance.

Jones and Finer conclude that women, notably those with less education, would most benefit from increased availability of first-trimester abortion services, and that an increased emphasis should be placed on the provision of these services to this population.

Abortion Training Initiative in New York City Hospitals

In The New York City Mayoral Abortion Training Initiative at Public Hospitals, published in Contraception, authors Maryam Guiahi, et al, set out to describe and understand the first-ever abortion training political initiative on the provision of abortion services and abortion residency training.

In 2002, NARAL/NY obtained the support of newly elected Mayor Michael Bloomberg to integrate residency training in abortion care into the eight New York City (NYC) public hospitals that have OB/GYN training programs. The authors completed in-depth interviews with 22 participants who have knowledge of abortion training and services in the NYC public hospital system before and/or after the initiative.

In these interviews, respondents identified strategies that helped achieve renovation of abortion facilities, updating of abortion services and protocols, and training of abortion providers. The initiative led to the introduction of several modern abortion methods including medication abortion and MVAs for first-trimester abortions and D&Es for second-trimester abortion. The initiative also expanded the provision of immediate postabortion contraception. Respondents also identified public health impacts including improvement of abortion services, empowerment of abortion providers, and legitimization of abortion training and services.

Authors concluded that this political initiative should be a model for other city governments to influence obstetrics and gynecology resident training and the provision of abortion services.

Tailored Health Messaging Improves Contraceptive Adherance

In Tailored Health Messaging Improves Contraceptive Continuation and Adherence: Results from a Randomized Controlled Trial, published in Contraception, authors Samantha Garbers, et al, conducted interventions to improve contraceptive method continuation and adherence, given that discontinuation and incorrect use of contraceptive methods may contribute to as many as 1 million unintended pregnancies annually in the United States.

The authors conducted a randomized controlled trial of 224 patients at two family planning sites which tested the efficacy of a computer-based contraceptive assessment module in increasing the proportion of patients who continued use of their chosen contraceptive method 4 months after the family planning visit.

Results indicated that family planning patients who used the module and received individually tailored health materials were significantly more likely to continue use of their chosen contraceptive method [95% compared to 77%; odds ratio (OR)=5.48; 95% confidence interval (CI): 1.72–17.42] and to adhere to this method (86% compared to 69%; OR=2.74; 95% CI: 1.21–6.21). No significant differences in these outcomes were found for participants who used the module but did not receive tailored materials when compared to the control group.

The authors concluded that tailored health materials significantly improved contraceptive method continuation and adherence, but noted that additional research on the impact of the intervention on continuation and adherence in a larger sample and over a longer follow-up period is merited.

Contraceptive Care in the Veterans Healthcare System

In Contraceptive Care in the VA Healthcare System,published in Contraception, authors Sonya Borrero, et al, highlight how little is known about contraceptive care within the Veterans Affairs (VA) health care system.  This study was conducted to assess the prevalence of documented contraception by race and ethnicity within the VA and to examine the association between receiving primary care in women’s health clinics (WHCs) and having a documented contraceptive method.

The authors examined data from 103,950 female veterans aged 18-45 years from the year 2008.  Attention was paid to the associations between race/ethnicity and receipt of care in a WHC with having a method of contraception.

Results indicated that a meager 22% of women veterans had a documented method of contaception during 2008. Hispanic and African-American women were significantly less likely to have a method compared to whites, and women who went to WHC’s were significantly more likely to have a method of contraception compared to women who went to traditional primary care clinics.

The authors concluded that overall contraceptive prevalance in the VA is low, but receiving care in a WHC is associated with a significantly higher likelihood of having a contraceptive method.