jueves, 11 de junio de 2009

Power dynamics within relationships may play a role in sexual risk-taking

News from The Guttmacher Institute * -Power dynamics in heterosexual relationships—which partner has the higher income, greater control over sexual and contraceptive decisions, and the stronger commitment to the relationship—may play a role in couples’ decisions to engage in risky behavior, according to “Sexual Risk-Taking Among Adult Dating Couples in the United States,”by John O. G. Billy et al., published in the June 2009 issue of Perspectives on Sexual and Reproductive Health. The authors measured risky behavior by looking at whether couples had had recent anal sex and whether they had done anything to protect themselves from STDs.

According to the new analysis of data collected from 335 dating heterosexual couples participating in the National Couples Survey, couples’ sexual behaviors are not completely controlled by either partner. Several characteristics of each partner are related to risk-taking. However, some of these—having known someone with AIDS, having had an STD and perceiving that getting AIDS would be bad—are linked to risky behavior only if the partner reporting these characteristics has enough power in the relationship to influence the sexual situation.

The analysis found that couples of lower education and income levels, couples in which the female partner has had a greater number of sexual partners and couples in which the male partner has a more traditional gender role ideology have an elevated likelihood of engaging in anal sex. By contrast, couples in which the female perceives a high risk of getting AIDS are less likely than others to engage in anal sex. Couples in which the male partner has a relatively high education and income are more likely than others to do nothing to protect themselves against STDs, suggesting that couples of higher socioeconomic status perceive their risk of STD infection as lower than their poorer peers.

Although using condoms and being monogamous reduce the incidence of STDs, the authors suggest that public health efforts to encourage condom use and monogamy underestimate the difficulty people have in practicing those behaviors. Instead, Billy and colleagues suggest that couples-based interventions take into consideration relationship and power dynamics to help couples initiate and sustain safer-sex practices.

Also in this issue of Perspectives on Sexual and Reproductive Health:

Teenage women who engage in risky behavior, have unintended pregnancies or experience pregnancy problems are at increased risk of becoming involved in intimate partner violence as young adults, according to “Intimate Partner Violence Among Economically Disadvantaged Young Adult Women: Associations with Adolescent Risk-Taking and Pregnancy Experiences,” by Lydia O’Donnell et al. Twenty-nine percent of participants in the Reach for Health Longitudinal Study reported having been victims of intimate partner violence as young adults, while 21% reported having perpetrated such violence. The authors report that both behaviors are positively associated with aggressive behavior during middle school, lifetime number of sexual partners and having a history of unintended pregnancy, abortion, miscarriage or fertility problems. They recommend early interventions to help young women develop the skills they need to resolve conflicts with peers and partners, as well as greater integration of reproductive health and community violence prevention efforts.

Television portrayals of sexuality, which typically stress the positive aspects of sex rather than its potential problems and consequences, may build high expectations that are unlikely to be met by teenagers’ actual experience. According to “It’s Better on TV: Does Television Set Teenagers Up for Regret Following Sexual Initiation?by Steven C. Martino et al., 61% of females and 39% of males who had sex for the first time during a three-year longitudinal study reported that they wished they had waited to have sex, and many teens regretted more than one aspect of the experience. However, the national survey of 2,003 teens aged 12–17 found a link between exposure to sexual content on television and the likelihood of regret only for males. To help young people make more carefully considered decisions about initiating sexual activity, the authors recommend limiting teenagers’ exposure to sexual content on TV, ensuring balanced portrayals of sex in the media and helping teenagers think critically about what they see on TV.

The risk of poor outcomes of second births to teens is related to young mothers’ smoking during pregnancy, gaining too little weight while pregnant, having closely spaced pregnancies and receiving inadequate prenatal care—behaviors that may be modified with appropriate interventions—according to “Second Births to Teenage Mothers: Risk Factors for Low Birth Weight and Preterm Birth,” by Susan N. Partington et al. The authors examined data for 3,665 pairs of births to teen mothers in Milwaukee, and found a greater likelihood of preterm delivery for second than for first births. They suggest that health care providers work to identify and address modifiable health risk behaviors during routine clinic visits. They also recommend that to ensure the long-term economic well-being of both teen mothers and their children, programs encourage and support young mothers in finishing high school and pursuing higher education.

Access to emergency contraception remains a challenge for some teens in California, even if they live near pharmacies with staff who are certified to provide the method without a prescription, according to “Barriers to Adolescents’ Getting Emergency Contraception Through Pharmacy Access in California: Differences by Language and Religion,”by Olivia Sampson et al. Researchers posing as English- and Spanish-speaking teens called 115 pharmacy-access pharmacies in California in 2005–2006 to assess how easy it is for teens to access emergency contraception in a timely manner. The authors report that only 36% of calls were successful (meaning that the pharmacy staff told the caller she could come in immediately to obtain emergency contraception from a pharmacist who is certified to provide the method without a prescription). Calls to pharmacies in rural areas or by Spanish-speaking callers were less likely to be successful than were calls to urban pharmacies or by English speakers. The authors report that language, pharmacists’ availability, pharmacists’ knowledge of and clinical comfort regarding the method, and lack of communication and collaboration between pharmacists and clinicians were barriers to teens’ ability to obtain access to emergency contraception. They recommend addressing language barriers and improving cultural competency in California pharmacies, in order to improve access to both reproductive health care and health care in general.

Parental notification requirements for minors seeking abortion may be detrimental to teens’ welfare, according to “Minors’ Behavioral Responses to Parental Involvement Laws: Delaying Abortion Until Age 18,”by Silvie Colman and Ted Joyce. The authors studied abortions among teens in Texas in 1997–2003, a period that includes the implementation of the state’s parental involvement law and the immediate aftermath of that change. They found that many teens who get pregnant 3–4 months before they turn 18 put off having an abortion until after their birthday, when they are no longer subject to the requirement. As a result, the rate of second-trimester abortions has increased among this group of teens. Minors who are able to delay their abortion until age 18 to avoid parental involvement incur a substantial increase in the cost and complexity of the abortion. Given the greater costs and medical risks associated with later term abortions than with early ones, the authors recommend that policymakers considering this type of legislation take into account that parental involvement laws may reduce the well-being of teenagers.

* The Guttmacher Institute works to advance sexual and reproductive health in the United States and worldwide through an interrelated program of social science research, policy analysis and public education designed to generate new ideas, encourage enlightened public debate, promote sound policy and program development, and, ultimately, inform individual decision making. Learn more at Guttmacher.org.
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