Postgraduate Experiences With an Advanced Reproductive Health and Abortion Training and Leadership Program

BACKGROUND AND OBJECTIVES

Family physicians are critical to reproductive health service provision including miscarriage management and abortion care, but many graduates report barriers in integrating these services into practice. We designed and implemented CREATE (Continuing Reproductive Education for Advanced Training Efficacy), an elective advanced training and leadership program for senior residents aimed to help new graduates integrate miscarriage and abortion care into practice.

METHODS

We surveyed all 53 program graduates at graduation, and 47 completed a follow-up survey in March 2016. We describe program graduates' current reproductive health practices and differences by respondent characteristics. We report facilitators (or enabling factors) and barriers that graduates encountered in attempting to integrate reproductive health care into practice, as well as the perceived impact of the CREATE program.

RESULTS

Forty-two percent of CREATE graduates were providing miscarriage management and 35% were providing abortion care at the time of the follow-up survey. Factors associated with abortion provision at follow-up include strength of intention to provide at graduation and higher volume of uterine aspirations performed during residency. Graduates reported a range of barriers, including internal factors such as strength of competing interests, and external barriers such as administrative and staff resistance. Graduates found the additional procedural training, networking opportunities, and the complication simulation to be the most helpful aspects of the CREATE program.

CONCLUSIONS

The CREATE program model may provide a useful template for family medicine residencies working to incorporate advanced abortion training or other advanced procedural skills into their curricula. Future curricular interventions should consider providing additional postgraduate support, particularly in provider shortage areas.

The Role of Publicly Funded Family Planning Sites In Health Insurance Enrollment

CONTEXT

Publicly funded family planning providers are well positioned to help uninsured individuals learn about health insurance coverage options and effectively navigate the enrollment process. Understanding how these providers are engaged in enrollment assistance and the challenges they face in providing assistance is important for maximizing their role in health insurance outreach and enrollment.

METHODS

In 2014, some 684 sites participating in California's family planning program were surveyed about their involvement in helping clients enroll in health insurance. Weighted univariate and bivariate analyses were conducted to examine enrollment activities and perceived barriers to facilitating enrollment by site characteristics.

RESULTS

Most family planning program sites provided eligibility screening (68%), enrollment education (77%), on-site enrollment assistance (55%) and referrals for off-site enrollment support (91%). The proportion of sites offering each type of assistance was highest among community clinics (83-96%), primary care and multispecialty sites (65-95%), Title X-funded sites (72-98%), sites with contracts to provide primary care services (64-93%) and sites using only electronic health records (66-94%). Commonly identified barriers to providing assistance were lack of staff time (reported by 52% of sites), lack of funding (47%), lack of physical space (34%) and lack of staff knowledge (33%); only 20% of sites received funding to support enrollment activities.

CONCLUSIONS

Although there were significant variations among them, publicly funded family planning providers in California are actively engaged in health insurance enrollment. Supporting their vital role in enrollment could help in the achievement of universal health insurance coverage.

Women's Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study

IMPORTANCE

The idea that abortion leads to adverse psychological outcomes has been the basis for legislation mandating counseling before obtaining an abortion and other policies to restrict access to abortion.

OBJECTIVE

To assess women's psychological well-being 5 years after receiving or being denied an abortion.

DESIGN, SETTING, AND PARTICIPANTS

This study presents data from the Turnaway Study, a prospective longitudinal study with a quasi-experimental design. Women were recruited from January 1, 2008, to December 31, 2010, from 30 abortion facilities in 21 states throughout the United States, interviewed via telephone 1 week after seeking an abortion, and then interviewed semiannually for 5 years, totaling 11 interview waves. Interviews were completed January 31, 2016. We examined the psychological trajectories of women who received abortions just under the facility's gestational limit (near-limit group) and compared them with women who sought but were denied an abortion because they were just beyond the facility gestational limit (turnaway group, which includes the turnaway-birth and turnaway-no-birth groups). We used mixed effects linear and logistic regression analyses to assess whether psychological trajectories differed by study group.

MAIN OUTCOMES AND MEASURES

We included 6 measures of mental health and well-being: 2 measures of depression and 2 measures of anxiety assessed using the Brief Symptom Inventory, as well as self-esteem, and life satisfaction.

RESULTS

Of the 956 women (mean [SD] age, 24.9 [5.8] years) in the study, at 1 week after seeking an abortion, compared with the near-limit group, women denied an abortion reported more anxiety symptoms (turnaway-births, 0.57; 95% CI, 0.01 to 1.13; turnaway-no-births, 2.29; 95% CI, 1.39 to 3.18), lower self-esteem (turnaway-births, -0.33; 95% CI, -0.56 to -0.09; turnaway-no-births, -0.40; 95% CI, -0.78 to -0.02), lower life satisfaction (turnaway-births, -0.16; 95% CI, -0.38 to 0.06; turnaway-no-births, -0.41; 95% CI, -0.77 to -0.06), and similar levels of depression (turnaway-births, 0.13; 95% CI, -0.46 to 0.72; turnaway-no-births, 0.44; 95% CI, -0.50 to 1.39).

CONCLUSIONS AND RELEVANCE

In this study, compared with having an abortion, being denied an abortion may be associated with greater risk of initially experiencing adverse psychological outcomes. Psychological well-being improved over time so that both groups of women eventually converged. These findings do not support policies that restrict women's access to abortion on the basis that abortion harms women's mental health.

Adolescent Latino Reproductive Health: A Review of the Literature

Latino adolescent reproductive health has become an increasingly important topic because of the growth in the numbers of Latino youth and because Latino youth are at high risk for negative reproductive health outcomes. Latinas now have the highest teen birth rates, and Latinos have disproportionately high rates of HIV/AIDS. These trends highlight the need for greater understanding of the sexual and reproductive health and behavior of Latino youth. This overview provides an introduction to key aspects of the Latino population. It then examines and synthesizes the existing literature by domains useful to the study of Latinos. Areas that receive in-depth coverage are socioeconomic status, family, national origin, peers and partners, and acculturation. Based on the current state of knowledge and the issues facing young Latinos, suggestions for future research and uses for existing data and past research are included.

Does abortion increase women's risk for post-traumatic stress? Findings from a prospective longitudinal cohort study

OBJECTIVE

To prospectively assess women's risk for post-traumatic stress disorder (PTSD) and of experiencing post-traumatic stress symptoms (PTSS) over 4 ears after seeking an abortion, and to assess whether symptoms are attributed to the pregnancy, abortion or birth, or other events in women's lives.

DESIGN

Prospective longitudinal cohort study which followed women from approximately 1 week after receiving or being denied an abortion (baseline), then every 6 months for 4 years (9 interview waves).

SETTING

30 abortion facilities located throughout the USA.

PARTICIPANTS

Among 956 women presenting for abortion care, some of whom received an abortion and some of whom were denied due to advanced gestational age; 863 women are included in the longitudinal analyses.

MAIN OUTCOME MEASURES

PTSS and PTSD risk were measured using the Primary Care PTSD Screen (PC-PTSD). Index pregnancy-related PTSS was measured by coding the event(s) described by women as the cause of their symptoms.

ANALYSES

We used unadjusted and adjusted logistic mixed-effects regression analyses to assess whether PTSS, PTSD risk and pregnancy-related PTSS trajectories of women obtaining abortions differed from those who were denied one.

RESULTS

At baseline, 39% of participants reported any PTSS and 16% reported three or more symptoms. Among women with symptoms 1-week post-abortion seeking (n=338), 30% said their symptoms were due to experiences of sexual, physical or emotional abuse or violence; 20% attributed their symptoms to non-violent relationship issues; and 19% said they were due to the index pregnancy. Baseline levels of PTSS, PTSD risk and pregnancy-related PTSS outcomes did not differ significantly between women who received and women who were denied an abortion. PTSS, PTSD risk and pregnancy-related PTSS declined over time for all study groups.

CONCLUSIONS

Women who received an abortion were at no higher risk of PTSD than women denied an abortion.

The effect of abortion on having and achieving aspirational one-year plans

Background

Women commonly report seeking abortion in order to achieve personal life goals. Few studies have investigated whether an abortion enables women to achieve such goals.

Methods

Data are from the Turnaway Study, a prospective cohort study of women recruited from 30 abortion facilities across the US. The sample included women in one of four groups: Women who presented for abortion just over the facility’s gestational limit, were denied an abortion and went on to parent the child (Parenting Turnaways, n = 146) or did not parent (Non-Parenting Turnaways, n = 64), those who presented just under the facility’s gestational limit and received an abortion (Near-Limits, n = 413) and those who presented in the first trimester and received an abortion (First Trimesters, n = 254). Participants were interviewed by telephone one week, six months and one year after they sought an abortion. We used mixed effects logistic regression to assess the relationship between receiving versus being denied abortion and having an aspirational one year goal and achieving it.

Results

The 757 participants in this analysis reported a total of 1,304 one-year plans. The most common one-year plans were related to education (21.3 %), employment (18.9 %), other (16.3 %), and change in residence (10.4 %). Most goals (80 %) were aspirational, defined as a positive plan for the next year. First Trimesters and Near-Limits were over 6 times as likely as Parenting Turnaways to report aspirational one-year plans [Adjusted Odds Ratio (AOR) = 6.37 and 6.56 respectively, p < 0.001 for both]. Among all plans in which achievement was measurable (n = 1,024, 87 %), Near-Limits (45.6 %, AOR = 1.91, p = 0.003) and Non-Parenting Turnaways (47.9 %, AOR = 2.09, p = 0.026) were more likely to have both an aspirational plan and to have achieved it than Parenting Turnaways (30.4 %).

Conclusions

These findings suggest that ensuring women can have a wanted abortion enables them to maintain a positive future outlook and achieve their aspirational life plans.

Projections and opinions from 100 experts in long-acting reversible contraception

OBJECTIVE

This survey of published researchers of long-acting reversible contraceptives (LARCs) examines their opinions about important barriers to LARC use in the United States (US), projections for LARC use in the absence of barriers and attitudes toward incentives for clinicians to provide and women to use LARC methods.

STUDY DESIGN

We identified 182 authors of 59 peer-reviewed papers on LARC use published since 2013. A total of 104 completed an internet survey. We used descriptive and multivariate analyses to assess LARC use barriers and respondent characteristics associated with LARC projections and opinions.

RESULTS

The most commonly identified barrier was the cost of the device (63%), followed by women's knowledge of safety, method acceptability and expectations about use. A shortage of trained providers was a commonly cited barrier, primarily of primary care providers (49%). Median and modal projections of LARC use in the absence of these barriers were 25-29% of contracepting women. There was limited support for provider incentives and almost no support for incentives for women to use LARC methods, primarily out of concern about coercion.

CONCLUSIONS

Clinical and social science LARC experts project at least a doubling of the current US rate of LARC use if barriers to method provision and adoption are removed. While LARC experts recognize the promise of LARC methods to better meet women's contraceptive needs, they anticipate that the majority of US women will not choose LARC methods. Reducing unintended pregnancy rates will depend on knowledge, availability and use of a wider range of methods of contraception to meet women's individual needs.

IMPLICATIONS

Efforts to increase LARC use need to meet the dual goals of increasing access to LARC methods and protecting women's reproductive autonomy. To accomplish this, we need reasonable expectations for use, provider training, low-cost devices and noncoercive counseling, rather than incentives for provision or use.

Mental Health Diagnoses 3 Years After Receiving or Being Denied an Abortion in the United States

OBJECTIVES

We set out to assess the occurrence of new depression and anxiety diagnoses in women 3 years after they sought an abortion.

METHODS

We conducted semiannual telephone interviews of 956 women who sought abortions from 30 US facilities. Adjusted multivariable discrete-time logistic survival models examined whether the study group (women who obtained abortions just under a facility's gestational age limit, who were denied abortions and carried to term, who were denied abortions and did not carry to term, and who received first-trimester abortions) predicted depression or anxiety onset during seven 6-month time intervals.

RESULTS

The 3-year cumulative probability of professionally diagnosed depression was 9% to 14%; for anxiety it was 10% to 15%, with no study group differences. Women in the first-trimester group and women denied abortions who did not give birth had greater odds of new self-diagnosed anxiety than did women who obtained abortions just under facility gestational limits.

CONCLUSIONS

Among women seeking abortions near facility gestational limits, those who obtained abortions were at no greater mental health risk than were women who carried an unwanted pregnancy to term.

A comparison of depression and anxiety symptom trajectories between women who had an abortion and women denied one

BACKGROUND

This study prospectively assesses the mental health outcomes among women seeking abortions, by comparing women having later abortions with women denied abortions, up to 2 years post-abortion seeking.

METHOD

We present the first 2 years of a 5-year telephone interview study that is following 956 women who sought an abortion from 30 facilities throughout the USA. We use adjusted linear mixed-effects regression analyses to assess whether symptoms of depression and anxiety, as measured by the Brief Symptom Inventory-short form and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, differ over time among women denied an abortion due to advanced gestational age, compared with women who received abortions.

RESULTS

Baseline predicted mean depressive symptom scores for women denied abortion (3.07) were similar to women receiving an abortion just below the gestational limit (2.86). Depressive symptoms declined over time, with no difference between groups. Initial predicted mean anxiety symptoms were higher among women denied care (2.59) than among women who had an abortion just below the gestational limit (1.91). Anxiety levels in the two groups declined and converged after 1 year.

CONCLUSIONS

Women who received an abortion had similar or lower levels of depression and anxiety than women denied an abortion. Our findings do not support the notion that abortion is a cause of mental health problems.

Potential public sector cost-savings from over-the-counter access to oral contraceptives

OBJECTIVE

This study estimates how making oral contraceptive pills (OCPs) available without a prescription may affect contraceptive use, unintended pregnancies and associated contraceptive and pregnancy costs among low-income women.

STUDY DESIGN

Based on published figures, we estimate two scenarios [low over-the-counter (OTC) use and high OTC use] of the proportion of low-income women likely to switch to an OTC pill and predict adoption of OCPs according to the out-of-pocket costs per pill pack. We then estimate cost-savings of each scenario by comparing the total public sector cost of providing OCPs OTC and medical care for unintended pregnancy.

RESULTS

Twenty-one percent of low-income women at risk for unintended pregnancy are very likely to use OCPs if they were available without a prescription. Women's use of OTC OCPs varies widely by the out-of-pocket pill pack cost. In a scenario assuming no out-of-pocket costs for the over-the counter pill, an additional 11-21% of low-income women will use the pill, resulting in a 20-36% decrease in the number of women using no method or a method less effective than the pill, and a 7-25% decrease in the number of unintended pregnancies, depending on the level of use and any effect on contraceptive failure rates.

CONCLUSIONS

If out-of-pocket costs for such pills are low, OTC access could have a significant effect on use of effective contraceptives and unintended pregnancy. Public health plans may reduce expenditures on pregnancy and contraceptive healthcare services by covering oral contraceptives as an OTC product.

IMPLICATIONS

Interest in OTC access to oral contraceptives is high. Removing the prescription barrier, particularly if pill packs are available at low or zero out-of-pocket cost, could increase the use of effective methods of contraception and reduce unintended pregnancy and healthcare costs for contraceptive and pregnancy care.

Risk of violence from the man involved in the pregnancy after receiving or being denied an abortion

BACKGROUND

Intimate partner violence is common among women having abortions, with between 6% and 22% reporting recent violence from an intimate partner. Concern about violence is a reason some pregnant women decide to terminate their pregnancies. Whether risk of violence decreases after having an abortion, remains unknown.

METHODS

Data are from the Turnaway Study, a prospective cohort study of women seeking abortions at 30 facilities across the U.S. Participants included women who: presented just prior to a facility's gestational age limit and received abortions (Near Limit Abortion Group, n = 452), presented just beyond the gestational limit and were denied abortions (Turnaways, n = 231), and received first trimester abortions (First Trimester Abortion Group, n = 273). Mixed effects logistic regression was used to assess the relationship between receiving versus being denied abortion and subsequent violence from the man involved in the pregnancy over 2.5 years.

RESULTS

Physical violence decreased for Near Limits (adjusted odds ratios (aOR), 0.93 per month; 95% Confidence Interval (CI) 0.90, 0.96), but not Turnaways who gave birth (P < .05 versus Near Limits). The decrease for First Trimesters was similar to Near Limits (P = .324). Psychological violence decreased for all groups (aOR, 0.97; CI 0.94, 1.00), with no differential change across groups.

CONCLUSIONS

Policies restricting abortion provision may result in more women being unable to terminate unwanted pregnancies, potentially keeping them in contact with violent partners, and putting women and their children at risk.

Perceived stress and emotional social support among women who are denied or receive abortions in the United States: a prospective cohort study

BACKGROUND

Examining women's stress and social support following denial and receipt of abortion furthers understanding of the effects of unwanted childbearing and abortion on women's well-being. This study investigated perceived stress and emotional social support over time among women who were denied wanted abortions and who received abortions, and compared outcomes between the groups.

METHODS

The Turnaway Study is a prospective cohort study of women who sought abortions at 30 abortion facilities across the United States, and follows women via semiannual phone interviews for five years. Participants include 956 English or Spanish speaking women aged 15 and over who sought abortions between 2008 and 2010 and whose gestation in pregnancy fit one of three groups: women who presented up to three weeks beyond a facility's gestational age limit and were denied an abortion; women presenting within two weeks below the limit who received an abortion; and women who received a first trimester abortion. The outcomes were modified versions of the Perceived Stress Scale and the Multidimensional Scale of Perceived Social Support. Longitudinal mixed effects models were used to assess differences in outcomes between study groups over 30 months.

RESULTS

Women denied abortions initially had higher perceived stress than women receiving abortions near gestational age limits (1.0 unit difference on 0-16 scale, P = 0.003). Women receiving first-trimester abortions initially had lower perceived stress than women receiving abortions near gestational age limits (0.6 difference, P = 0.045). By six months, all groups' levels of perceived stress were similar, and levels remained similar through 30 months. Emotional social support scores did not differ among women receiving abortions near gestational limits versus women denied abortions or women having first trimester abortions initially or over time.

CONCLUSIONS

Soon after being denied abortions, women experienced higher perceived stress than women who received abortions. The study found no longer-term differences in perceived stress or emotional social support between women who received versus were denied abortions.

Does abortion reduce self-esteem and life satisfaction?

Purpose

This study aims to assess the effects of obtaining an abortion versus being denied an abortion on self-esteem and life satisfaction.

Methods

We present the first 2.5 years of a 5-year longitudinal telephone-interview study that follows 956 women who sought an abortion from 30 facilities across the USA. We examine the self-esteem and life satisfaction trajectories of women who sought and received abortions just under the facility’s gestational age limit, of women who sought and received abortions in their first trimester of pregnancy, and of women who sought abortions just beyond the facility gestational limit and were denied an abortion. We use adjusted mixed effects linear regression analyses to assess whether the trajectories of women who sought and obtained an abortion differ from those who were denied one.

Results

Women denied an abortion initially reported lower self-esteem and life satisfaction than women who sought and obtained an abortion. For all study groups, except those who obtained first trimester abortions, self-esteem and life satisfaction improved over time. The initially lower levels of self-esteem and life satisfaction among women denied an abortion improved more rapidly reaching similar levels as those obtaining abortions at 6 months to one year after abortion seeking. For women obtaining first trimester abortions, initially higher levels of life satisfaction remained steady over time.

Conclusions

There is no evidence that abortion harms women’s self-esteem or life satisfaction in the short term.

Limited socioeconomic opportunities and Latina teen childbearing: a qualitative study of family and structural factors affecting future expectations

The decrease in adolescent birth rates in the United States has been slower among Latinas than among other ethnic/racial groups. Limited research has explored how socioeconomic opportunities influence childbearing among Latina adolescents. We conducted in-depth interviews with 65 pregnant foreign- and US-born Latina women (31 adolescents; 34 adults) in two California counties. We assessed perceived socioeconomic opportunities and examined how family, immigration and acculturation affected the relationships between socioeconomic opportunities and adolescent childbearing. Compared with women who delayed childbearing into adulthood, pregnant adolescents described having few resources for educational and career development and experiencing numerous socioeconomic and social barriers to achieving their goals. Socioeconomic instability and policies limiting access to education influenced childbearing for immigrant adolescents. In contrast, family disintegration tied to poverty figured prominently in US-born adolescents' childbearing. Limited socioeconomic opportunities may play a large role in persistently high pregnancy rates among Latina adolescents.

Understanding why women seek abortions in the US

BACKGROUND

The current political climate with regards to abortion in the US, along with the economic recession may be affecting women's reasons for seeking abortion, warranting a new investigation into the reasons why women seek abortion.

METHODS

Data for this study were drawn from baseline quantitative and qualitative data from the Turnaway Study, an ongoing, five-year, longitudinal study evaluating the health and socioeconomic consequences of receiving or being denied an abortion in the US. While the study has followed women for over two full years, it relies on the baseline data which were collected from 2008 through the end of 2010. The sample included 954 women from 30 abortion facilities across the US who responded to two open ended questions regarding the reasons why they wanted to terminate their pregnancy approximately one week after seeking an abortion.

RESULTS

Women's reasons for seeking an abortion fell into 11 broad themes. The predominant themes identified as reasons for seeking abortion included financial reasons (40%), timing (36%), partner related reasons (31%), and the need to focus on other children (29%). Most women reported multiple reasons for seeking an abortion crossing over several themes (64%). Using mixed effects multivariate logistic regression analyses, we identified the social and demographic predictors of the predominant themes women gave for seeking an abortion.

CONCLUSIONS

Study findings demonstrate that the reasons women seek abortion are complex and interrelated, similar to those found in previous studies. While some women stated only one factor that contributed to their desire to terminate their pregnancies, others pointed to a myriad of factors that, cumulatively, resulted in their seeking abortion. As indicated by the differences we observed among women's reasons by individual characteristics, women seek abortion for reasons related to their circumstances, including their socioeconomic status, age, health, parity and marital status. It is important that policy makers consider women's motivations for choosing abortion, as decisions to support or oppose such legislation could have profound effects on the health, socioeconomic outcomes and life trajectories of women facing unwanted pregnancies.

Interest in a pericoital pill among women in family planning and abortion clinics

BACKGROUND

The purpose of this study was to determine whether women might be interested in repeated use of a pericoital pill, a pill taken around the time of each act of intercourse.

STUDY DESIGN

We surveyed women from abortion (n=635) and family planning (n=981) clinics regarding their interest in using a pericoital pill.

RESULTS

Over two thirds (69%) of abortion and 50% of family planning clients said they would definitely or probably be interested in a pericoital pill. Significant predictors of interest in a pericoital pill included race/ethnicity, ease of getting a birth control prescription, frequent unprotected intercourse and seeking abortion services.

CONCLUSION

More work is needed to establish the effectiveness of a pericoital pill and determine how frequently a pericoital pill might be used by women who currently have unprotected intercourse.

Educational barriers, social isolation, and stable romantic relationships among pregnant immigrant Latina teens

Latina teen birth rates, particularly those of immigrant Latinas, surpass those of any major racial/ ethnic group. Little is known about how immigration experiences influence early childbearing. Fourteen pregnant Latina immigrant teens were interviewed regarding their feelings about pregnancy and birth control, educational and vocational expectations, and their partners' influences. Common themes included feelings of isolation, barriers to education and future opportunities, and a heavy reliance on partners as a stable source of emotional and financial support, all of which appeared to influence teens' desire for pregnancy. Findings suggest the need to help immigrant youth overcome barriers to education and work and to offer them culturally and linguistically appropriate clinical care including birth control information and services, preconception and prenatal care, and assistance navigating the system.

Unprotected intercourse among women wanting to avoid pregnancy: attitudes, behaviors, and beliefs

OBJECTIVE

To better understand the behaviors associated with unintended pregnancy, including the frequency and reasons why women engage in unprotected intercourse (UI), to help guide efforts to prevent unintended pregnancy.

METHODS

We surveyed 1,392 women with no history of abortion in 13 family planning clinics across the United States regarding the frequency with which they engaged in UI, the reasons for engaging in UI, attitudes toward UI, and their knowledge about the risks of conception.

RESULTS

Nearly half (46%) of respondents engaged in UI within the past 3 months, mostly owing to barriers accessing birth control (49%), not planning to have sex (45%), and the belief that they could not get pregnant (42%). The most prevalent attitudes about UI were that it "feels better" (42%) or "more natural" (41%). Factors associated with an increased odds of having engaged in UI, included holding the views that UI is okay at certain times, feels better, and is more natural, underestimating the risk of conception from 1 year of UI, experiencing difficulty getting birth control prescriptions, having less than a college education, being ages 20 to 24, and being African American/Black.

CONCLUSION

Compared with our research on abortion clients, family planning clients report high, yet somewhat lower, rates of UI, similar reasons for having UI, and misconceptions about the risk of conception from repeated acts of UI. Long-acting, reversible contraception may offer some of the benefits of UI in terms of spontaneity and pleasure, while reducing women's pregnancy risk.

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.

Estimating the fertility effect of expansions of publicly funded family planning services in California

OBJECTIVE

To estimate the number of unintended pregnancies averted through the provision of family planning services to low income women in Family PACT, California's Medicaid waiver program.

STUDY DESIGN

We use a Markov model to estimate the number of pregnancies in the absence of Family PACT based on the contraceptive method mix used before program enrollment, and pregnancies in the presence of the program, based on method dispensing claims.

RESULTS

Nearly 1 million (998,084) women were provided with contraceptives in Family PACT in 2007. Contraceptive services averted over an estimated 286,700 unintended pregnancies including 122,000 abortions, 133,000 unintended births, and over 40,000 births among teens.

CONCLUSION

This conservative measure of the effect of Family PACT on unintended pregnancies indicates the benefit of expanding access to contraceptive services, an example for other states considering expanding access to family planning services through a state plan amendment under health care reform.

Willingness to have unprotected sex

Little is known about people's willingness to engage in sex without protection from unwanted pregnancy. This study surveyed 1,497 women and men at 75 clinics and physician offices across California after their reproductive health care visits in late 2007 and early 2008. When asked if they would have sex without contraception, 30% said definitively that yes, they would have unprotected sex, and 20% indicated they would "sometimes" or "maybe" engage in unprotected sex. In multivariate models, compared to non-Latino White respondents, Latinos who responded to the survey in English were 52% more likely and African Americans were 75% more likely to report willingness to have unprotected intercourse. Wanting a child within the next three years was associated with increased willingness to have unprotected sex. Age, gender, parity, and relationship status were not significant in multivariate models. A considerable proportion of women and men may be willing to have unprotected sex, even with access to subsidized contraceptive services and even when recently counseled about birth control. The dominant behavioral models of contraceptive use need to acknowledge the widespread likelihood of occasional unprotected sex, even among people motivated to usually use contraceptives. Findings underscore the need to make contraceptive methods accessible, easy to use, and even pleasurable.

Factors Associated With Delayed Childbearing: From the Voices of Expectant Latina Adults and Teens in California

There has been limited research on the protective factors that help Latinas delay childbearing until adulthood. In-depth interviews were conducted with 65 pregnant Latina teenage and adult women in California who were about to have their first child. Lack of or inconsistent birth control use as teens was attributed to wanting or ambivalence toward childbearing, concern about contraceptive side effects and infertility, and/or inadequate contraceptive information. Parental influence was cited as the primary reason for avoiding teen childbearing, as well as the feeling that a baby would have interfered with life plans. Close parental supervision and positive relationships with parents appeared to protect some adults from teen childbearing. The findings from this study point to the need to improve Latinos’ birth control knowledge and strengthen parents’ ability to establish supportive relationships with their children.