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The role of couple negotiation in unmet need for contraception and the decision to stop childbearing in Uganda.

This study uses survey and focus-group data from the 1995-96 Negotiating Reproductive Outcomes study in Uganda to describe the nature of the decision to stop childbearing and to question the simplifying assumption of consensus decision-making implicit in much demographic research on unmet need. Negotiation is characterized in four stages, from normative precedent for decision-making to communication, disagreement, and conflict resolution. Indirect forms of communication between partners predominate, contributing to the tendency of both men and women to overestimate each other's demand for additional children. Partner opposition is found to cause a statistically significant increase in unmet need reported by women and a shift in contraceptive mix favoring use of traditional methods over modern methods. For women, partner opposition may account for as much as 20 percent of unmet need in urban areas, 12 percent in rural areas, and 15 percent overall.

Adult↗

First sexual intercourse: age, coercion, and later regrets reported by a birth cohort.

OBJECTIVES: To investigate how age at first sexual intercourse is related to the reported circumstances and to determine how these corresponded to views in early adulthood about its timing. DESIGN: Cross sectional study within a birth cohort using a questionnaire presented by computer. SETTING: Dunedin, New Zealand in 1993-4. SUBJECTS: 477 men and 458 women enrolled in the Dunedin Multidisciplinary Health and Development Study, comprising 92% of survivors of the cohort. RESULTS: The median age at first intercourse was 17 years for men and 16 years for women. Only one man (0.2%) but 30 (7%) women reported being forced to have intercourse on the first occasion. For women, there were increasing rates of coercion with younger age at first intercourse. More men than women reported that they and their partner were equally willing (77% (316/413) v 53% (222/419)). Mutual willingness of both partners was greater for those who reported that it was also the first time for their partner. Timing of first intercourse was considered about right by 49% (200/411) of men and 38% (148/388) of women. Many women (54% (211/388) reported that they should have waited longer, and this rose to 70% (90/129) for women reporting intercourse before age 16. CONCLUSIONS: Most women regretted having sexual intercourse before age 16. First intercourse at younger ages is associated with risks that are shared unequally between men and women. This information is important to young people themselves.

Adult↗

Ambivalence among women applying for abortion.

BACKGROUND: Our purpose was to characterize women expressing ambivalence when applying for abortion. MATERIAL AND METHODS: Data were collected, by self-administered questionnaires, from 339 women. Thirty percent were in doubt about the decision when the abortion was due. Socio-economic factors more often influenced the choice among ambivalent women than among those not in any doubt. RESULTS: Ambivalent women more often felt exposed to social pressure and some felt that the abortion was not their own choice. Their decision-making was marked by doubt during the entire process. CONCLUSIONS: There is a need for professional support during this decision-making process. Many of the ambivalent women stated that their decision might not have been the same under different personal circumstances.

Abortion Applicants↗

Vulvovaginitis: promotion of condom use to prevent sexually transmitted disease.

Many studies have suggested that merely warning people about the dangers of sexually transmitted diseases (STDs) and urging the use of condoms as protection will not result in widespread use of condoms. Regular condom use appears to be grounded in knowledge of its effectiveness, perception of STD risk, and belief in a partner's acceptance. But these are not the only barriers to condom use. Negotiating condom use often comes at a sensitive stage in intimate relationships, when individuals prefer to avoid such discussions and simply to trust the powerful and compelling feelings of mutual attraction. This review will consider (1) the effectiveness of condoms in preventing STD transmission, (2) barriers to the use of condoms, and (3) recommended strategies to promote acceptance and use of condoms by heterosexual women.

Condoms↗

Medically indigent women seeking abortion prior to legalization: New York City, 1969-1970.

If the efforts now underway to limit access to abortion services in the United States are successful, their greatest impact will be on women who lack the funds to obtain abortions elsewhere. There is little published information, however, about the experience of medically indigent women who sought abortions under the old, restrictive state laws. This article details the psychiatric evaluation of 199 women requesting a therapeutic abortion at a large municipal hospital in New York City under a restrictive abortion law. Thirty-nine percent had tried to abort the pregnancy. Fifty-seven percent had concrete evidence of serious psychiatric disorder. Forty-eight percent had been traumatized by severe family disruption, gross emotional deprivation or abuse during childhood. Seventy-nine percent lacked emotional support from the man responsible for the pregnancy, and the majority were experiencing overwhelming stress from the interplay of multiple problems exacerbated by their unwanted pregnancy.

Abortion, Legal↗

Facial expressions of emotion in mother-infant interaction.

Face movements of infants 2 months of age when they are interacting with their mothers give evidence both for innate representation of the mother as a partner in communication and for an emotional system that evaluates her expressions and regulates their interpersonal contact. Although the facial neuro-motor system is immature in infancy, it can generate many expressions that compare closely with those by which adults transmit emotions and control engagements and relationships. It also expresses rudiments of special motivation for speaking. Even newborns show clear evidence of organized facial expressions defining distinct communicative states that respond to maternal care. Emotional communication is multimodal; as infants gain in perceptuo-motor and cognitive powers, they both express and respond to simultaneous signals of affect in multiple channels of voice, gesture and postural change. Face expressions form but part of a stream of motor evidence of central affective state and its changes. Mothers present to infants a form of expressive activity (baby talk) that has clearly marked synchronous visible and audible features. The precocious expressive capacities and sensitivities of infants and maternal fostering of them would appear to be a human adaptation to facilitate development of observational learning and language. Developments in the first year expand the scope of communication and play without changing the fundamental emotional code by which infant and familiar caretakers construct and defend their special relationships.

Adult↗

Comprehension monitoring in preschool children.

This study examined the ability of 2 1/2-4 1/2-years-olds to recognize comprehension difficulties and to implement strategies for resolving them. In the course of a play interaction, an adult female experimenter made a series of requests, some of which were designed to be difficult for the child to understand or to execute. Children's responses to these requests were compared with their responses to control requests that were easy to comprehend and comply with 3-year-olds exhibited appropriate and selective monitoring responses for some kinds of problems but not others, while 4-year-olds displayed discriminative monitoring for all types of problems presented. In contrast to previous experimental findings, these results indicate that young children are capable of detecting a variety of comprehension problems and possess appropriate strategies for resolving these difficulties with a partner in communication.

Child Development↗

Validating a model developed to predict prenatal care utilization.

BACKGROUND: Many pregnant women in the United States do not obtain adequate prenatal care. While it is essential to provide women with access to prenatal care, access alone is insufficient to guarantee that all women will receive adequate prenatal care. Previous research has identified a number of personal and cultural barriers to prenatal care. We have integrated these barriers into an explanatory model called the Social Pregnancy Interaction Model, the centerpiece of which is the concept of a "social pregnancy identity," as distinct from the physiologic reality of pregnancy. The purpose of this study was to validate the dimensions of this model. METHODS: Based on previous qualitative work, a questionnaire was developed. It was administered by interview to a convenience sample of 287 pregnant women receiving prenatal care in 11 practices in central Missouri. Item analysis and factor analysis were used to define scales and validate the relationships predicted by the model. RESULTS: With some modifications, the following dimensions of the model were confirmed as distinct and significant: awareness of pregnancy, acceptance of pregnancy, self-care, communication with family, communication with partner, social attitudes toward prenatal care, and attitudes toward the health care provider. CONCLUSIONS: The model has potential for predicting the utilization of prenatal care. The results also suggest that a woman's relationship with her prenatal care provider is important to obtaining adequate prenatal care.

Adolescent↗

HIV-infected women and sexual risk reduction: the relevance of existing models of behavior change.

This article utilizes constructs of the AIDS Risk Reduction Model (ARRM) to examine condom use in a sample of 215 HIV-infected women in New Jersey. We find evidence that processes affecting condom use in HIV-infected individuals are similar to those found in HIV-negative individuals. Results suggest that partner-related factors are important to consistent condom use in HIV-infected women. Women are more likely to use condoms consistently if they have high perceived power to influence their partner's condom use, have partners who are HIV seronegative, and have partners who do not want more children. Conflicts with the partner decrease the probability of consistent condom use. Also negatively associated with condom use are the woman's use of drugs and/or alcohol and her belief that condoms reduce sexual enjoyment. Implications of these findings for designing interventions for HIV-infected women are considered.

Adult↗

Psychosocial factors associated with condom use among African-American drug abusers in treatment.

Although strategies for decreasing injection drug use have met with moderate success, efforts to decrease high-risk sexual behaviors have been less successful. Because condom use reduces HIV transmission, it is critically important to identify the attitudinal, emotional, and behavioral factors associated with using condoms. This study evaluated the relationship between condom use and various psychological and behavioral variables among heterosexual, African-American, cocaine-dependent men within the context of the AIDS Risk Reduction Model (ARRM). Subjects who used condoms (n = 52) reported significantly higher levels of self-efficacy, condom use skills, and sexual communication with partners than non-users (n = 84). However, the groups did not differ in perceived susceptibility, anxiety concerning HIV transmission, response efficacy, or knowledge regarding HIV. These findings suggest that future interventions focus on enhancing self-efficacy and condom use skills, as well as eroticizing condom use.

Adult↗

Contraceptive and sexual practices among single women with an unplanned pregnancy: partner influences.

Data from an urban obstetrics clinic on 291 unmarried women with a current unplanned pregnancy show that women with only one partner in the past year are older and are more likely to use the most effective contraceptive methods than are women who have more than one partner. Women with only one partner are also more likely to be solely responsible for decision-making about the choice of contraceptive methods, and are not as likely to use drugs in conjunction with sex. However, women with one partner are also less likely than others to use condoms or to protect in some other way against sexually transmitted diseases or the human immunodeficiency virus.

Adolescent↗

Educational outcomes in teenage pregnancy and parenting programs: results from a demonstration.

A comparison of five in-school educational and service approaches offered at seven sites in Arizona to 789 pregnant and parenting teenagers shows that except for those who enroll in a program in their third trimester, pregnant and parenting teenagers who attend a comprehensive, school-based, community-linked program are significantly more likely to continue in school than are those who have no access to a special program. The comprehensive program's impact is greatest among Hispanic students, younger students, those in grades 9-10, those who are living with their partner and those who enter the program in the first trimester. Two of the program components--strong outreach efforts and case management-are believed to have an especially favorable impact on continuation in school.

Adolescent↗

Developmental sophistication among adolescents of negotiation strategies for condom use.

Condoms are an important method of reducing the risk of sexually transmitted disease among sexually active adolescents. This study used a developmental approach to examine the negotiation of condom use. The Interpersonal Negotiation Strategy Interview was administered to adolescents using two vignettes that were focused on the negotiation of "safer sex" behaviors. The sample consisted of 196 girls and 92 boys recruited from their primary care clinic or Job Corps. The mean scores for each problem-solving step were at the subjective, unilateral stage, which indicates that problems are resolved through one-way methods. Current educational strategies and the lack of mutuality in adolescents' sexual relationships influence the level of negotiation skills. Interventions need to be at the appropriate developmental level but also need to encourage progress toward collaborative relationships.

Adolescent↗

Stage of behavior change for condom use: the influence of partner type, relationship and pregnancy factors.

A theoretical model was used to examine the influence of relationship factors, pregnancy intentions, contraceptive behavior and other psychosocial characteristics on stages of behavior change in condom use among heterosexual black women of reproductive age. Data from an inner-city street survey compared women who were not contemplating condom use, women who were attempting to use condoms or had used them consistently for short periods of time, and those who had achieved long-term consistent use. Women's relationship with their main partner appears to be an important factor in understanding their use of condoms both with main partners and with other partners. For condom use with the main partner, factors such as emotional closeness and partner support were significant predictors of the likelihood that women would be attempting to use condoms rather than not contemplating use. Cohabitation and the belief that condom use builds trust were significant predictors of long-term consistent condom use. Having a regular or main partner was strongly associated with intentions to use condoms with other partners. Women who wanted to become pregnant were much less likely to intend to use condoms with their main partner, and women using oral contraceptives were less likely to be long-term consistent condom users.

Adolescent↗

Individual counseling of patients with sexually transmitted diseases. A way to improve partner notification in a Zambian setting?

BACKGROUND: Sexually transmitted diseases (STD) are a major health problem in Zambia. Partner notification, which is a recommended strategy to decrease STD, must be improved. GOAL: To assess whether individual counseling of patients with STD, combined with contact slip(s), had any impact on the proportion of sex partners traced in an urban setting in Zambia. STUDY DESIGN: A randomized trial comprised of 94 women and 302 men with STD. RESULTS: Women and men in the intervention group informed more partners than did those in the control group. In the intervention group, 1.8 partners per man was treated compared to 1.2 in the control group (P < 0.001). There was no difference between the two groups of women. There was a gradual decline from numbers of partners informed to numbers of partners treated according to the patient to number of contact slips filed. CONCLUSIONS: Individual counseling of men with STD improved partner notification.

Adolescent↗

HIV-related concerns and behaviors among Hispanic women.

Hispanic women whose sexual partners have other sexual partners may be at risk for HIV. A structured interview was administered to 106 Dominican and Puerto Rican women who reported that they knew or suspected that their partner had other partners. A subsample participated in qualitative interviews. The study assessed concern about HIV and predictors of condom use. The majority of women reported that they worried about getting HIV and almost half had been HIV-tested. Most of the women discussed HIV/AIDS concerns with their partners, and one-third reported some condom use. Predictors of condom use were: born in the Dominican Republic/Puerto Rico, having talked with their partner about being tested, and belief that he used condoms with others. Although the women were concerned about HIV, condom use was infrequent. Results suggested methods to address this discrepancy: introducing condoms early in the relationship, developing women-controlled methods, and directly influencing men's behavior.

Adult↗