Leo Morris

Sexual behavior among U.S. high school students, 1990-1995

CONTEXT High rates of unintended pregnancy and sexually transmitted diseases (STDs), including HIV infection, among adolescents are major public health concerns that have created interest in trends in teenage sexual activity. METHODS Nationally representative data from Youth Risk Behavior Surveys conducted in 1990, 1991, 1993 and 1995 are used to examine levels of sexual experience, age at first intercourse, current sexual activity and condom use at last intercourse among students in grades 9-12. RESULTS The proportion of students who reported being sexually experienced remained at 53-54% from 1990 through 1995, while the percentage of sexually active students who used condoms at last intercourse rose from 46% to 54% between 1991 and 1995. Black students were more likely than white students to report being sexually experienced, being currently sexually active and having had four or more lifetime sexual partners; black students also reported a significantly younger age at first intercourse. Gender differences in sexual behavior were found more frequently among black students than among white or Hispanic students. CONCLUSIONS Although levels of sexual experience for high school students in the United States have not risen during the 1990s, a very high percentage of students continue to be at risk for unintended pregnancy and STDs, including HIV infection.

Increased cesarean section rates and emerging patterns of health insurance in Shanghai, China.

OBJECTIVES This study examined the trend in cesarean section deliveries and the factors associated with it in the Minhang District of Shanghai, China. METHODS A representative sample of the members of 2716 households in the district were interviewed in the fall of 1993. This study analyzed the data from 1959 married women of reproductive age with at least one live birth. RESULTS During the past 3 decades, the proportion of infants born by cesarean section increased from 4.7% to 22.5%. Logistic regression analysis revealed that the highest cesarean section rate, which occurred in the most recent period of 1988 through 1993, was associated with form of medical payment, self-reported complications during pregnancy, higher birthweight, and maternal age. Government insurance pays all costs of cesarean sections and accounted for the highest proportion of the cesarean section rate. CONCLUSIONS The high rates of cesarean sections in China are surprising given the lack of the factors that usually lead to cesarean sections. The increasing cesarean section rates may be an early indication that emerging forms of health insurance and fee-for-service payments to physicians will lead to an excessive emphasis on costly, high-technology medical care in China.

The Decline in US Teen Pregnancy Rates, 1990–1995

Objectives. Estimate pregnancy, abortion, and birth rates for 1990 to 1995 for all teens, sexually experienced teens, and sexually active teens. Design. Retrospective analysis of national data on pregnancies, abortions, and births. Participants. US women aged 15 to 19 years. Outcome Measures. Annual pregnancy, abortion, and birth rates for 1990 to 1995 for women aged 15 to 19 years, with and without adjustments for sexual experience (ever had intercourse), and sexual activity (had intercourse within last 3 months). Results. Approximately 40% of women aged 15 to 19 years were sexually active in 1995. Teen pregnancy rates were constant from 1990 to 1991. From 1991 to 1995, the annual pregnancy rate for women aged 15 to 19 years decreased by 13% to 83.6 per 1000. The percentage of teen pregnancies that ended in induced abortions decreased yearly; thus, the abortion rate decreased more than the birth rate (21% vs 9%). From 1988 to 1995, the proportion of sexually experienced teens decreased nonsignificantly. Conclusions. After a 9% rise from 1985 to 1990, teen pregnancy rates reached a turning point in 1991 and are now declining. Physicians should counsel their adolescent patients about responsible sexual behavior, including abstinence and proper use of regular and emergency contraception.

The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania.

A national household survey of 4,861 women aged 15-44 on reproductive health issues was conducted in Romania in 1993. The survey provided the opportunity to study the impact of policy changes by comparing selected aspects of fertility, abortion, and contraceptive use before and after the December 1989 revolution, when the laws restricting abortion and contraceptive use were abolished. After abortion became legal, the total fertility rate dropped to below replacement level, while the induced abortion rate doubled. Contraceptive prevalence increased 20 percent, but augmentation of the use of traditional methods, rather than the change in legislation, accounted for 70 percent of the increase. Limited sex education and contraceptive information, mistrust and misinformation about modern methods, a lack of adequately trained providers, and a shortage or uneven distribution of contraceptive supplies are major reasons for the continued high rates of unintended pregnancy.

Young adults in Latin America and the Caribbean: their sexual experience and contraceptive use.

Comparisons of data from 4 Young Adult Reproductive Health Surveys and from 4 other national surveys show that 55% of 15-19-year-old Jamaican females had had sexual intercourse compared to 12-21% in the remaining 7 areas. The proportion of 20-24-year-old females who had had premarital intercourse ranged from 36% in Guatemala City to 91% in Jamaica. Only in Mexico City had fewer than half of 15-19-year-old males ever had intercourse; comparable proportions of 20-24-year-olds ranged from 85% in Mexico City and Guatemala City to over 90% in Jamaica and Salvador. Mean age at 1st premarital intercourse among the females ranged from 16.6 in Brazil and Costa Rica to 17 in Mexico City and Salvador Brazil and the mean age of their partners ranged from 19.7 in Jamaica to 22.6 in Costa Rica. Among the males age at 1st intercourse ranged from 14.3 in Jamaica to 15.7 in Mexico City. 41% of females in Jamaica said that they or their partner had practiced contraception at 1st premarital intercourse compared with 10-23% in the Latin American countries. Method use at 1st intercourse was higher among males than females in Mexico City and Guatemala City but higher among females in Jamaica and Salvador Brazil. In Mexico City both females and males principally had used rhythm and the condom at 1st intercourse while in Salvador Costa Rica Panama and Brazil young women had mainly relied on oral contraceptives at 1st intercourse. In Costa Rica Mexico City Guatemala City Panama and Brazil 28-42% of women 15-24 conceived at least once premaritally. About 3/4 of unmarried ever-pregnant Jamaican women aged 15-24. 2/3 of comparable Brazilians and half of those in Mexico city and Costa Rica had had an unintended 1st pregnancy. (authors)

Infant mortality and breast-feeding in North-Eastern Brazil.

Summary The effects of breast-feeding on infant health have been a topic of considerable discussion in recent years. In this paper multivariate techniques are used to examine the relationship between the failure to breast-feed and mortality among infants in four states of north east Brazil. It was found that breast-fed children were significantly more likely to survive infancy than children who were never breast-fed, even when other socio-economic, demographic and health variables were taken into account. This relationship was much more marked in rural than in urban settings. Other variables significantly associated with mortality were parity, mothers age at childs birth, mothers employment status and use of maternal/child health services. These findings are important for the particular population studied as well as for much of Latin America where incidence and duration of breast-feeding tend to be low but infant mortality is quite high

Premarital sexual activity and contraceptive use in Santiago Chile.

The Santiago Young Adult Reproductive Health Survey was conducted in 1988 to examine the sexual behavior of and contraceptive use among young adults in Chile. The survey was based on multistage household probability samples of 865 women and 800 men aged 15-24 who were living in Santiago in 1988. Findings show that 35 percent of females and 65 percent of males had had premarital intercourse. Among those who had done so, the median age at first experience was 18.4 years for women and 16.4 years for men. Only 20 percent of females and 19 percent of males used contraceptives at first premarital intercourse. Use of contraceptives increased with age at the time of that event. Fertility data reveal that 70 percent of first births were premaritally conceived, and more than one-third of these were born prior to union. The high rates of premarital and unintended pregnancy among young women and the low prevalence of effective contraceptive use indicate a need for greater emphasis on sex education and family planning services directed at adolescents and unmarried young adults in Santiago.

Cesarean delivery in northeast region of Brazil, 1978-80.

This study presents information on cesarean section rates for the last baby born to 1,746 women in Northeast Brazil between January 1978 and the date of a 1980 household survey. For hospital deliveries, the c-section rate is 19 per cent. Rates were highest in the major urban areas and lowest in rural areas. Within residence categories, the section rate was related directly to education, early prenatal care, and delivery in private hospitals.

Contraceptive use and fertility levels in Sao Paulo State, Brazil.

A survey of 4188 households was conducted in Sao Paulo State Brazil in 1978 to obtain information on fertility levels and contraceptive use. The survey showed a statewide decline in fertility from a crude birth rate of 29 per 1000 in 1970 to 24 in 1978. The results show that 64% of currently married women aged 15-44 use contraceptives. Even with this high rate of contraceptive use an estiamted 475 thousand women are in need of family planning services. In addition a high percentage of unplanned pregnancies is causing a serious family planning problem. (Authors)

Sterilization in the northeast of Brazil

Results of household surveys carried out in four states in the Northeast of Brazil showed that female sterilization is the most prevalent method among women who want no more children. Many women who indicated an interest in tubal ligation, however, had not been sterilized. Access to sterilization depends on the type of hospital in which the child was delivered and the type of delivery the woman had. Over 60% of the sterilized women reported that they had a tubal ligation at the time they were hospitalized for a cesarean delivery. Compared with unsterilized women, the sterilized women are characterized by relatively higher education levels and a greater likelihood of urban residence and were far more likely to have had cesarean deliveries and, therefore, to have qualified for postpartum sterilization on medical grounds.