The influence of patriarchal behavior on birth control access and use among recent Hispanic immigrants.

It is commonly assumed that Hispanic immigrants in the United States subscribe to a patriarchal ideology that keeps women subordinated to men, often through violence and exploitative reproductive behaviors. If this assumption is true, we might expect to find that in the Hispanic culture patriarchal males control decision-making about access to and use of birth control. Structured interviews of 100 Hispanic men and 100 Hispanic women who were recent immigrants to a Midwest community were conducted to examine this assumption. Results did not support this assumption among this study population. We found no patriarchal ideology supporting women's subordination to men, violence as a mechanism of control, reproduction as a way of exploitation, or cultural influences discouraging access to and use of birth control in the Hispanic community. Rather, these immigrants revealed adequate knowledge of birth control use and positive perceptions of gender equality. Gaining a better understanding of the limited influence of patriarchal ideology on the use of birth control and family planning services among this Hispanic community may inform the development of family planning services tailored for new Hispanic immigrants.

Physicians' intention to educate about emergency contraception.

BACKGROUND AND OBJECTIVES: Our objective was to examine the intention of academic primary care physicians to educate women about emergency contraception (EC) and whether differences in their intention varies with patient situation, knowledge and attitudes about EC, gender, or specialty. METHODS: As part of a larger cross-sectional survey about intention to prescribe EC with 96 faculty physicians from one Southern and three Midwestern universities, we analyzed factors associated with intention to educate patients about EC. Physicians were from departments of family medicine, obstetrics-gynecology, and pediatrics. RESULTS: The main outcome variable was intention to educate about EC. Attitudes and perceived peer expectations on educating about EC predicted physicians' intentions to provide EC education to their patients. Neither knowledge about EC nor physician demographics predicted intention to educate. Almost one in five respondents were reluctant to provide education to sexually active adolescents. Physicians who had high intention to educate were more likely than others to believe that educating about EC enhances a woman's reproductive options and that EC education reduces unintended pregnancy and abortion. Providers with low intention to educate were more likely to consider EC education to be inconvenient and to take too much clinic time. CONCLUSIONS: To maximize training programs, physicians' attitudes, beliefs, and professional expectations should be examined when designing and initiating educational interventions.

The role of pregnancy intention in HIV prevention in South Africa: a proposed model for policy and practice.

Mother-to-child transmission is a continuing source of new HIV infections in South Africa. The paper posits that insight into the socio-cultural, behavioural, environmental and economic factors that sustain the HIV epidemic is as important as understanding the biological causes of the disease when planning and implementing interventions to prevent and reduce perinatal transmission. Furthermore, understanding the pregnancy intentions of individuals in areas of endemic HIV/AIDS is vital for providing the best care for individuals who are HIV-positive. This paper suggests a model for types of support and interventions that are relative to the intention of HIV-positive women or couples to become pregnant. Included among these are interventions for prevention of unwanted pregnancy, prevention of transmission of HIV, protection of the infant, and protection of the mother.

Pregnancy wantedness and child attachment security: is there a relationship?

OBJECTIVES: Few studies examine the consequences of unwanted pregnancy on child development, and most of those that do, use measures of pregnancy intention. Here we use measures of pregnancy wantedness, together with measures of maternal motivation, to examine the potential effect of wantedness on the child's attachment relationship with its mother. METHODS: Using data collected from 78 primiparous Black women who had applied for an Early Head Start program in a Midwestern city and who had completed a pregnancy acceptance questionnaire, we created four measures: Pregnancy Wantedness, Positive Maternal Motivation, Negative Maternal Motivation, and Social Reinforcement for the pregnancy. Each child had been assessed at about 11 months of age for Difficult Temperament and at about 14 months of age for Attachment Security. We then tested both regression and linear structural equation models in order to predict the child's attachment security with the remaining variables. RESULTS: Pregnancy Wantedness is predicted with an R (2) of .198 by Negative Maternal Motivation and Social Reinforcement but does not predict Attachment Security, which is predicted with an R (2) of .375 by Positive Maternal Motivation, Negative Maternal Motivation, and Difficult Temperament. CONCLUSIONS: Our analyses indicate that in a multivariate context there is no relationship between the wantedness of a pregnancy and the subsequent attachment security of the child for this sample of low-income Black primiparous mothers. This finding is related to some conceptual and measurement issues of pregnancy wantedness, the irrelevance of some aspects of wantedness to parent-child interaction, and the powerful effect of maternal motivations on child attachment security.

Using Photovoice to improve family planning services for immigrant Hispanics.

In a participatory action research program called Photovoice, Hispanic immigrants in a Midwestern community took photographs to provide researchers with insight regarding family planning. This report describes the Photovoice approach, why the researchers chose it, how they implemented it, what they learned, and the benefits derived for a larger service project.

Social well-being in pregnant women: intended versus unintended pregnancies.

The relationship between pregnancy intention (unintended versus intended pregnancy) and social well-being was examined in a sample of 72 pregnant, mostly low-income women attending Women, Infants, and Children programs and prenatal clinics in a midwestern community. Feelings of happiness about giving birth and the extent to which having a baby would fill a void in one's life were also examined. Pregnancy intention was significantly associated with reduced social support. Feelings of happiness about having the baby positively correlated with all domains of social support and negatively correlated with loneliness and family relationship problems. The belief that having a baby could fill a void in a woman's life was strongly correlated with perceived loneliness. Interventions to increase social support and to address areas of stress for women whose pregnancies are unintended are recommended. Future research in larger random samples is needed to better test these associations and to make recommendations for specific practice interventions to increase social well-being.

Barriers to reporting sexual assault for women and men: perspectives of college students.

The authors asked college students to rate the importance of a list of barriers to reporting rape and sexual assault among male and female victims. The authors' findings indicate that barriers prevalent 30 years ago, prior to efforts by the rape reform movement, continue to be considered important among college men and women. The barriers rated as the most important were (1) shame, guilt, embarrassment, not wanting friends and family to know; (2) concerns about confidentiality; and (3) fear of not being believed. Both genders perceived a fear of being judged as gay as an important barrier for male victims of sexual assault or rape and fear of retaliation by the perpetrator to be an important barrier for female victims.

Male Hispanic immigrants talk about family planning.

In order to improve delivery of family planning services by better understanding the views of people affected, researchers conducted four focus groups among Hispanic men who recently migrated to a Midwestern community. Participants expressed opinions about, attitudes towards, and knowledge of such matters as family planning, birth control information and access, the influence of religion on family planning and birth control decisions, general familial relations, the prevalence of infidelity, use of and access to the health care system, and cultural differences between the U.S. and their countries of origin. The men voiced opinions and attitudes supportive of family planning and appeared knowledgeable about various methods of birth control. Understanding the attitudes held by immigrant men is important for health care providers in designing successful service interventions for this rapidly growing segment of the population.

Using the theory of reasoned action to explain physician intention to prescribe emergency contraception.

CONTEXT: Although research has examined providers' knowledge, attitudes and prescribing behaviors with regard to emergency contraception, none has used a theory-based approach to understanding the interplay of these factors. METHODS: A cross-sectional survey of 96 faculty physicians from one Southern and three Midwestern universities was conducted in 2004 to assess factors associated with intention to prescribe emergency contraception. The theory of reasoned action guided the study hypotheses and survey design. Correlation and regression analyses were used to examine the data. RESULTS: Only 42% of respondents strongly intended to prescribe emergency contraception for teenagers, but 65-77% intended to do so for all other specified groups (women who ask for the method, who have had a method problem, who have experienced rape or incest, and who have had unprotected sex). Consistent with the theory of reasoned action, high intention to prescribe emergency contraception was associated with positive attitudes toward doing so and with the perception that specific colleagues or professional groups support prescribing it; however, the perception of support by colleagues or professional groups in general did not predict intention. Also consistent with the theory, physicians' knowledge about emergency contraception and their demographic characteristics were not significant. CONCLUSIONS: Interventions to encourage physicians to provide emergency contraception should take into account their attitudes toward the method and the components of those attitudes.