THERE OUGHTA BE A LAW (NOT!)

"Many governments around the world using criminal penalties to try to prevent abortions are out of step with their publics," according to the director of a project that conducted opinion surveys in 18 countries during the first half of 2008.1 Overall, only 18% of the more than 18,000 participants said that their government should legally restrict abortion; another 23% favored nonpunitive government efforts, such as education and counseling, to discourage abortion, and 52% felt that abortion should be a matter of individual choice. In 17 countries, both developed and developing, support for criminal penalties represented the minority opinion; in Indonesia, however, 60% of respondents favored this approach to curbing abortion. Countries in which the majority of those polled rejected restrictive abortion laws included seven in which such laws are in place. Support for government involvement in efforts to prevent abortion rose with degree of religious observance; it fell with increasing age, education or income.

1. WorldPublicOpinion.org, World publics reject criminal penalties for abortion: public at odds with their country’s laws in half of countries polled, <WorldPublicOpinion.org>, accessed June 18, 2008.

COMPARING HORMONALS

A review of randomized controlled trials indicates that the contraceptive patch and the vaginal ring are similar in effectiveness to combined oral contraceptives.1 The 11 trials (three comparing the patch and the pill, and eight comparing the ring and the pill) also revealed differences between the pill and the other methods. Consistency of use was greater with the patch than with the pill, but patch users were more likely than oral contraceptive users to drop out of the trial early, and they reported more breast discomfort, painful periods, nausea and vomiting. Ring users reported greater method satisfaction than pill users; they had more vaginal irritation and discharge than women taking oral contraceptives, but fewer bleeding problems and less nausea, irritability and depression. The researchers suggest that future studies include more detailed information on whether women use their methods correctly and are satisfied with them.

1. Lopez LM et al., Skin patch and vaginal ring versus combined oral contraceptives for contraception, Cochrane Database of Systematic Reviews, 2008, Issue 1, CD003552.

BREAST-FEEDING SUPPORT NOT WHAT IT SHOULD BE

U.S. women breast-feed at levels far below national targets, and one reason may be that they get inadequate support for breast-feeding in hospitals and birth centers.1 A nationwide survey of such facilities yielded data that were grouped into scales assessing practices regarding mother-newborn contact after delivery and during the facility stay, breast-feeding assistance and postdischarge support, newborn feeding practices, staff training on breast-feeding, and structural factors that could influence the practice. For the 2,687 responding facilities, the mean total score was 63 out of a possible 100. The highest score (80) was for breast-feeding assistance, and the lowest (40) was for support after discharge. Scores were generally highest in the West and Northeast, and lowest in the South. Birth centers scored higher than hospitals (86 vs. 62), but scores did not vary by facilities’ maternity caseload. Substantial proportions of facilities reported practices that are not supportive of breast-feeding, such as providing breast-feeding mothers with samples of infant formula on discharge (70%) and giving a majority of healthy, full-term breast-fed infants pacifiers (45%) or supplements (24%).

1. DiGirolamo AM et al., Breastfeeding-related maternity practices at hospitals and birth centers—United States, 2007, Morbidity and Mortality Weekly Report, 2008, 57(23):621–625.

DO VIRGINITY PLEDGES WORK?

Virginity pledges appear to reduce the risk of sexual initiation even when differences in young people’s propensity to pledge are taken into account.1 When interviewed in 2001, 24% of a national sample of sexually inexperienced 12–17-year-olds reported having made a virginity pledge; these youth differed from others on a range of demographic and psychosocial measures. Using data from a three-year longitudinal follow-up, adjusted to eliminate these differences, analysts found that pledging was associated with postponement of sexual initiation; they estimated that among youth with characteristics that indicate an inclination to pledge, 42% of those who do not pledge will initiate intercourse within a three-year period, compared with 34% of those who pledge. For youth who had not had intercourse by the end of the study, pledging did not predict participation in noncoital sexual behavior; nor was it associated with inconsistent condom use among those who had had sex, as might be expected if young people who receive strong abstinence messages also get incomplete information about condom use. The researchers note that whereas pledging may have an effect on those who feel they are freely choosing to pledge, it is unlikely to reduce the risk of sexual initiation among those who are coerced into pledging or whose social environments support sexual behavior. "Thus," they conclude, "it may be important and useful to have both pledge programs and comprehensive sex education available" to serve a wide range of teenagers.

1. Martino SC et al., Virginity pledges among the willing: delays in first intercourse and consistency of condom use, Journal of Adolescent Health, 2008 (forthcoming).

CALL TO ACTION ON HIV AMONG LATINOS

A network of Latino community and health leaders has issued a set of recommendations for federal actions to address HIV and AIDS among Latinos.1 Noting the sharp disparities between Latinos and whites in such measures as HIV diagnoses, AIDS prevalence and rates of early HIV testing, the group calls for "immediate attention, understanding and action at the national level through committed leadership, enlightened policies, and targeted resources." Key recommendations include the development of a comprehensive plan to address HIV and AIDS in all affected communities; federal involvement in initiatives to increase access to HIV testing, prevention and treatment services in Latino communities; and a focus on "structural-environmental realities that drive HIV transmission for Latinos." Also highlighted are the need for the federal government to work to improve the collection of data on HIV and AIDS among Latinos, including residents of Puerto Rico; increase the amount and flexibility of federal funding for HIV care; amend immigration policies that compromise the health or human rights of individuals with HIV or AIDS; and invest in developing leadership within the Latino community.

1. National Latino/Hispanic AIDS Action Network, Latino/Hispanic HIV/AIDS federal policy recommendations: addressing the Latino AIDS crisis, <http://www.latinoaidsagenda.org/documents/NLAAN_Recommendations_PageTyp…;, accessed June 27, 2008.

TREND HEADED THE WRONG WAY

Nearly half of all HIV diagnoses in 33 surveillance states between 2001 and 2006 were made in men who have sex with men, and this group is the only one that showed an increase in the number of diagnoses over that period.1 HIV diagnoses attributable to male-to-male sexual contact rose by almost 2% annually; at the same time, yearly diagnoses related to high-risk heterosexual activity fell by 4%, and those related to injection-drug use dropped by almost 10%. Among men who have sex with men, 25–44-year-olds accounted for the greatest proportion of HIV diagnoses in 2001–2006 (64%), but 13–24-year-olds registered the largest annual increase (12%); statistically significant increases occurred among the youngest men in almost every racial and ethnic category examined. Overall, the number of HIV diagnoses among black men who have sex with men rose by 12% during the six-year period, but among 13–24-year-olds in this group, the number nearly doubled. Asians and Pacific Islanders accounted for no more than 220 annual HIV diagnoses, but they had the largest proportional increase of any racial or ethnic group (12% yearly); those aged 13–24 showed an annual increase of 31%.

1. Mitsch A et al., Trends in HIV/AIDS diagnoses among men who have sex with men—33 states, 2001–2006, Morbidity and Mortality Weekly Report, 2008, 57(25):681–686.

DEALING WITH SUBSTANCE USE DURING PREGNANCY

Treatment for substance abuse as part of prenatal care can improve maternal and infant outcomes, according to findings from a study of nearly 50,000 California women who gave birth in 1999–2003.1 The women attended a health maintenance organization whose prenatal services are linked to a program that screens all women for the risk of substance use during pregnancy; those identified as being at risk are immediately referred to a substance abuse expert, who conducts an in-depth assessment and provides appropriate interventions or referrals. Of 10 birth outcomes studied, five—low birth weight, preterm delivery, placental abruption, preterm labor and intrauterine fetal death—occurred significantly less often among women who screened positive and received an assessment and treatment than among those who screened positive but did not receive further program services. Results of multivariate analysis confirmed these findings. The researchers comment that because the program improves the health of women and their infants, its impact "reaches beyond them to positively influence the health and well-being of the community at large."

1. Goler NC et al., Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard, Journal of Perinatology, advance online publication, doi:10.1038/jp.2007.70, June 26, 2008.

IN BRIEF

• Need to know the number of people living with AIDS in Denmark? Or the birthrate in Monaco? Users of the Web site <www.GlobalHealthFacts.org> can now create custom data sheets showing the latest data on a wide range of health, demographic and economic measures for developed and developing countries throughout the world. Comparative data can be assembled for up to five countries, and the data sheets can be converted to PDFs, printed, e-mailed or saved.

• The Fifth Annual HealthGrades Women’s Health Outcomes in American Hospitals Study reports on the quality of care that women and their newborns received at hospitals in 17 states for the period 2004–2006. In addition to showing rates of maternal complications for various types of deliveries and neonatal mortality rates, the report identifies top-performing hospitals. The report is available at <http://www.healthgrades.com/media/dms/pdf/HealthGradesWomensStudy2008.p…;.

• With declines in infant mortality stalled and the health of women of childbearing age beginning to decline, a shift in focus from prenatal care to preconception care may benefit the health of women and their newborns. Healthy Women, Healthy Babies discusses the "most important issues and obstacles" to making this shift and outlines possible ways to address them. The issue brief is available at <http://healthyamericans.org/reports/files/BirthOutcomesLong0608.pdf>.