The Best Intentions Unintended Pregnancy and the Well-Being of Children and Families (1995) / Chapter Skim
Currently Skimming:
Socioeconomic and Cultural Influences on Contraceptive Use
Socioeconomic and Cultural Influences on Contraceptive Use
Pages 183-217
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From page 183... ...
Nonetheless, in the aggregate, they help to form the environment in which individual decisions about contraception and sexual activity occur. Consideration of them must be part of any serious inquiry 183
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From page 184... ...
For example, even the concept of unintended pregnancy may be alien to some groups whose views of pregnancy and childbearing may be based more on fatalism or other value systems than the notion that these events can or should be carefully planned by such artificial means as contraception. Appreciable diversity can also complicate the task of designing culturally competent intervention programs that respect differences in feelings and values regarding unintended pregnancy, contraception, and related topics.
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From page 185... ...
For example, some immigrants arrive in the United States from countries whose systems of family planning services are arguably better organized than those here and whose range of available contraceptive methods is broader. Some bring with them rich traditions of folk medicine (such as reliance on herbal medicines and various folk remedies and use of neighborhood practitioners rather than doctors for health care)
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From page 186... ...
They view these efforts as encouraging premature sexual activity and sexual activity outside the bounds of formally approved unions. Hence, such efforts are perceived as undermining traditional family values.
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From page 187... ...
Despite the Church's clear stand against artificial means of birth control, most Catholic women and couples in the United States use a wide variety of contraceptive methods; 75 percent of white Catholic couples practice contraception, and among those couples, 63 percent use sterilization or oral contraceptives (Goldscheider and Mosher, 19911. Not surprisingly, the major predictor of personal practice is the degree of "religiosity," that is, the degree to which religion is seen as important and to which individuals observe other aspects of their religion (D ' Antonio, 19941.
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From page 188... ...
In summary, the availability of effective contraception and abortion and the broader range of sexual behavior considered acceptable in many groups in the United States present a challenge to those espousing traditional family values. Although the majority of Americans profess relatively tolerant attitudes, there is no single shared ethic about what constitutes appropriate family structures or sexual behavior.
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From page 189... ...
Sexual activity in late adolescence has become increasingly common in recent years (Laumann et al., 19441. In the late 1960s, for example, about 55 percent of boys and 35 percent of girls had had intercourse by the age of 18; by the late 1980s, these figures had increased to 73 percent for boys and 56 percent for girls (The Alan Guttmacher Institute, 19941.
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From page 190... ...
are given little support or assistance in understanding sexual feelings, defining responsible sexual behavior, and learning respect for themselves and for others." That the media are saturated with sexual material is incontestable. A 1991 study of sexual behaviors on network prime time television (i.e., ABC, CBS, NBC, and Fox)
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From page 191... ...
Advertisements for birth control now routinely appear in many magazines and some, though not all, newspapers (Lipman, 19861. Interestingly, public opinion appears to favor contraceptive advertising Trough the media.
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From page 192... ...
Sexual activity is frequent and most often engaged in by unmarried partners who rarely appear to use contraception, yet rarely get pregnant. Does exposure to such content contribute to early or unprotected sexual intercourse with multiple partners and high rates of unintended pregnancies among both adolescents and adults?
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From page 193... ...
Further studies of the impact of the media on sexual behavior may well find patterns of effects similar to those established for violence. More than 1,000 studies have consistently found small positive relationships between exposure to violent content in the visual media (primarily television and movies)
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From page 194... ...
and publicly financed family planning programs (Chapter 8) , several additional topics merit highlighting.
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From page 195... ...
AFDC and Other Transfer Programs A large literature has addressed the influence of the major income transfer programs in the United States (especially AFDC, Medicaid, and the Food Stamp program) on marriage, the labor supply, household structure, pregnancy and
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From page 196... ...
Medicaid eligibility is an important avenue to free or highly subsidized contraceptive services for many poor women and in the past was also a source of financing for some abortions (see Jackson and Klerman, 1994~. To the degree that contraceptive prices act as barriers to contraceptive access for poor women, the Medicaid program should improve contraceptive access and thereby reduce the risk of unintended pregnancy.
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From page 197... ...
According to Moffitt, stronger and somewhat more consistent program effects are often estimated for the 1980s, suggesting that income transfer programs do have a discernible effect on female headship (Ellwood and Bane, 1985) and remarriage (Duncan and Hoffman, 1990~.
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From page 198... ...
raises the possibility that in the field of contraceptive services, too, black women may be at risk of less than adequate care. Another set of factors that may help to account for the differences is based in the long and complicated relationship of black Americans to contraception and the birth control movement generally.
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From page 199... ...
During this time, concerns began to develop that have continued to influence the attitudes of many black Americans toward birth control programs: The question of who is to control the programs and whose objectives are they to meet clearly surfaced during this period.... Historical analysis ...
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From page 200... ...
Although rules mandated that participation in government-subsidized family planning programs should be voluntary, stories soon surfaced about case workers who had informed women that their public assistance depended on their use of birth control. Critics argued that the specter of governmental coercion made birth control appear to be an obligation for poor women rather than a matter of personal choice.
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From page 201... ...
Although members of the black community expressed some concerns about birth control and race suicide during the 1930s and 1940s, development of governmental family planning programs in the 1960s and 1970s fueled renewed concerns about the links between birth control and genocide. Black Americans responded to such programs with suspicion, ambivalence, skepticism, and, at times, open hostility.
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From page 202... ...
Some black men, many associated with nationalist organizations, have voiced strong opposition to government-sponsored family planning programs, although many black women have not agreed, seeing birth control more as a survival mechanism than as a genocidal tool. The words of Congresswoman Shirley Chisholm (1970:114)
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From page 203... ...
they expose the perniciousness and tenacity of racial stereotypes." The precise extent to which historical wounds and current injustices affect contraceptive use, misuse, and failure among black Americans is unknown, but there clearly is reason to see a connection- one that is rarely acknowledged candidly in discussions about differing patterns of contraceptive use and unintended pregnancy. VIOLENCE Violence against women rape and sexual abuse in particular may also be associated in several ways with unintended pregnancy, especially among adolescents.
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From page 204... ...
, a link between the two is plausible (Boyer and Fine, 1992; Butler and Burton, 1990; Gershenson et al., 19891. Researchers have hypothesized that pregnancy is more likely among those with a history of sexual abuse because sexual victimization can be associated with lower self-esteem, sexual maladjustment, and feelings of powerlessness and hopelessness feelings that might in turn impede careful use of contraception once sexual activity has
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From page 205... ...
Although there are no data to measure what portion of such relationships include sexual coercion or violence, the significant age difference suggests an unequal power balance between the parties, which in turn could set the stage for less than voluntary sexual activity. As was recently said at a public meeting on teen pregnancy, "can you really call an unsupervised outing between a 13-year-old girl and a 24year-old man a 'date'?
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From page 206... ...
In 1968, for example, Chilman cautioned against organizing family planning education and programs that focus only on women, noting that the limited research available at the time suggested deep male interest in issues of family size and contraception. More recently, an increasing number of meetings,
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From page 207... ...
Similarly, it is estimated that 2 percent of Title X program clients in 1991 and 2 percent of Medicaid family planning recipients in 1990 were male (Ku, 19931. Since Medicaid eligibility is based primarily on participation in AFDC or recent program expansions to low-income pregnant women, it is not surprising that few males receive family planning services
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From page 208... ...
Even though most family planning clinics report serving few male clients, they do not ignore condoms. Virtually all of the clinics surveyed by Burt et al.
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From page 209... ...
More than half of the providers who perform more than 400 abortions annually report that they have been picketed at least 20 times annually as well (Henshaw, 19911. The relationship of abortion opposition to unintended pregnancy centers on three issues: first, because some facilities that provide abortions also dispense contraceptive services and supplies, any restriction on access to abortion facilities may also limit access to contraception; second, the number of unintended pregnancies resolved by abortion rather than childbearing may be affected; and three, the general climate of controversy created around the issue of abortion may spill over into other areas of reproductive services and education, confusing clients about what services are actually available and with what restrictions, affecting the morale and performance of those who work in the family planning field, and encouraging an atmosphere of high emotion on all issues of reproductive and sexual health, not just abortion.
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From page 210... ...
Recently, the number of abortions performed in the United States has begun to decline; in 1992, 1.5 million abortions occurred versus 1.6 million in 1990 (Henshaw and Van Vort, 1994) , and a decreasing proportion of all pregnancies, including unintended pregnancies, are now being resolved by abortion (Henshaw and Van Vort, 1994; Henshaw et al., 1991)
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From page 211... ...
That is, because some object to abortion, fewer abortion-related data are collected-a development that has affected the federal abortion surveillance system operated by the CDC, which relies on these state and local estimates in compiling its own aggregate statistics. Similarly, some systems to collect information on publicly supported family planning programs were shelved for years; research sponsored by such public agencies as the National Institutes of Health has been scrutinized and occasionally reshaped quite directly by abortion opponents; and efforts to increase public information and education about such lethal problems as HIV/AIDS have been stymied as well.
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From page 212... ...
Family planning clinics: Current status and recent changes in services, clients, staffing and income sources. In Publicly Supported Family Planning in the United States.
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From page 213... ...
Title X and family planning services for men. Fam Plann Perspect.
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From page 214... ...
Ku L Financing of family planning services.
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From page 215... ...
A plan to pay welfare mothers for birth control. New York Times, February 9, 1991.
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From page 216... ...
Sonenstein FL, Pleck JH. The male role in family planning: What do we know?
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From page 217... ...
. Anti-Family Planning.
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