American Women Of Reproductive Age Research Articles

Awareness and Intent to Use Pre-exposure Prophylaxis (PrEP) Among African American Women in a Family Planning Clinic.

Due to the gap between cisgender women eligible for and those accessing pre-exposure prophylaxis (PrEP) for HIV prevention, it is critical to understand knowledge of and attitudes toward PrEP among HIV-vulnerable women. PrEP utilization is particularly low among African American women in the USA. Family planning clinics provide key access points to reach HIV-vulnerable African American women as well as to translate research findings into clinical practice. Our study aimed to (1) describe the awareness of and interest in PrEP among African American cisgender women attending a family planning clinic and (2) document the barriers and facilitators to PrEP uptake among these women. A cross-sectional survey was conducted with sexually active African American women of reproductive age attending a family planning clinic. Descriptive statistics were used to characterize the sample, and bivariate analysis was used to detect difference between categorical and outcome variables. In our survey (N = 109), over 80% of participants listed not knowing PrEP was available as the primary reason for not currently taking PrEP. Seventy percent reported they would probably or definitely like to take PrEP - demonstrating that barriers to uptake might stem from knowledge deficits rather than attitudes toward prevention. Study findings have the potential to inform strategies to increase awareness of PrEP as an HIV prevention option as well as to equip women with greater self-efficacy to access PrEP in family planning settings.

Religious hospital policies on reproductive care: what do patients want to know?

Religious hospitals are a large and growing part of the American healthcare system. Patients who receive obstetric and other reproductive care in religious hospitals may face religiously-based restrictions on the treatment their doctor can provide. Little is known about patients' knowledge or preferences regarding religiously restricted reproductive healthcare. We aimed to assess women's preferences for knowing a hospital's religion and religiously based restrictions before deciding where to seek care and the acceptability of a hospital denying miscarriage treatment options for religious reasons, with and without informing the patient that other options may be available. We conducted a national survey of women aged 18-45 years. The sample was recruited from AmeriSpeak, a probability-based research panel of civilian noninstitutionalized adults. Of 2857 women invited to participate, 1430 completed surveys online or over the phone, for a survey response rate of 50.1%. All analyses adjusted for the complex sampling design and were weighted to generate estimates representative of the population of US adult reproductive-age women. We used χ2 tests and multivariable logistic regression to evaluate associations. One third of women aged 18-45 years (34.5%) believe it is somewhat or very important to know a hospital's religion when deciding where to get care, but 80.7% feel it is somewhat or very important to know about a hospital's religious restrictions on care. Being Catholic or attending religious services more frequently does not make one more or less likely to want this information. Compared with Protestant women who do not identify as born-again, women of other religious backgrounds are more likely to consider it important to know a hospital's religious affiliation. These include religious minority women (adjusted odds ratio, 2.17; 95% confidence interval, 1.11-4.27), those who reported no religion/atheist/agnostic (adjusted odds ratio, 2.27; 95% confidence interval, 1.19-4.34), and born-again Protestants (adjusted odds ratio, 2.38; 95% confidence interval, 1.32-4.28). Religious minority women (adjusted odds ratio, 2.36; 95% confidence interval, 1.01-5.51) and those who reported no religion/atheist/agnostic (adjusted odds ratio, 3.16; 95% confidence interval, 1.42-7.04) were more likely to want to know a hospital's restrictions on care. More than two thirds of women find it unacceptable for the hospital to restrict information and treatment options during miscarriage based on religion. Women who attended weekly religious services were significantly more likely to accept such restrictions (adjusted odds ratio, 3.13; 95% confidence interval, 1.70-5.76) and to consider transfer to another site an acceptable solution (adjusted odds ratio, 3.22; 95% confidence interval, 1.69-6.12). The question, "When should a religious hospital be allowed to restrict care based on religion?" was asked, and 52.3% responded never; 16.6%, always; and 31.1%,"under some conditions. The vast majority of adult American women of reproductive age want information about a hospital's religious restrictions on care when deciding where to go for obstetrics/gynecology care. Growth in the US Catholic health care sector suggests an increasing need for transparency about these restrictions so that women can make informed decisions and, when needed, seek alternative providers.

Maternal Risk Factors in a Cohort Study of Mexican Americans Living Near the U.S.-Mexico Border [10R

INTRODUCTION: Preterm and early term births are higher in border versus non-border regions of Texas, though the prevalence of maternal risk factors contributing to negative birth outcomes in this region is not well understood. METHODS: Weighted descriptive analyses were conducted on self-reported medical history and information on first pregnancy collected from 384 women ages 19-49 at enrollment into the Cameron County Hispanic Cohort, a prospective study of Mexican Americans residing in South Texas near the U.S.-Mexico border. RESULTS: Women in the sample were predominantly Hispanic (89.8%), married (69.5%), and born outside the U.S. (57.5%), with average age of 36.7 years. Nearly one-quarter (23.1%) smoked 100 cigarettes or more in their lifetime. A majority (83.3%) of participants were obese or overweight, and sizeable proportions reported having high blood pressure (22.4%) or high cholesterol (11.1%). During their first pregnancy, most participants (79.0%) reported attending at least 6 prenatal visits. Prevalence of high blood pressure, diabetes, and preeclampsia during pregnancy was 7.6%, 3.2%, and 7.1%, respectively. Approximately 27% had cesarean delivery for the first pregnancy. Self-reported outcomes of the first pregnancy included preterm delivery (11.3%), miscarriage (9.7%), abortion (3.9%), and infant death (3.0%). CONCLUSION: Findings from this study indicate a higher burden of overweight/obesity and hypertensive disorders, as well as cesarean and preterm delivery, among Mexican American women of reproductive age in the South Texas border region compared to state averages. Interventions aimed at mitigating maternal risk factors may help improve birth outcomes and the long term health of women in this population.

Menstrual Disorders

Menstrual Disorders

Genome-Wide DNA Methylation Indicates Silencing of Tumor Suppressor Genes in Uterine Leiomyoma

BackgroundUterine leiomyomas, or fibroids, represent the most common benign tumor of the female reproductive tract. Fibroids become symptomatic in 30% of all women and up to 70% of African American women of reproductive age. Epigenetic dysregulation of individual genes has been demonstrated in leiomyoma cells; however, the in vivo genome-wide distribution of such epigenetic abnormalities remains unknown.Principal FindingsWe characterized and compared genome-wide DNA methylation and mRNA expression profiles in uterine leiomyoma and matched adjacent normal myometrial tissues from 18 African American women. We found 55 genes with differential promoter methylation and concominant differences in mRNA expression in uterine leiomyoma versus normal myometrium. Eighty percent of the identified genes showed an inverse relationship between DNA methylation status and mRNA expression in uterine leiomyoma tissues, and the majority of genes (62%) displayed hypermethylation associated with gene silencing. We selected three genes, the known tumor suppressors KLF11, DLEC1, and KRT19 and verified promoter hypermethylation, mRNA repression and protein expression using bisulfite sequencing, real-time PCR and western blot. Incubation of primary leiomyoma smooth muscle cells with a DNA methyltransferase inhibitor restored KLF11, DLEC1 and KRT19 mRNA levels.ConclusionsThese results suggest a possible functional role of promoter DNA methylation-mediated gene silencing in the pathogenesis of uterine leiomyoma in African American women.

A public health focus on infertility prevention, detection, and management

In 2002, 2 million American women of reproductive age were infertile. Infertility is also common among men. The Centers for Disease Control and Prevention (CDC) conducts surveillance and research on the causes of infertility, monitors the safety and efficacy of infertility treatment, and sponsors national prevention programs. A CDC-wide working group found that, despite this effort, considerable gaps and opportunities exist in surveillance, research, communication, and program and policy development. We intend to consult with other federal agencies, professional and consumer organizations, the scientific community, the health care community, industry, and other stakeholders, and participate in the development of a national public health plan for the prevention, detection, and management of infertility.

Racial Disparities in Birth Outcomes Increase with Maternal Age: Recent Data from North Carolina

Racial disparities in birth outcomes persist in North Carolina and the United States. We examined patterns of birth outcomes and womens health measures in North Carolina by race and age to portray the largest disparities. We wanted to see if our data were consistent with the "weathering hypothesis," which holds that the health of African American women may begin to deteriorate in early adulthood, with negative effects on birth outcomes. We conducted a descriptive analysis of 1999-2003 North Carolina live birth and infant death records and 2001-2003 Behavioral Risk Factor Surveillance System survey data. Birth outcome measures examined were low birth weight, very low birth weight, infant mortality neonatal mortality and postneonatal mortality. Womens health measures examined were obesity self-reported health status, high blood pressure, high cholesterol, current smoking, and smoking during pregnancy. Rates for whites and African Americans were compared for each of three age groups. Racial disparities in birth outcomes increase with increasing maternal age. African American teens often experience better birth outcomes than older African American women. Racial disparities in measures of womens health also increase with increasing age. Health problems among older African American women of reproductive age may contribute substantially to racial disparities in birth outcomes. Improving the health of older African American women may be an effective strategy to reduce the overall racial disparities in birth outcomes.

Contraceptive use and risk of unintended pregnancy in California

California is home to more than one out of eight American women of reproductive age. Because California has a large, diverse and growing population, national statistics do not necessarily describe the reproductive health of California women. This article presents risk for pregnancy and sexually transmitted infections among women in California based on the California Women's Health Survey. Over 8900 women of reproductive age who participated in this survey between 1998 and 2001 provide estimates of access to care and use of family-planning methods in the state. We find that 49% of the female population aged 18–44 in California is at risk of unintended pregnancy. Nine percent (9%) of women at risk of an unintended pregnancy are not using any method of contraception, primarily for method-related reasons, such as a concern about side effects or a dislike of available contraceptive methods. Among women at risk for unintended pregnancy, we find disparities by race/ethnicity and education in use of contraceptive methods.

Predictors of cervical cancer screening in Mexican American women of reproductive age.

Several barriers impede cancer prevention in the Mexican American population. This study identified sociocultural factors that could be used to increase screening rates for cervical cancer in women of reproductive age. A survey was conducted in 1991 of 366 Mexican American women ages 18 to 40 in Tucson, Arizona, to assess current compliance with cervical cancer screening guidelines and several psychological, social, and cultural variables. Women who had never been screened (13 percent of the sample) had a knowledge deficit, no gynecological care, and no sexual activity. Women not screened annually (16 percent) lacked preventive care, imperfectly understood the Pap test, had lower self-efficacy expectations for understanding physicians, experienced higher emotional stress about the test, and were older and less acculturated. Women who have never been screened require basic education on cancer and cancer screening and policy changes increasing access to care. For women with less routine screening, preventive care, supportive attitudes, and health care skills must be encouraged.

Predictors of high-risk behavior in unmarried American women: Adolescent environment as risk factor

Background: Heterosexual intercourse with two or more partners in a short time period represents a highrisk behavior for acquisition and transmission of sexually transmitted pathogens (STDs). Identification of factors that may predict high-risk sexual behavior can help to focus primary prevention strategies on women at risk for future acquisition of infection. Methods: We analyzed survey data obtained in 1988 from a nationally representative sample of 8,450 American women of reproductive age in order to identify such factors. Results: Of all sexually experienced unmarried women, 6.6% reported having had two or more sexual partners in the preceding three months. Earlier age at first sexual intercourse was associated with multiple recent partners, and with lower reports of abstinence. Birth region in the West, lack of attendance at religious services as an adolescent, and having a mother who had her first child before she was 25 years of age were factors associated with multiple recent partners. Among unmarried white women having a mother who worked full time and not living with both parents during adolescence were associated with multiple recent partners; among unmarried black women, the inverse was true ( p for racial difference <.05). Multivariate analysis showed western birth region and earlier age at first sexual intercourse to be significant predictors of having multiple recent sex partners. Conclusions: Early environment and race influence later sexual behavior. These factors should be considered in targeting and planning education for STD prevention.

Self-reported pelvic inflammatory disease in the united states, 1988

Objective. —To assess any changes in the characteristics of women with self-reported pelvic inflammatory disease (PID) between 1982 and 1988 and to evaluate the role of additional behavioral factors. In 1982, PID was a frequent problem among American women of reproductive age, occurring in one in seven. It was also more common among older (≥30 years) than younger women, more common among blacks than among whites, and more common among formerly married women than among those currently married. Design. —We analyzed data on self-reported PID from the cycle IV National Survey of Family Growth, conducted in 1988. Sample. —The survey was conducted with a multistage probability sample of 8450 women. Results. —The findings from 1982 were all replicated. Additional variables available in 1988 show that PID is more common among women with multiple (two or more) sexual partners (10% to 22%) compared with those with only one lifetime partner (7%) and among women who report a history of sexually transmitted disease (STD) (26%) compared with those with no STD history (10%). Controlling for other variables, age, race, vaginal douching, age at first intercourse, STD history, and number of lifetime partners emerged as independent predictors of self-reported PID among American women of reproductive age. Conclusion. —PID is still a widely prevalent condition among American women; PID is associated with a variety of risk factors for STD. Prevention of lower genital tract infection is crucial to avoiding PID and its sequelae. ( JAMA . 1991;266:2570-2573)

Self-Reported Pelvic Inflammatory Disease in the United States, 1988

Objective. —To assess any changes in the characteristics of women with self-reported pelvic inflammatory disease (PID) between 1982 and 1988 and to evaluate the role of additional behavioral factors. In 1982, PID was a frequent problem among American women of reproductive age, occurring in one in seven. It was also more common among older (≥30 years) than younger women, more common among blacks than among whites, and more common among formerly married women than among those currently married. Design. —We analyzed data on self-reported PID from the cycle IV National Survey of Family Growth, conducted in 1988. Sample. —The survey was conducted with a multistage probability sample of 8450 women. Results. —The findings from 1982 were all replicated. Additional variables available in 1988 show that PID is more common among women with multiple (two or more) sexual partners (10% to 22%) compared with those with only one lifetime partner (7%) and among women who report a history of sexually transmitted disease (STD) (26%) compared with those with no STD history (10%). Controlling for other variables, age, race, vaginal douching, age at first intercourse, STD history, and number of lifetime partners emerged as independent predictors of self-reported PID among American women of reproductive age. Conclusion. —PID is still a widely prevalent condition among American women; PID is associated with a variety of risk factors for STD. Prevention of lower genital tract infection is crucial to avoiding PID and its sequelae. ( JAMA . 1991;266:2570-2573)

Self-reported Pelvic Inflammatory Disease in the United States, 1988

--To assess any changes in the characteristics of women with self-reported pelvic inflammatory disease (PID) between 1982 and 1988 and to evaluate the role of additional behavioral factors. In 1982, PID was a frequent problem among American women of reproductive age, occurring in one in seven. It was also more common among older (greater than or equal to 30 years) than younger women, more common among blacks than among whites, and more common among formerly married women than among those currently married. --We analyzed data on self-reported PID from the cycle IV National Survey of Family Growth, conducted in 1988. --The survey was conducted with a multistage probability sample of 8450 women. --The findings from 1982 were all replicated. Additional variables available in 1988 show that PID is more common among women with multiple (two or more) sexual partners (10% to 22%) compared with those with only one lifetime partner (7%) and among women who report a history of sexually transmitted disease (STD) (26%) compared with those with no STD history (10%). Controlling for other variables, age, race, vaginal douching, age at first intercourse, STD history, and number of lifetime partners emerged as independent predictors of self-reported PID among American women of reproductive age. --PID is still a widely prevalent condition among American women, PID is associated with a variety of risk factors for STD. Prevention of lower genital tract infection is crucial to avoiding PID and its sequelae.

Unintended Pregnancy Among American Women

This research note presents new estimates of the proportion of American women of reproductive age who experience unintended pregnancies, unintended births and abortions. The data are based on tabulations from the 1982 National Survey of Family Growth (NSFG) and the Alan Guttmacher Institute's 1981-1982 national survey of abortion providers. Of 6.1 million women who became pregnant in 1982, 3.7 million gave birth, 1.6 million had abortions and 0.9 million experienced miscarriages. An estimated 37% of all births in the 5 years preceding the 1982 NSFG were unintended. Applying that proportion to 1982 births results in an estimate of 1.3 million unintended births. It can be assumed that all 1.6 million abortions were terminations of unintended pregnancies. Respondents in the 1982 NSFG reported that 40% of the births they had ever had were unintended. 33% of NSFG respondents said that they had had at least 1 unintended birth during their life. Abortions were seriously underreported in the NSFG, as they have been in most other surveys. Only 47% of the abortions that occurred during the period 1977-1981 were reported. The real proportion of women of reproductive age who have ever had an abortion appears to be 21%. 65% of all women aged 40-44 in 1982 had had at least 1 unintended pregnancy, and more than 1/3 of them had had at least 1 abortion. It is probably inappropriate to view these levels as representative of the proportions of today's young women who will ever experience an unintended pregnancy or abortion. Estimates of the proportion of women who will have had abortions by age 45 indicate that 18% of women will have had a 1st abortion by age 20; 41% will have had one by age 30; and 46%, by age 45.

Factors related to infertility in the United States, 1965-1976.

Although the overall rate of infertility among American women of reproductive age remained fairly constant between 1965 and 1976, the percentage of young black women who were infertile increased very sharply. In 1976, 18% of black women of reproductive age were infertile, whereas only 9% of white women of the same age were infertile. With use of national data bases, the relationships between sexual activity, complications of pregnancy, sexually transmitted diseases, pelvic inflammatory disease, use of contraception, and infertility were examined. Available evidence shows a strong association between sexually transmitted diseases, pelvic inflammatory disease, and infertility trends. Our projections indicate that sexually transmitted diseases operating through pelvic infections account for much of the race differential in infertility as well as for one-half to one-third of the increase. In 1976 5-8% of 20-29-year-old black women were estimated to suffer infertility attributable to sexually transmitted diseases. Among white women the estimated incidence of infertility caused by sexually transmitted diseases was 0.7-1%.