Individual Characteristics Of Women Research Articles

Risk factors for placenta accreta spectrum disorders in women with any prior cesarean and a placenta previa or low lying: a prospective population-based study

This study aimed to identify the risk factors for placenta accreta spectrum (PAS) in women who had at least one previous cesarean delivery and a placenta previa or low-lying. The PACCRETA prospective population-based study took place in 12 regional perinatal networks from 2013 through 2015. All women with one or more prior cesareans and a placenta previa or low lying were included. Placenta accreta spectrum (PAS) was diagnosed at delivery according to standardized clinical and histological criteria. Of the 520,114 deliveries, 396 fulfilled inclusion criteria; 108 were classified with PAS at delivery. Combining the number of prior cesareans and the placental location yielded a rate ranging from 5% for one prior cesarean combined with a posterior low-lying placenta to 63% for three or more prior cesareans combined with placenta previa. The factors independently associated with PAS disorders were BMI ≥ 30, previous uterine surgery, previous postpartum hemorrhage, a higher number of prior cesareans, and a placenta previa. Finally, in this high-risk population, the rate of PAS disorders varies greatly, not only with the number of prior cesareans but also with the exact placental location and some of the women's individual characteristics. Risk stratification is thus possible in this population.

Failed induction of labor in term nulliparous women with an unfavorable cervix: Comparison of cervical ripening by two forms of vaginal prostaglandins (slow-release pessary and vaginal gel).

To compare the rate of failed induction after cervical ripening by two forms of vaginal prostaglandins. This two-year retrospective study (January 1, 2016, through December 31, 2017) in two tertiary maternity units included nulliparous women with a singleton fetus in cephalic presentation and an unfavorable cervix requiring labor induction for prolonged pregnancy. The principal endpoint was the rate of failed induction, defined by the performance of a cesarean delivery before 6 cm of dilation. Cervical ripening was initiated by prostaglandins for 24h, using a slow-release pessary (unit A) or a vaginal gel (unit B). The care protocol of the two groups after the first 24h were similar. The women's individual characteristics were compared between the two units. The rates of failed induction were then compared between the two units, first by univariate and then by multivariable analysis adjusted for the characteristics that differed significantly between the units. Among the 17,217 women delivered in the two maternity units during the study period, 178 met our inclusion criteria (125 in unit A (slow-release pessary) and 53 in unit B (vaginal gel)). The rate of failed induction was similar: 21.6% in unit A (slow-release pessary) and 17.0% in unit B (vaginal gel) (P=0.48). The multivariate analysis did not show any difference about failed induction, time from the onset of induction to delivery, and vaginal delivery rate within 24h. The rate of failed induction of labor did not differ between slow-release pessary and vaginal gel.

Influence of the maternity unit and region of delivery on episiotomy practice in France: a nationwide population-based study.

Our objective was to identify factors associated with episiotomy practice in France, in particular, characteristics of the maternity units and regions of delivery. We performed a national cross-sectional population-based study in all French maternity units in 2016 including 9284 women with vaginal delivery. Our outcome was the performance of an episiotomy. After stratification for parity, associations of episiotomy practice with individual and organizational characteristics and the region of delivery were estimated with multilevel logistic regression models. The variability in maternity unit episiotomy rates explained by the characteristics studied was estimated by the proportional change in variance. A total of 19.9% of the women had an episiotomy. The principal factors associated with episiotomy practice were maternal and obstetric and delivery in a maternity unit with <2000 annual deliveries. After adjusting for individual, obstetric and organizational characteristics, the practice of episiotomy was strongly associated with women's region of delivery. Additionally, women's individual characteristics did not explain the significant variability in episiotomy rates between maternity units (P < 0.001) but maternity unit characteristics partly did (proportion of variance explained: 7.2% for primiparas and 13.6% for multiparas) and regional differences still more (18% and 30.7%, respectively). Episiotomy practices in France in 2016 varied strongly between maternity units, largely due to regional differences. Targeted actions by the regional perinatal care networks may reduce the national episiotomy rate and standardize practices.

Factors affecting the frequency and contents of routine antenatal care in remote rural China in 2009–2016: An observational study

We assessed factors associated with the frequency and contents of antenatal care (ANC) in remote rural China, including the province of residence and individual-level factors. Survey-based cross-sectional study. Five provinces in remote rural China: Guizhou, Hunan, Jilin, Ningxia and Shaanxi. A cohort of 3918 women with a live birth in 2009-2016. Poisson regression. ANC frequency: five or more visits, starting in the first trimester. ANC contents: coverage of six care components and overuse of ultrasound. Three-quarters (72.9%) of women had five or more ANC visits, starting in the first trimester; 68.8% received all six care components and 94.5% had three or more ultrasounds. Only 30.9% of women sought ANC from township hospitals, paying between $3.80 and $25.80 per visit. ANC frequency and contents were associated with the socio-economic characteristics of the women, but provincial effects were much greater, even after adjusting for individual factors. Women living in Guizhou and Ningxia, the two poorest provinces, with high proportions of ethnic minorities, were particularly underserved. Compared with women in Shaanxi, women in Guizhou were 33% (adjusted RR0.67, 95%CI 0.61-0.74) less likely to receive five or more ANC visits, starting in the first trimester; women in Ningxia were 17% less likely (adjusted RR0.83, 95%CI 0.76-0.90) to receive all six care components. The province of residence was a stronger predictor of ANC frequency and contents than the individual characteristics of women in China, suggesting that strengthening the decentralised system of the financing and organisation of ANC at the province level is crucial for achieving success. Future efforts are warranted to engage subregional administrations. The province of residence was a stronger predictor of ANC frequency and contents than the individual characteristics of women.

도시와 농촌여성노인의 개인적 특성, 운동습관, 낙상효능감 및 낙상위험지각이 주관적 건강 수준에 미치는 영향

본 연구는 도시와 농촌에 거주하는 여성노인을 대상으로 개인적 특성, 운동습관, 낙상효능감(FES-K), 낙상위험지각(PFR), 주관적 건강(SRH)을 비교하고 주관적 건강 수준에 미치는 영향을 확인하기 위해 실시하였다. 도시와 농촌 지역의 65세 이상의 여성노인 173명을 대상으로 신체조성 측정 및 설문(개인 및 운동특성, FES-K, PFR, SRH)을 실시하였고 χ², t-test, ANOVA, 상관관계, 다중회귀분석(stepwise)을 통해 분석한 결과는 다음과 같다. 첫째, 여성노인의 개인적 특성 항목 중 연령(p<.05), 신장과 체중(p<.05), 주거형태(p<.001)에서 지역간 유의한 차이가 나타났고, 운동습관에서는 운동유무(p<.01), 운동빈도(p<.01), 운동시간(p<.001)에서 도시여성노인이 유의하게 높은 빈도와 평균점수가 나타났으며 낙상효능감(p<.05), 주관적 건강 수준(p<.05)은 도시여성노인이 낙상위험지각(p<.05)은 농촌여성노인이 유의하게 높게 나타났다. 둘째, 대상자의 특성에 따른 주관적 건강 수준의 차이는 주거형태(p<.05), 운동유무(p<.01), 운동빈도(p<.05), 운동시간(p<.01), 운동종류(p<.01), 낙상유무(p<.01)에서 유의하게 나타났다. 셋째, 상관관계 결과, 주관적 건강은 운동유무(p<.01), 운동빈도(p<.01), 운동시간(p<.001), 낙상효능감(p<.001)과 정적상관이 나타났으며, 농촌여성노인(p<.05)과 낙상경험자(p<.01), 낙상위험지각(p<.001)과 부적상관이 나타났다. 넷째, 다중회귀분석 결과, 낙상효능감(p<.01), 낙상위험지각(p<.01), 운동시간(p<.05), 낙상경험(p<.05)이 주관적 건강 수준에 유의한 영향을 미치는 것으로 나타났으며, 낙상효능감과 운동시간은 정적 영향을 낙상위험지각과 낙상경험은 부적영향을 미치는 것으로 검증되었다. 본 연구의 결과는 곧 다가올 초고령사회를 대비하여 지역별 낙상 예방 프로그램 개발 및 건강자각도 증진을 위한 기초자료로 사용될 수 있으리라 기대한다.

Association of Oxytocin Use and Artificial Rupture of Membranes With Cesarean Delivery in France.

To evaluate whether the decrease in the frequency of oxytocin administration and artificial rupture of membranes observed between the 2010 and 2016 French Perinatal Surveys was associated with a change in the frequency of cesarean delivery or cesarean delivery indications among women who entered labor spontaneously. This cross-sectional study included women who participated in the 2010 and 2016 French National surveys who had singleton pregnancies and who gave birth at at least 37 weeks of gestation after spontaneous labor to a liveborn neonate in cephalic presentation. To test whether the observed decrease of oxytocin administration and artificial rupture of membranes between the two study years was explained by the women's individual characteristics and maternity units' organizational characteristics change, multivariable analyses were performed. The same strategy was applied for the change in intrapartum cesarean delivery rates between the 2 years. These analyses were repeated in nulliparous, low obstetric risk women, multiparous low obstetric risk women, and women with a previous cesarean delivery. The cesarean delivery indications were compared in 2010 and 2016. Oxytocin administration decreased significantly from 58.3% in 2010 to 45.2% in 2016 (adjusted odds ratio [aOR] 0.51; 95% CI 0.47-0.55), as did artificial rupture of membranes, from 52.4% to 42.6% (aOR 0.66; 95% CI 0.62-0.71). The intrapartum cesarean delivery rate remained stable-6.9% compared with 6.6% (aOR 0.93; 95% CI 0.82-1.06). The same patterns were observed in low risk groups and women with a previous cesarean delivery. The cesarean delivery indications were similar in both years. The significant decrease in oxytocin administration and artificial rupture of membranes in 2016 compared with 2010 was not accompanied by an increase in the intrapartum cesarean delivery rate for women in France who entered labor spontaneously. These results support the recent international guidelines.

Social Inequalities in Fertility in Women Residing in Urban Neighbourhoods in Spain: A Multilevel Approach.

Reproductive health inequalities tend to be more marked in large cities because they include neighbourhoods with unequal social and community networks, resources and opportunities. The aim was to describe social inequalities in fertility patterns among women who gave birth between 2007 and 2016 in the city of Barcelona (Spain) by jointly evaluating the effect of individual and socioeconomic neighbourhood characteristics. We conducted a multilevel study of women's individual characteristics (age, educational attainment, and country of origin) and neighbourhood characteristics (disposable household income, percentage of unemployment and percentage of foreigners). Multilevel modelling revealed significant variability in fertility across neighbourhoods after adjustment for individual explanatory variables. The fertility rate (FR) was higher in better educated women (adjusted relative risk: aRR 2.76), those aged 30-39years (aRR 2.13), and in those born in Spain in relation to their respective reference groups. The FR was lowest in women with upper to post-secondary, non-tertiary education (aRR 0.86) who were born in high income countries (aRR 0.57). Women living in neighbourhoods with a low income (aRR 1.46) and with a higher unemployment (aRR 1.33) were more likely to have children. In contrast, women living in neighbourhoods with a lower percentage of foreigners had the lowest FR (aRR 0.81). The neighbourhood's characteristics played an important role in fertility patterns, independently of women's individual characteristics. At the contextual level, the highest FR was found in the poorest settings, highlighting inequalities. At the individual level, the FR was highest among women with higher education and in their thirties.

Association Between Individual and Intimate Partner Factors and Cervical Cancer Screening in Kenya.

IntroductionCervical cancer is the most prevalent cancer among women in Kenya. Although cervical cancer screening could reduce illness and death, screening rates remain low. Kenyan women’s individual characteristics and intimate partner factors may be associated with cervical cancer screening; however, a lack of nationally representative data has precluded study until recently. The objective of our study was to examine individual and intimate partner factors associated with cervical cancer screening in Kenya.MethodsWe conducted secondary data analysis of responses by women who completed the cervical cancer screening and domestic violence questions in the Kenya Demographic and Health Survey, 2014 (N = 3,222). By using multivariable regression analyses, we calculated the association of cervical cancer screening with age, religion, education, wealth, recent exposure to family planning on television, head of household’s sex, and experience of intimate partner violence.ResultsRates of cervical cancer screening among women in Kenya increased with age. The wealthiest women and women with post-secondary education had greater odds of reporting being screened for cervical cancer than the poorest women and uneducated women. Christians and women exposed to prevention messaging on television had higher odds of screening than Muslims and women with no exposure. Victims of intimate partner violence had lower odds of being screened than women who had not experienced intimate partner violence.ConclusionIdentified barriers to screening in this sample mirror previous findings, though with additional nuances. Model fit data and theoretical review suggest that additional, unmeasured variables may contribute to variability in cervical cancer screening rates. Inclusion of additional variables specific to cervical cancer in future national surveys could strengthen the ability to identify factors associated with screening.

Access to Abortion in Central Appalachian States: Examining County of Residence and County‐Level Attributes

Studies of how women's individual characteristics and place of residence are related to variability in gestational age at the time of abortion have not examined county of residence and county-level characteristics. The county level is potentially meaningful, given that county is the smallest geographic unit with policy implications. Data on 38,611 abortions that took place in North Carolina, Virginia and West Virginia in 2012 were used to study the relationship between gestational age and county-level attributes (e.g., metropolitan status and poverty). Three-level hierarchical linear models captured individuals nested in county of residence, clustered by state of residence, and adjusted for individual characteristics and distance traveled to care. Eight percent of the variation in gestational age at abortion was attributable to county-level characteristics. Residents of counties characterized by persistent poverty obtained abortions 2.3 days later in gestation than those from counties not characterized by that level of economic hardship. Women living in nonmetropolitan counties obtained abortions 1.7 days later than those living in metropolitan counties, even after distance traveled and county-level poverty were controlled for. County of residence is relevant to gestational age at the time of abortion for women in these three states. Evidence that county-level attributes are related to access adds insight to the consequences for women when the landscape of abortion service delivery shifts. Integrating county of residence into research on access to abortion services may be critical to capturing disparities in access.

Pioneers in the Study of Crowds in Foreign Psychology: Scipio Sighele and Henry Fournial

Introduction. By the end of the 19th century the society had to adapt to new threats—namely, increasing the number and activity of the proletariat masses and spreading socialist and anarchist ideas. Many researchers concentrated their study on characteristics of crowds. Scipio Sighele and Henry Fournial have been pioneers in this field.&#x0D; Theoretical Basis. The paper describes two concepts which provided a starting point for studying crowds in foreign psychology. The main issues considered by Scipio Sighele and Henry Fournial were as follows: characteristics of the crowd as a social institution, its properties, activization factors, characteristics of leaders, personality changes within crowds, and the problem of criminal liability for mass crimes. The paper presents an innovative view of (a) the origin of excessive generalization of the crowd concept, (b) its uncritical acceptance in defining a number of social organizations, (c) and wrongful attributing characteristics of individual women to the crowd as the subject of mass action.&#x0D; Results. The revealed tendencies and a clearly distorted perception of crowds among representatives of the anthropological and criminalistic approach determined the critical attitude towards new science of temporary social groups.&#x0D; Discussion. A distinct trend towards isolated cognitive constructs and almost complete disregard for the study of the past contribute to a distorted understanding of the phenomenon of crowds in modern social psychology of spontaneous groups. The ideas of researchers of the past seem to be a necessary precondition for developing a holistic approach to this problem.&#x0D; Highlights&#x0D; &#x0D; Sighele and H. Fournial created the background for scientific understanding of the phenomenon of crowds until the mid 20th century; they considered the characteristics of the crowd as a social institution, its properties, activization factors, characteristics of leaders, personality changes within crowds, the problem of criminal responsibility for mass crimes.&#x0D; Methodological weaknesses in S. Sighele’s and H. Fournial’s studies included: (a) attributing negative traits of criminal crowds to other crowd types, (b) attributing a reduced intellectual potential to any meeting, and (c) attributing characteristics of women in the crowd to the crowd as the subject of mass action.&#x0D; The heritage of S. Sighele, H. Fournial, and other researchers of the initial period can help in overcoming excessive individualism and rationalism in modern crowd psychology.&#x0D; &#x0D;

Study of the Determinants of the Use of Breast Cancer Screening in Women 35 to 65 Years in the Region of Thies (Senegal)

Introduction: In Senegal, breast cancer is the second most common cancer of women after cervical cancer. It is a cancer accessible to clinical and radiological screening. The objective of this study was to study the determinants of the use of breast cancer screening among women aged 35 to 65 in the Thies region in 2015. Material and Methods: It was a descriptive and analytical cross-sectional study. It was conducted with a sample of women selected using a two-stage cluster survey. The study used a questionnaire to collect data on the individual characteristics of women, knowledge, attitudes and practice on breast cancer and quality of care in an individual interview at the homes of women after consent. The data was entered on the Epi Info 3.5.3 software and analyzed with the R 3.3.3 software. A description of qualitative variables across proportions and quantitative variables by mean and standard deviation was performed. Parametric or non-parametric tests were used to examine the association between the dependent variable (breast cancer screening) and explanatory variables (predisposing factors, resources, health needs) according to their applicability conditions and at a risk α equal 5%. Finally, all variables with p less than 0.25 were used to construct an explanatory model by simple logistic regression. Results: The study involved 960 women aged 35 to 65 years. The average age was 43.8 years with a standard deviation of 8.3 years. The rate of breast cancer screening was 25.7%. Educated women (OR adjusted = 1.89 [1.25 - 2.85]), women who resided in urban settings (adjusted OR = 1.79 [1.05 - 3.04]), those who experienced at least one risk factor for breast cancer (OR adjusted = 2.71 [1.81 - 4.06]) were more likely to use screening breast cancer. In contrast, women with low socioeconomic status (adjusted OR = 0.66 [0.45 - 0.97]) were less likely to be screened. Conclusion: Level of education, knowledge of breast cancer and having received screening advice are factors to consider in improving the rate of breast cancer screening in Thies, and the most important remains public awareness.

Why Do Women Deliver at Home? Multilevel Modeling of Ethiopian National Demographic and Health Survey Data

BackgroundDespite of the existing intensive efforts to improve maternal health in Ethiopia, the proportion of birth delivered at home remains high and is still the top priority among the national health threats.ObjectiveThe study aimed to examine effects of individual women and community-level factors of women’s decision on place of delivery in Ethiopia.MethodsData were obtained from the nationally representative 2011 Ethiopian Demographic and Health Survey (EDHS) which used a two-stage cluster sampling design with rural-urban and regions as strata. The EDHS collected data from a big sample size but our study focused on a sample of 7,908 women whose most recent birth was within five years preceding 2011 and 576 communities in which the women were living in. The data were analyzed using a two-level mixed-effects logistic regression to determine fixed-effects of individual- and community-level factors and random-intercept of between-cluster characteristics.ResultsIn the current study, 6980 out of 7908 deliveries (88.3%) took place at home. Lower educational levels (OR=2.74, 95%CI:1.84,4.70; p<0.0001), making no or only a limited number of ANC visits (OR=3.72,95%CI:2.85, 4.83; p<0.0001), non-exposure to media (OR=1.51, 95%CI 1.13, 2.01; p=0.004), higher parity (OR=2.68, 95%CI:1.96,3.68; p<0.0001), and perceived distance problem to reach health facilities (OR=1.29, 95%CI:1.03,1.62; p=0.022) were positively associated with home delivery. About 75% of the total variance in the odds of giving birth at home was accounted for the between-community differences of characteristics (ICC=0.75, p<0.0001). With regard to community-level characteristics, rural communities (OR=4.67, 95%CI:3.06,7.11; p<0.0001), pastoralist communities (OR=4.53, 95%CI:2.81,7.28; p<0.0001), communities with higher poverty levels (OR=1.49 95%CI:1.08,2.22; p=0.048), with lower levels of ANC utilization (OR=2.01, 95%CI:1.42,2.85; p<0.0001) and problem of distance to a health facility (OR=1.29, 95%CI:1.03,1.62; p=0.004) had a positive influence on women to give birth at home.ConclusionsNot only individual characteristics of women, but also community-level factors determine women’s decision to deliver at home.

Venues for Meeting Sex Partners and Partner HIV Risk Characteristics: HIV Prevention Trials Network (HPTN064) Women's HIV Seroincidence Study (ISIS).

Identifying venues where women meet sexual partners, particular partners who increase women's risk of acquiring HIV, could inform prevention efforts. We categorized venues where women enrolled in HPTN 064 reported meeting their last three sex partners as: (1) Formal, (2) Public, (3) Private, and (4) Virtual spaces. We used multinomial logistic regression to assess the association between these venues and women's individual characteristics and reports of their partners' HIV risk characteristics. The 2099 women reported meeting 3991 partners, 51% at Public, 30% Private, 17% Formal and 3% at Virtual venues. Women meeting partners at Formal venues reported more education and condom use than women meeting partners at other venues. Fewer partners met through Formal venues had "high" risk characteristics for HIV than through other venues and hence may pose less risk of HIV transmission. HIV prevention interventions can help women choose partners with fewer risk characteristics across all venue types.

Geographical variations in fertility and transition to second and third birth in Britain.

Geographical variations in fertility have been observed within several countries in Northern Europe, with higher fertility in rural areas, smaller settlements and city suburbs. However, the processes underlying such fertility variations across residential contexts are not well understood. This paper contributes to the on-going debate by looking at local variations in fertility in Britain. It aims to disentangle the relative contribution of a number of factors, including the socio-economic characteristics of individuals, housing conditions, patterns of residential relocation and lastly, contextual factors stricto sensu. In addition, it seeks to identify those aspects of reproductive behaviour which are more likely to be associated with the observed spatial differences, and to distinguish between those that may be influenced by local context and those that respond to social influences at different scales. The focus is on local fertility contexts which, we argue, have the potential to influence the fertility behaviour of individuals through processes of social learning. Individual level data from the British Household Panel Survey and methods of event history analysis are used to explore women's transitions to second and third order births in Britain in the early 21st century. Our findings indicate that individual reproductive life paths respond to a variety of social processes acting at various scales, and that these influences vary by birth order. Most interestingly, local fertility contexts influence transition to first birth but not transition to higher order births, which are mainly associated with individual characteristics of women and their partners. Dominant spacing effects, however, suggest that local contexts have an indirect impact on second and third births through age at the onset of childbearing. The study demonstrates the importance of considering social interaction theories, and their extension to scale-sensitive spatial contexts in which these interactions take place, when analysing geographical variations in fertility. Future research seeking to explain subnational fertility variations must recognize the importance of developing theoretical understandings to inform empirical work.

Gendered social forces: A review of the impact of institutionalized factors on women and girls' criminal justice trajectories.

Increasing arrest rates for girls and women have been documented both nationally and internationally and have propelled the development of promising theories of female antisocial behavior and crime. Nonetheless, many psychological theories focus exclusively on individual characteristics of women that promote criminality. Fewer theorists incorporate the influence of institutional and social policy factors in models of female antisociality and criminal justice involvement, despite growing evidence supporting the impact of these institutional factors on female crime. The present review expands existing conceptualizations by reviewing evidence about the extent to which the response of the criminal justice system disproportionately affects women across four key institutional domains: (1) processing and sentencing decisions, (2) relabeling and responding to youth status offenses, (3) arrests for drug offenses, and (4) pro and dual arrests for domestic violence incidents. Evidence largely supports the existence of gendered practices in the institutional response of the justice system to female crime, in that institutional changes have disproportionately influenced women's involvement in the justice system or have otherwise resulted in consequences that are different for women than men. Language: en

Contraceptive Discontinuation among Honduran Women Who Use Reversible Methods

A panel study examining the effects of women's individual characteristics, side effects experienced, and service quality on their contraceptive discontinuation was undertaken in four urban areas of Honduras. Data were collected from October 2006 to December 2007. The baseline sample consisted of 800 women aged 15-44 who were new or continuing users of an injectable contraceptive, the IUD, or an oral contraceptive. A total of 671 women (84 percent) were reinterviewed after one year. Life tables and Cox proportional hazards models were used to present discontinuation rates and factors associated with contraceptive discontinuation. Among new users, discontinuation of the baseline method at 12 months was high (45 percent), especially for users of an injectable method (50 percent). In the hazards model, service quality had little effect on discontinuation, whereas individual characteristics and the experience of specific side effects showed significant effects. The results suggest that programs should emphasize continuous contraceptive coverage rather than continuous use of a particular method.

Infertility service use among U.S. women: 1995 and 2002

To examine trends in use of medical services for infertility, by individual characteristics of women. Pooled data from two cycles (1995 and 2002) of the National Survey of Family Growth, a periodically conducted, nationally representative, cross-sectional survey of women 15-44 years of age. The analysis sample was composed of 2,005 women 22-44 years of age with current fertility problems. None. Ever having used infertility services, and highest level of services used. Between 1995 and 2002, ever-use of infertility services by fertility-impaired women age 22-44 years continued to be closely associated with older age, nulliparity, formal marital status, and higher socioeconomic status (education, household income, and private health insurance). Net of these factors, race and Hispanic origin, showed no significant association with either the use of services overall or the highest level of services used. After controlling for compositional changes in these individual characteristics, a slight decline was seen in ever-use of services overall from 1995 to 2002. No effect of survey year was noted in the highest level of services. Infertility service use among fertility-impaired women remains closely tied with socioeconomic factors. The "threshold effect" of these factors has shifted upward to the receipt of more costly services such as assisted reproductive technologies. These higher level services remain a relatively small fraction of the services reported in a general population sample of fertility-impaired women.

Disentangling Discrimination on Spanish Boards of Directors

The detection of discrimination on boards of directors is an interesting issue in the study of labour market inequalities, since the presence of a discriminated group would be especially scarce and tracking the possible causes of discrimination would be easier in the last steps of a professional career. Identifying the types of discrimination is a key issue, because they are usually mixed and distorted by the presence of other elements. In order to disentangle the different causes, an extreme case such as Spain, where the percentage of women on boards ranges from 6.6% to 8.6%, becomes especially relevant. In this study, discrete variable models are used to estimate the proportion of women on the boards of directors of the largest Spanish companies in 2005 and 2008. Some signals of discrimination have been identified. We have found evidence of the dynamics of Becker's model of taste-based discrimination, as time and competition can act in favour of women's presence on Spanish boards. There are clubby companies in which the homogeneity of the board prevails. This could also indicate traces of taste-based discrimination. When there is additional information about women's individual characteristics (i.e. family-based firms, cooperatives), statistical discrimination is reduced. Finally, we have detected the presence of companies that can systematically underestimate the abilities of women to fill these positions, a situation that tends to disappear when the companies already have female directors. We interpret this contagious factor as a signal of mistake-based discrimination.

Late entry into prenatal care: the neighborhood context.

This study investigated individual and neighborhood factors associated with late entry into prenatal care. Data from 220,694 New York City birth certificates were linked with data from the 1990 census and other secondary sources to determine the effect of women's individual characteristics and their neighborhood context on timing of prenatal care entry. Results indicate that 15 percent of New York City's pregnant women entered prenatal care late and that residence in a distressed urban neighborhood significantly increased the risk of late initiation, even in a model controlling for individual risk factors. Implications for social workers include the importance of outreach and case management for pregnant women, the value of health and social policies targeting distressed urban neighborhoods, and the need to ensure that Medicaid managed care implementation fosters use of prenatal care. The findings also underscore the importance of continuing to strive for a policy that ensures lifelong universal access to health care.

Dual-Method Use Among an Ethnically Diverse Group of Women at Risk of HIV Infection

Few U.S. women protect themselves against both pregnancy and sexually transmitted diseases (STDs) by using an efficient contraceptive method and a condom. Understanding the factors that influence dual-method use could help improve interventions aimed at encouraging protective behaviors. Interviews were conducted with 552 low-income women at risk of HIV who attended public health or economic assistance facilities in Miami in 1994 and 1995. Multinomial logit analyses were used to determine the influence of women's background characteristics, perceived vulnerability to pregnancy and AIDS, and relationship characteristics on the odds of dual-method use. Overall, 20% of the women used dual methods. Women who were not married, who worried about both pregnancy and AIDS, who had ever had an STD, who were confident they could refuse a sexual encounter in the absence of a condom and who made family planning decisions jointly with their partner were the most likely to use dual methods rather than a single method (odds ratios, 2.0-3.5); those who considered the condom only somewhat effective in preventing AIDS or who shared economic decision-making with their partner were the least likely to use dual methods rather than a single method (0.5-0.6). The results were generally similar in analyses examining the odds of dual-method use involving an efficient contraceptive, except that black and Hispanic women were significantly more likely than whites to use condoms in conjunction with efficient contraceptives (3.3-7.1). Both women's individual characteristics and the context of their sexual relationships influence whether they simultaneously protect themselves from pregnancy and HIV. The involvement of male partners in family planning decision-making and women's control over economic decision-making ensure greater protection against HIV infection.