Women's Reports Research Articles

The Invisible Hand that Rocks the Cradle: On the Limits of Time Use Surveys

ABSTRACTAlmost every intervention in the field of international agricultural development — from microcredit finance to fertilizer subsidies to trade policy — has come to recognize gender, and relationships within households, as important. Yet most interventions continue to treat the household as a ‘black box’, with changes within the household measured by the effects on income, anthropometry, health, or other secondary metrics within bargaining models. In this context, there has been increasing interest in time use studies as a way to peer inside this black box. This article offers a review of methods and identifies some of the difficulties facing time use studies in capturing intrahousehold dynamics, and presents the results of a two‐season simultaneous activity time use study in Malawi which aimed to address these difficulties. The results suggest significant limitations to time use surveys. The kinds of reproductive labour that often interest researchers may be invisible to the women responding to time use surveys, with the result that care work is dramatically under‐reported. The authors discuss the implications of the divergence between researchers’ concerns and the women's reports of their lives for time use surveys, and for feminist development research methods more broadly.

Does Marijuana Contribute to Intimate Partner Aggression? Temporal Effects in a Community Sample of Marijuana-Using Couples

Although patterns of marijuana use are positively associated with intimate partner aggression, there is little evidence that episodes of marijuana use contribute to the occurrence of episodes of relationship conflict and aggression. The present ecological momentary assessment study considered the temporal relationship between marijuana use episodes and the occurrence of conflict, verbal aggression, and physical aggression between intimate partners in the next 2 hours. A sample of 183 cohabiting marijuana-using couples (ages 18-30) were recruited from the community. For 30 consecutive days, each partner independently reported episodes of marijuana use and partner conflict, including verbal and physical aggression perpetration and victimization within conflicts. Temporal associations between each partner's marijuana use and subsequent conflict and aggression were examined using the Actor-Partner Interdependence Model. Analyses accounted for between-person effects of marijuana use frequency and total conflicts. We observed temporal effects of actor (but not partner) marijuana use on men's and women's reports of conflict and verbal aggression perpetration and victimization within 2 hours of use. Marijuana use episodes did not alter the likelihood of physical aggression in the next 2 hours. Partner concordance in marijuana use had no effect on verbal or physical aggression or victimization. The positive temporal effects of marijuana on conflict and verbal aggression remained significant after accounting for the effect of drinking episodes. Within generally concordant, marijuana-using young couples, marijuana use episodes contribute to the occurrence of relationship conflict and verbal aggression.

An exploratory study of whether pregnancy outcomes influence maternal self-reported history of child maltreatment.

Childhood maltreatment is common and has been increasingly studied in relation to perinatal outcomes. While retrospective self-report is convenient to use in studies assessing the impact of maltreatment on perinatal outcomes, it may be vulnerable to bias. We assessed bias in reporting of maltreatment with respect to women's experiences of adverse perinatal outcomes in a cohort of 230 women enrolled in studies of maternal mental illness. Each woman provided a self-reported history of childhood maltreatment via the Childhood Trauma Questionnaire at two time points: 1) the preconception or prenatal period and 2) the postpartum period. While most women's reports of maltreatment agreed, there was less agreement for physical neglect among women experiencing adverse perinatal outcomes. Further, among women who discrepantly reported maltreatment, those experiencing adverse pregnancy outcomes tended to report physical neglect after delivery but not before, and associations between physical neglect measured after delivery and adverse pregnancy outcomes were larger than associations that assessed physical neglect before delivery. There were larger associations between post-delivery measured maltreatment and perinatal outcomes among women who had not previously been pregnant and in those with higher postpartum depressive symptoms. Although additional larger studies in the general population are necessary to replicate these findings, they suggest retrospective reporting of childhood maltreatment, namely physical neglect, may be prone to systematic differential recall bias with respect to perinatal outcomes. Measures of childhood maltreatment reported before delivery may be needed to validly estimate associations between maternal exposure to childhood physical neglect and perinatal outcomes.

Methodological Considerations in Couples' Fertility Intentions: Missing Men and the Viability of Women's Proxy Reports.

Introduction Recent efforts show potential to advance research on unintended childbearing by taking a couple-level approach. However, this work has neither adequately addressed methodological concerns stemming from the challenges associated with male fertility data nor considered the viability of women's proxy reports of fathers intentions. Methods Data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) were used to assess the implications of low response rates among men on couples' unintended childbearing. Then, the accuracy of women's proxy reports of fathers intentions was assessed. Weighted logistic regression analyses were conducted to determine how women's characteristics were associated with men's survey participation whereas weighted multinomial logistic regression analyses were applied to determine how women's characteristics were linked with the accuracy of her proxy report. Results Almost half (46%) of women cannot be matched with data from the child's father, and this discrepancy is most problematic for women who are black, foreign-born, less educated, and unmarried at birth. Women's proxy reports appear viable as 75% of women's reports are consistent with men's responses. Yet, proxy reports underestimate disagreement in couples' intentions as mothers who intended the birth are at an increased risk of "inaccurately" reporting that fathers share their intentions. Discussion Direct approaches to couples' intentions yield privileged samples and systematically omit women at the greatest risk of an unintended birth. However, proxies underestimate disagreement in couples' intentions-a key contribution to the couple approach. Accordingly each approach has its own merits which must be considered in light of specified research questions.

Association Between Obstetric Provider's Advice and Gestational Weight Gain.

Objective This study examined associations between pregnant women's report of obstetric provider GWG advice, self-reported adherence to such advice, and GWG. Methods Healthy pregnant women (N = 91) who started obstetric care prior to 17 weeks of gestation completed assessments between 30 and 34 weeks of gestation. These included survey (questions on receipt of and adherence to provider GWG advice, and demographics) and anthropometric measures. GWG data were abstracted from electronic health records. Analyses included Chi square and Mann-Whitney tests, and binary and multivariate logistic regressions. Results The cohort's median age was 28 years, 68% of women were White, 78% had a college education, 50.5% were overweight or obese before the pregnancy, and 62.6% had GWGs above the Institute of Medicine-recommended ranges. Sixty-seven percent of women reported having received GWG advice from their obstetric providers and, of those, 54.1% reported that they followed their provider's advice. Controlling for race, education and pre-pregnancy BMI, receipt of GWG advice was marginally associated with increased odds of excessive weight gain (OR 2.52, CI 0.89-7.16). However, women that reported following the advice had lower odds of excessive GWG (OR 0.18, CI 0.03-0.91) and, on average, gained 11.3 pounds less than those who reported following the advice somewhat or not at all. Conclusions Frequency of GWG advice from obstetric providers is less than optimal. When given and followed, provider advice may reduce the risk of excessive GWG. Research to understand factors that facilitate providers GWG advice giving and women's adherence to providers' advice, and to develop interventions to optimize both, is needed.

Delivering Breast Reconstruction Information to Patients: Women Report on Preferred Information Delivery Styles and Options.

To discover missed opportunities for providing information to women undergoing breast reconstruction in an effort to decrease regret and improve patient education, teaching modalities, and satisfaction. Thirty- to 45-minute semi-structured interviews were conducted exploring patient experiences with information provision on breast reconstruction. Purposeful sampling was used to include women with a variety of reconstruction types at different time points along their recovery. Using grounded theory methodology, 2 independent reviewers analyzed the transcripts and generated thematic codes based on patient responses. BREAST-Q scores were also collected to compare satisfaction scores with qualitative responses. Patients were interested in a wide variety of topics related to breast reconstruction including the pros and cons of different options, nipple-sparing mastectomies, immediate breast reconstruction, oncological safety/monitoring and the impact of chemotherapy and radiotherapy, secondary procedures (balancing, nipple reconstruction), post-operative recovery, and long-term expectations. Patients valued accessing information from multiple sources, seeing numerous photographs, being guided to reliable information online, and having access to a frequently asked questions file or document. Information delivery via interaction with medical personnel and previously reconstructed patients was most appreciated. Compared with BREAST-Q scores for satisfaction with the plastic surgeon (mean: 95.7, range: 60-100), informational satisfaction scores were lower at 74.7 (50-100), confirming the informational gaps expressed by interviewees. Women having recently undergone breast reconstruction reported key deficiencies in information provided prior to surgery and identified preferred information delivery options. Addressing women's educational needs is important to achieve appropriate expectations and improve satisfaction.

Prevalence of Prolonged Latent Phase and Labor Outcomes: Review of Birth Records in a Swedish Population.

The prevalence of a prolonged latent phase of labor has been described as ranging from 5% to 6.5% in previous research. The aim of this study was to describe the prevalence of the prolonged latent phase of 18 hours or more, based on women's report, in women intending vaginal birth and who had spontaneous onset of labor. An additional aim was to compare the incidence of obstetric interventions, and the labor and neonatal outcomes in women with and without a prolonged latent phase. A descriptive and comparative study was performed in a mid-sized hospital in western Sweden. The sample consisted of 1343 birth records of women who intended vaginal births and who had spontaneous onset of labor at 37 or more weeks' gestation during a one-year period (2013-2014). Background characteristics, obstetric interventions, and labor and neonatal outcomes were compared between women with latent phases lasting less than 18 hours and 18 hours or more, based on women's self-report. Odds ratios with 95% confidence intervals were calculated for the different exposure variables. A prolonged latent phase lasting 18 hours or more occurred in 23% of all births analyzed (n = 1343). A prolonged latent phase was more common among nulliparous women (29.2%) but also common for multiparous women (17%). Nulliparous and multiparous women who experienced a prolonged latent phase were more often exposed to amniotomy during latent phase. For nulliparous women, the adjusted odds ratio (aOR) was 11.57 (95% confidence interval [CI], 5.25-25.51) and for multiparous women the aOR was 18.73 (95% CI, 9.06-38.69). Similarly, amniotomy during active phase was more common for both nulliparous and multiparous women who experienced a prolonged latent phase (aOR, 4.05; 95% CI, 2.53-6.47 and aOR, 3.93; 95% CI, 2.43-6.37, respectively). Women with latent phases of 18 hours or more, more often experienced augmentation of labor during all phases, especially during latent phase. For nulliparous women, the aOR was 10.13 (95% CI, 2.82-36.39) and for multiparous women, aOR was11.9 (95% CI, 3.69-38.71). A prolonged latent phase was associated with more instrumental vaginal births for multiparas (aOR, 2.58; 95% CI, 1.27-5.26) and emergency cesarean regardless of parity (nulliparous women: aOR, 3.21; 95% CI, 1.08-9.50 and multiparous women: aOR, 3.93; 95% CI, 1.67-9.26). Based on women's self-report, the prevalence of a prolonged latent phase in women at term who planned a vaginal birth and had spontaneous onset of labor was higher than previously reported. Women with a prolonged latent phase were more likely to receive obstetric interventions. Assisted vaginal birth was more common for nulliparous women with prolonged latent phase and emergency cesarean occurred more frequently for both nulliparous women and multiparous women with a prolonged latent phase.

Polly, Nancy, and Torchy Crack the Case: Those Relentless Women Reporters

Polly, Nancy, and Torchy Crack the Case: Those Relentless Women Reporters

Women's health in the occupied Palestinian territories: Contextual influences on subjective and objective health measures.

The links between two commonly used measures of health—self-rated health (SRH) and self-reported illness (SRI)–and socio-economic and contextual factors are poorly understood in Low and Middle Income Countries (LMICs) and more specifically among women in conflict areas. This study assesses the socioeconomic determinants of three self-reported measures of health among women in the occupied Palestinian territories; self-reported self-rated health (SRH) and two self-reported illness indicators (acute and chronic diseases). Data were obtained from the 2010 Palestinian Family Health Survey (PFHS), providing a sample of 14,819 women aged 15–54. Data were used to construct three binary dependent variable—SRH (poor or otherwise), and reporting two SRI indicators—general illness and chronic illness (yes or otherwise). Multilevel logistic regression models for each dependent variable were estimated, with individual level socioeconomic and sociodemographic predictors and random intercepts at the governorate and community level included, to explore the determinants of inequalities in health. Consistent socioeconomic inequalities in women’s reports of both SRH and SRI are found. Better educated, wealthier women are significantly less likely to report an SRI and poor SRH. However, intra-oPt regional disparities are not consistent across SRH and SRI. Women from the Gaza Strip are less likely to report poor SRH compared to women from all other regions in the West Bank. Geographic and residential factors, together with socioeconomic status, are key to understanding differences between women’s reports of SRI and SRH in the oPt. More evidence is needed on the health of women in the oPt beyond the ages currently included in surveys. The results for SRH show discrepancies which can often occur in conflict affected settings where a combination of ill-health and poor access to health services impact on women’s health. These results indicate that future policies should be developed in a holistic manner by targeting physical and mental health and well-being in programmes addressing the health needs of women, especially those in conflict affected zones.

Women's Experience of Orgasm During Intercourse: Question Semantics Affect Women's Reports and Men's Estimates of Orgasm Occurrence.

Most women report reliably experiencing orgasm from masturbation, but a smaller proportion of women report regularly experiencing orgasm from intercourse. Research suggests that concurrent clitoral stimulation during intercourse increases the likelihood of orgasm, yet most surveys of orgasm during intercourse leave unspecified whether vaginal intercourse does or does not include concurrent clitoral stimulation (assisted intercourse or unassisted intercourse, respectively). Using an online sample of 1569 men and 1478 women, we tested whether phrasing of questions about the occurrence of orgasm in intercourse modulates women's reported frequency and men's estimates of women's frequency of orgasm in intercourse. Participants provided estimates of orgasm when asked explicitly about intercourse with stimulation unspecified, assisted intercourse, and unassisted intercourse. Women's reports of orgasm occurrence were highest in response to assisted intercourse (51-60%), second highest in response to intercourse with clitoral stimulation unspecified (31-40%), and lowest in response to unassisted intercourse (21-30%). Men's estimates of women's orgasms were highest in response to assisted intercourse (61-70%), and lowest in response to unassisted intercourse (41-50%); in both conditions, men's estimates were significantly higher than women's reports. When clitoral stimulation was unspecified, women interpreted "orgasm in intercourse" in three ways: as from intercourse alone, as including concurrent clitoral stimulation though it was unspecified, or as an average of assisted and unassisted intercourse. Taken together, these results demonstrate that the phrasing of questions about women's orgasm produces markedly different orgasm estimates, and suggest that concurrent clitoral stimulation increases the likelihood of women experiencing orgasm in intercourse.

Women's and men's reports of past-year prevalence of intimate partner violence and rape and women's risk factors for intimate partner violence: A multicountry cross-sectional study in Asia and the Pacific.

BackgroundUnderstanding the past-year prevalence of male-perpetrated intimate partner violence (IPV) and risk factors is essential for building evidence-based prevention and monitoring progress to Sustainable Development Goal (SDG) 5.2, but so far, population-based research on this remains very limited. The objective of this study is to compare the population prevalence rates of past-year male-perpetrated IPV and nonpartner rape from women’s and men’s reports across 4 countries in Asia and the Pacific. A further objective is to describe the risk factors associated with women’s experience of past-year physical or sexual IPV from women’s reports and factors driving women’s past-year experience of partner violence.Methods and findingsThis paper presents findings from the United Nations Multi-country Study on Men and Violence in Asia and the Pacific. In the course of this study, in population-based cross-sectional surveys, 5,206 men and 3,106 women aged 18–49 years were interviewed from 4 countries: Cambodia, China, Papua New Guinea (PNG), and Sri Lanka. To measure risk factors, we use logistic regression and structural equation modelling to show pathways and mediators. The analysis was not based on a written plan, and following a reviewer’s comments, some material was moved to supplementary files and the regression was performed without variable elimination. Men reported more lifetime perpetration of IPV (physical or sexual IPV range 32.5%–80%) than women did experience (physical or sexual IPV range 27.5%–67.4%), but women’s reports of past-year experience (physical or sexual IPV range 8.2%–32.1%) were not very clearly different from men’s (physical or sexual IPV range 10.1%–34.0%). Women reported much more emotional/economic abuse (past-year ranges 1.4%–5.7% for men and 4.1%–27.7% for women). Reports of nonpartner rape were similar for men (range 0.8%–1.9% in the past year) and women (range 0.4%–2.3% in past year), except in Bougainville, where they were higher for men (11.7% versus 5.7%). The risk factor modelling shows 4 groups of variables to be important in experience of past-year sexual and/or physical IPV: (1) poverty, (2) all childhood trauma, (3) quarrelling and women’s limited control in relationships, and (4) partner factors (substance abuse, unemployment, and infidelity). The population attributable fraction (PAF) was largest for quarrelling often, but the second greatest PAF was for the group related to exposure to violence in childhood. The relationship control variable group had the third highest PAF, followed by other partner factors. Currently married women were also more at risk. In the structural model, a resilience pathway showed less poverty, higher education, and more gender-equitable ideas were connected and conveyed protection from IPV. These are all amenable risk factors. This research was cross-sectional, so we cannot be sure of the temporal sequence of exposure, but the outcome being a past-year measure to some extent mitigates this problem.ConclusionsPast-year IPV indicators based on women’s reported experience that were developed to track SDG 5 are probably reasonably reliable but will not always give the same prevalence as may be reported by men. Report validity requires further research. Interviews with men to track past-year nonpartner rape perpetration are feasible and important. The findings suggest a range of factors are associated with past-year physical and/or sexual IPV exposure; of particular interest is the resilience pathway suggested by the structural model, which is highly amenable to intervention and explains why combining economic empowerment of women and gender empowerment/relationship skills training has been successful. This study provides additional rationale for scaling up violence prevention interventions that combine economic and gender empowerment/relationship skills building of women, as well as the value of investing in girls’ education with a view to long-term violence reduction.

Sexual orientation and future parenthood in a 2011-2013 nationally representative United States sample.

Previous researchers have found evidence for differences in parenting goals between lesbian and gay people and their heterosexual peers. However, no previous research has quantified the parenting goals of bisexual people or evaluated parenting goals as a function of sexual partner gender. In addition, political and social climates for sexual minority people had improved rapidly since the last representative data on lesbian and gay peoples' plans for parenthood were collected. We analyzed data from 3,941 childless lesbian, gay, bisexual, and heterosexual participants from the 2011-2013 National Survey of Family Growth (NSFG; United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2014), a nationally representative sample of United States residents aged 15 to 44 years. We found that statistically significant, within-gender sexual orientation differences in parenting plans persist, despite social and legal changes. Consistent with hypotheses, bisexual men's parenting desires and intentions were similar to those of their heterosexual male peers and different from those of their gay male peers, while bisexual women's reports were more mixed. Also consistent with hypotheses, the gender of the most recent sexual partner was a strong predictor of parenting goals. We discuss implications for mental and reproductive health-care providers, attorneys, social workers, and others who interact with sexual minority adults. (PsycINFO Database Record

Women's Alcohol Sensitivity Predicts Alcohol-Related Regretted Sex.

Low sensitivity (LS) to alcohol's acute effects is a known risk factor for heavy drinking and its negative consequences. However, LS could be protective due to LS drinkers being less impaired at a given level of consumption. Here, we tested whether LS is associated with differences in men's and women's reports of alcohol-related regretted sex. Eight hundred and one young adults (393 women) aged 21 to 35 (M=23.11years) recruited for a study of alcohol's effects on cognition completed self-report measures of alcohol sensitivity, typical alcohol use, and alcohol consequences (including regretted sex). Participants whose alcohol sensitivity scores classified them as LS were more likely to experience alcohol-related regretted sex than were high-sensitivity (HS) participants. However, when controlling for typical alcohol use and experience of alcohol consequences in general, alcohol sensitivity was negatively associated with risk of alcohol-related regretted sex, but only among women. At a given level of consumption, and controlling for experience of alcohol consequences other than regretted sex, reduced sensitivity to certain effects of alcohol may be a protective factor for women against risk for alcohol-related regretted sexual situations. This study provides insight on the unique risks of drinking among LS and HS women.

Risk of Depressive Symptoms Associated with Morbidity in Postpartum Women in Rural Bangladesh

ClinicalTrials.gov NCT0019882.

Studying entrepreneurial occupations in the Terman women.

To achieve a better understanding of entrepreneurship development in women, longitudinal data on 672 individuals collected from 1922 to 1959 were analysed in a secondary investigation of the Terman Longitudinal Study. Women's reports on their occupations during 10 different years were assigned to one of two categories: work for pay (0/1), and work allowing for self-employment (0/1) in the respective year. Structural equation modelling supported earlier results concerning male entrepreneurial activity. Personality and aspects of the parenting context the women had experienced by the average age of 12 predicted early entrepreneurial competencies (inventions, leadership) and occupational interests by age 13, which related to an entrepreneurship-related career goal in 1936, when the participants were about 27 years of age on average. Such a career goal in turn predicted a higher number of occasions of entrepreneurship-prone work. Surprisingly, we also found a relationship to divorce. Women who had experienced the failure of a marriage were in occupations with a potential for entrepreneurship more often. Reasons are discussed against a backdrop of historical timing and current findings to identify general aspects of entrepreneurship development.

Cortical dynamics of emotional autobiographical memory retrieval differ between women and men

Retrieval of autobiographical memories entails periods of search, access, and elaboration. Women's reports of their memories feature more detail and emotional content relative to men's. A key question is how these gender differences relate to unfolding changes in cortical activity during retrieval. We recorded EEG activity from 32 scalp electrodes as women and men were cued to retrieve positive, negative, and neutral autobiographical memories. Alpha (9–12Hz) oscillations were prominent at all EEG channels. Alpha coherence between channels was calculated as a measure of ms-level cortical synchrony. Across participants and memory types, a frontal cluster showed pronounced decreases in coherence with other channels during the first second of autobiographical retrieval. In the following second, a left parietal-centered cluster showed increased coherence with other channels. This effect strengthened and spread in the third second of retrieval, perhaps reflecting trace elaboration and/or evaluation of the memory. Although women and men gave similar subjective ratings of their memories, the second-by-second pattern of alpha coherence during autobiographical retrieval differed by gender and memory type. Specifically, women sustained the increased pattern of left-parietal coherence throughout the trial, whereas for men, alpha coherence in this cluster returned to baseline by second two for neutral memories and by second three for emotional memories. Examination of the temporal dynamics of cortical oscillations provides novel insight into autobiographical memory retrieval processes and to gendered retrieval in particular, suggesting that women may persist with elaboration and/or evaluation to a greater extent than men.

Long-term Recall of Pregnancy-related Events.

Early-life factors can be associated with future health outcomes and are often measured by maternal recall. We used data from the North Carolina Early Pregnancy Study and Follow-up to characterize long-term maternal recall. We used data from the Early Pregnancy Study as the gold standard to evaluate the accuracy of prepregnancy weight, early pregnancy behaviors, symptoms and duration of pregnancy, and child's birthweight reported at follow-up, for 109 women whose study pregnancies had resulted in a live birth. Most (81%) participants reported a prepregnancy weight at follow-up that correctly classified them by BMI category. Women reported experiencing pregnancy symptoms later at follow-up than what they reported in the Early Pregnancy Study. Accuracy of reporting of early pregnancy behaviors varied based on exposure. Overall, women who had abstained from a behavior were more likely to be classified correctly. Sensitivity of reporting was 0.14 for antibiotics, 0.30 for wine, 0.71 for brewed coffee, and 0.82 for vitamins. Most misclassification at follow-up was due to false-negative reporting. Among women who gave birth to singletons, 94% could report their child's correct birthweight within ½ pound and 86% could report duration of pregnancy within 7 days at follow-up. Self-report of prepregnancy weight, duration of pregnancy, and child's birthweight after almost 30 years was good, whereas self-reported pregnancy-related exposures resulted in higher levels of reporting error. Social desirability appeared to influence women's report of their behaviors at follow-up. Self-reported assessment of confidence in the recalled information was unrelated to accuracy.

An assessment of the association between asset ownership and intimate partner violence in Pakistan

ObjectiveThis study assessed the association between women's reports of asset ownership (home and land) and experience of three types of intimate partner violence (IPV): physical violence, emotional violence, and husbands' controlling behaviors. Study designPopulation-based secondary analysis. MethodThis cross-sectional study used data from a sub-sample of 658 women from the nationally representative Pakistan Demographic and Health Survey 2012–13. Logistic regression analyses were used to estimate the association between asset ownership and IPV. ResultsResults from logistic regressions indicated that when women owned assets their husbands were 2.3 times more likely to use controlling tactics (P < 0.001) which was mitigated only when women had a say in household decisions. Physical or emotional violence, however, was not significantly associated with women's asset ownership. ConclusionThe study findings highlight the importance of culture and context in policy implementation.

Unmet Need and Sex: Investigating the Role of Coital Frequency in Fertility Control.

We estimate the relationship between unmet need for contraception and coital frequency using data from the most recent Standard Demographic and Health Surveys conducted from 2005 to 2015. Individual-level analyses include 55 countries (n=245,732 women). The dependent variable is women's report of any sex in the last four weeks; the independent variable is current unmet need. Bivariate ecological results using country averages indicate that prevalence of unmet need is significantly negatively correlated with the proportion reporting recent sexual activity. Multivariate regression of individual-level data show that the overall odds ratio of having had sex in the last four weeks is 3.23 and 2.97 for women with met contraceptive need for spacing and limiting fertility, respectively, compared with women with unmet contraceptive need. These results suggest that current estimates of unmet need exaggerate the risk of unintended pregnancy because coital frequency is not uniform with respect to unmet need. Findings also suggest that, despite being categorized as having unmet need, many women may still be taking measures to control their fertility through regulating the tempo of marital coitus, thus reducing their risk of unintended pregnancy.

Believing Jeny About Her Pain

ABSTRACTA 19-year-old woman with cancer and excruciating pain was not easily responding to morphine. Some of the staff suspected that this pain was not physical, that it was all emotional. But when the palliative care team believed the young woman's report of her pain, they were able to arrive at the right combination of medicines to treat her pain, and to relieve her intolerable suffering.