Contraceptive Behavior Dynamics and Unintended Pregnancy: A Latent Transition Analysis.

The average U.S. woman wants to have two children; to do so, she will spend about three years pregnant, postpartum, or trying to become pregnant, and three decades trying to avoid pregnancy. However, few studies have examined individual patterns of contraceptive use over time. These trajectories are important to understand given the high rate of unintended pregnancy and how little we know about the complex relationship between contraceptive use, pregnancy intention, and patterns of reproductive behavior. We use data from the 2015-2017 National Survey of Family Growth to examine reproductive behavior and pregnancies across three years of calendar data. We identify seven behavior typologies, their prevalence, how women transition between them, and how pregnancies affect transitions. At any given time, half of women are reliably using contraception. A small proportion belong to a high pregnancy risk profile of transient contraceptive users, but some transition to using condoms or other methods consistently. An unintended pregnancy may initiate a transition into stable contraceptive use for some women, although that is primarily condom use. These findings have important implications for the ways contraception fits into women's lives and how that behavior interacts with relationships, sex, and life stage trajectories.

Contraceptive Practices, Preferences, and Barriers Among Abortion Clients in North Carolina.

OBJECTIVES: Abortion clinics provide an ideal setting for women to receive contraceptive care because the women served may not have other contacts with the health system and are at risk for unintended pregnancies. The objective of this study was to understand practices, preferences, and barriers to use of contraception for women obtaining abortions at clinics in North Carolina. METHODS: We conducted a cross-sectional survey of abortion clients and facilities at 10 abortion clinics in North Carolina. We collected data on contraceptive availability at each clinic. We collected individual responses on women's experiences obtaining contraception before the current pregnancy and their intentions for future use of contraception. RESULTS: From October 2015 to February 2016, 376 client surveys were completed at 9 clinics, and 10 clinic surveys were completed. Almost one-third of women (29%) reported that they had wanted to use contraception in the last year but were unable. Approximately three-fourths of respondents (76%) stated that they intend to use contraception after this pregnancy. Approximately one-fifth of women stated that would like to use long-acting reversible contraception (LARC) after this abortion. Only the clinics that accepted insurance for abortion and other services provided LARC at the time of the abortion (40%). CONCLUSIONS: This study provides a unique, statewide view into the contraceptive barriers for women seeking abortion in North Carolina. Addressing the relatively high demand for LARC after abortion could help significantly reduce unintended pregnancy and recourse to abortion in North Carolina.

Intimate Partner Violence Perpetration and Victimization Among Young Adult Sexual Minorities.

CONTEXT: Intimate partner violence (IPV) among sexual minority young adults has been understudied, and victimization and perpetration estimates are needed. METHODS: Data on 13,653 women and men aged 24-32 who participated in Wave 4 of the National Longitudinal Study of Adolescent to Adult Health were used to examine associations between sexual orientation and IPV perpetration and victimization in respondents' current or most recent relationship. Logistic regression analyses were used to identify associations between respondent characteristics and three IPV categories (physical violence, threatened violence and forced sex). RESULTS: Some 94% of males and 80% of females identified as 100% heterosexual; 4% of males and 16% of females as mostly heterosexual; 1% of males and 2% of females as bisexual; and 2% of males and females as either mostly homosexual or 100% homosexual. Compared with their heterosexual counterparts, mostly heterosexual women were more likely to report having perpetrated or been a victim of physical IPV (odds ratios, 1.9 and 1.6, respectively), having threatened violence (2.0) and having been a victim of threatened violence and forced sex (1.6 for each); mostly heterosexual males were more likely to have been a perpetrator or victim of physical IPV (3.1 and 1.8, respectively) and a perpetrator of forced sex and threatened violence (2.0 and 1.8, respectively). Bisexual males had elevated odds of physical violence victimization (3.3) and forced sex victimization (4.9) and perpetration (5.0). CONCLUSIONS: Some sexual minority groups are disproportionately affected by IPV, indicating a need for increased prevention efforts and for studies exploring the mechanisms underlying these differences.

Sources of Help for Dating Violence Victims: A Qualitative Inquiry Into the Perceptions of African American Teens.

Although teen dating violence victims' reticence in seeking help from adults is well documented, little is known about youths' comparative perceptions of the types of help offered by and effectiveness of various sources. This qualitative study solicited teens' perceptions of sources of help for victims using in-depth interviews with African American youth (ages 13-18) in two public high schools in New Orleans (N = 38). Participants were recruited purposively by researchers during lunchtime and via referral by school personnel. Interviews were transcribed verbatim and coded independently by two study team members. Thematic content analyses were conducted. Teens reported that victims were most likely to seek help from friends, who were largely expected to provide advice and comfort. Nearly half reported that teens would be likely to seek help from family, who would provide more active responses to dating violence (i.e., reporting to authorities, confronting the abuser). Fewer respondents believed teens would seek help from other adults, such as school personnel, who were also perceived as likely to enlist outside authorities. Fears about lack of confidentiality and over-reaction were the main perceived barriers to accessing help from adults. Furthermore, although respondents believed teens would be less likely to seek help from adults, adults were perceived as more effective at stopping abuse compared with peers. Interventions that train peer helpers, explain confidentiality to teens, increase school personnel's ability to provide confidential counseling, and promote use of health services may improve access to help for teen dating violence victims.