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Perspectives in Sexual and Reproductive Health

Differences in Family Planning Services by Rural–urban Geography: Survey of Title X–Supported Clinics In Great Plains and Midwestern States
CONTEXT Understanding the nature of rural–urban variation in U.S. family planning services would help address disparities in unmet contraceptive need. METHODS In 2012, some 558 Title X–supported clinics in 16 Great Plains and Midwestern states were surveyed. Rural–urban commuting area (RUCA) codes were used to categorize clinic locations as urban, large rural city, small rural town or isolated small rural town. Bivariate analyses examined key domains of service provision by RUCA category and clinic type. RESULTS The proportion of clinics offering walk‐in appointments was lower in isolated small rural towns (47%) than in the other RUCA categories (67–73%). Results were similar for sites that do not specialize in family planning or reproductive health, but no variation was seen among specialty clinics. Overall, availability of evening or weekend appointments varied in a linear fashion, falling from 73% in urban areas to 29% in isolated small rural towns. On‐site provision of most hormonal methods was most common in urban areas and least common in isolated small rural towns, while provision of nonhormonal methods was similar across RUCA categories. Sixty percent of clinics provided IUDs or implants. For clinics that did not, the only barriers that varied geographically were low IUD demand and lack of trained IUD providers; these barriers were most common in isolated rural towns (42% and 70%, respectively). CONCLUSIONS While important characteristics, such as clinics’ specialization (or lack thereof), are linked to the provision of family planning services, geographic disparities exist.

Young Sexual Minority Males in the United States: Sociodemographic Characteristics And Sexual Attraction, Identity and Behavior
Context HIV incidence is increasing among 13–24‐year‐old U.S. men who have sex with men, yet limited research is available to guide HIV prevention efforts for this population. Methods National Survey of Family Growth data collected in 2002, in 2006–2010 and in 2011–2013 from 8,068 males aged 15–24 were analyzed to describe the population of U.S. young sexual minority males (i.e., males reporting same‐sex attraction, identity or behavior). Correlates of sexual minority classification were assessed in logistic regression models. Results An estimated 10% of young males, representing a population of 2.1 million, were sexual minorities. Males had an elevated likelihood of being sexual minorities if they were aged 18–19 or 20–24, rather than 15–17 (prevalence ratio, 1.7 for each); belonged to nonblack, non‐Hispanic racial or ethnic minority groups (1.6); had no religious affiliation, rather than considering religion very important (1.9); or lived below the federal poverty level (1.3). They had a reduced likelihood of being sexual minorities if they lived in metropolitan areas outside of central cities (0.7). Among young sexual minority males, 44% were 15–19 years old, 29% were poor and 59% resided outside central cities. Forty‐seven percent had engaged in same‐sex behavior. Of those with data on all measured dimensions of sexuality, 24% reported same‐sex attraction, identity and behavior; 22% considered themselves heterosexual, yet had had a male sex partner. Conclusion Future investigations can further explore subpopulations of young sexual minority males and assess sexual trajectories, resilience and HIV risk.

Guttmacher Policy Report

Evidence Is Lacking on the Incidence and Consequences of Unsafe Abortion in Chile
The most important finding of a new analysis on clandestine abortion in Chile is just how little hard evidence actually exists on the topic. The new report, “Induced Abortion in Chile,” by Elena Prada, independent consultant, and Haley Ball of the Guttmacher Institute, documents major gaps in knowledge on the incidence and consequences of induced abortion, the characteristics of women seeking abortion and their reasons for doing so. The analysis also documents the lack of available information on contraceptive use, unintended pregnancy and other factors that influence the need for abortion.

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