In this issue.

Statistics tell us much about the occurrence of abortion in the United States: Each year over the past couple of decades, more than 20 of every 1,000 U.S. women between the ages of 15 and 44 had an abortion, and the rate declined throughout the 1990s. But the numbers do not tell us much about the women themselves: Which women are most likely to terminate pregnancies? Have all subgroups shared in the decline? Answers to these questions are crucial information for policymakers and family planning providers, because they pinpoint where the greatest need for assistance in preventing unintended pregnancies lies. In this issue of Perspectives on Sexual and Reproductive Health [page 226], Rachel K. Jones, Jacqueline E. Darroch and Stanley K. Henshaw provide a detailed portrait of U.S. women who have abortions, drawn from results of a survey of a nationally representative sample of abortion patients in 2000-2001.

The researchers find that while abortion is common among all subgroups of women--with rates averaging 21 abortions per 1,000 women aged 15-44--it occurs with the greatest frequency among those who are 18-29 years old, unmarried, black or Hispanic, or economically disadvantaged. Women aged 15-17, the most well-to-do, those with a college education and those with no religious affiliation have registered the greatest declines in recent years. Disadvantaged women, however, have fared considerably worse: Since 1994, abortion rates have risen among poor and low-income women, those covered by Medicaid and, to a lesser extent, women with less than a high school education.

Jones and her coauthors place these findings in the larger context of trends in pregnancy rates, as well as social and political conditions that may affect women's access to contraceptive services: changes in welfare policy, declines in the Medicaid rolls and stagnant levels of funding for Title X.

Also in This Issue

* Cognitive ability, frequently studied as a factor in teenage problem behaviors, is seldom examined as an antecedent to teenage sexual activity and childbearing. Darlene Shearer and colleagues [page 236] take advantage of the richness of the National Longitudinal Survey of Youth data set to explore the relationship between cognitive ability and early childbearing. They find that women with low cognitive scores are at increased risk of having a first birth by age 18, and those who give birth early have elevated odds of having a second birth before turning 20. In addition, women with the lowest scores begin having sex significantly earlier than those with the highest scores, and they are less likely to take a sexuality education course or to know when during the menstrual cycle the risk of conception is greatest. The authors stress that while young people with cognitive deficits have the same right as others to make choices about their sexual lives, they need appropriate support and education to understand the consequences of sexual activity and to protect themselves against unwanted sexual advances.

* Despite the wide variety of strategies that programs have taken to reduce levels of teenage pregnancies and births, and to delay young people's sexual debut, high-quality evaluations have documented few successes. Susan Philliber and colleagues report [page 244] on one strategy that works, at least for young women: a comprehensive youth development model offering year-round services for 13-15-year-olds. In a longitudinal, random-assignment evaluation of six New York City programs using this approach, the authors found that four in five participants remained involved for three years. At the end of that period, female participants were less likely than their peers outside the program to have initiated intercourse and been pregnant, and were more likely to have used a condom and hormonal contraceptive at their last sexual encounter. Philliber and her coauthors offer suggestions for increasing the program's success, particularly among males.

* The prevalence of sexually transmitted diseases and of risky sexual behavior is higher among black men than among whites, but studies of sexual risk-taking often have had only a limited ability to examine factors in these differences that may be related to race, such as family structure and educational attainment. The National Survey of Men, however, provides enough information on black men to overcome these difficulties. In analyses based on the 1991 survey [page 252], Rosalie J. Bakken and Mary Winter find that for black men, family structure during adolescence influences both the timing of first intercourse and later sexual risk-taking. The findings point up the importance of providing after-school supervision for black youth, helping parents communicate with their children about issues related to sexuality and addressing the obstacles that keep black youngsters from participating in school and community activities.

* When state laws require the reporting of statutory rape, researchers working with sexually active adolescents may find their ethical, legal and scientific responsibilities in conflict. In a comment [page 259], Nancy Findholt and Linda C. Robrecht examine the issues and suggest ways to meet the challenges. Their recommendations cover researchers' awareness of relevant laws and government regulations, issues that should be addressed in the informed consent process, safety protocols, and the role of parents and the community. Only by successfully integrating ethical, legal and scientific responsibilities, the authors contend, will researchers be able to serve both science and ethics.

--The Editors