Relationship power, decision making, and sexual relations: an exploratory study with couples of Mexican origin.

An emerging public health priority is strengthening women's ability to protect themselves from HIV/STDs and to negotiate safer sex behaviors with their heterosexual partners. A focus on Latina women is important for several reasons. First, Latina women are disproportionately affected by HIV/AIDS and other STDs. The annual rate of AIDS cases reported in 1999 among Hispanic female adults and adolescents (34.6 per 100,000) was over three times the rate among non-Hispanic Whites (9.0 per 100,000) (CDC, 1999). Compared to non-Hispanic Whites, Hispanic women also have higher rates of chlamydia, gonorrhea, and syphilis (Division of STD Prevention, 1999). Furthermore, HIV infection and AIDS have increased dramatically among U.S. women over the past 10 years and, since 1994, heterosexual contact has been the largest exposure category (CDC, 1999). Among Hispanic adult and adolescent women, heterosexual contact was the exposure category for 47% of AIDS cases and 43% of HIV infection cases reported through December 1999 (CDC, 1999).

Male condoms are currently the only widely accepted method for preventing the transmission of HIV and other STDs for sexually active individuals. Some men are unwilling to use condoms and, due to gender-based power imbalances, some women may be unable to negotiate use (Amaro, 1995). Wingood and DiClemente (2000) define lack of "perceived control or power to avoid unhealthy behaviors" (p. 544) as a behavioral risk factor that influences women's risk of HIV. Several researchers have suggested that women are likely to have difficulty in negotiating safer sex strategies with their male partners because of perceived imbalances in relationship power (e.g., Amaro, 1995; Amaro & Gornemann, 1992; Fullilove, Fullilove, Haynes & Gross, 1990; Gomez & Marin, 1996; Pulerwitz, Gortmaker, & DeJong, 2000; Wingood & DiClemente, 1998, 2000; Wingood, Hunter-Gamble, & DiClemente, 1993; Worth, 1989). At the same time, previous studies indicate that women's inability to negotiate condom use is one of the strongest correlates of poor condom use (Catania et al., 1992; Fullilove et al., 1990; Peterson et al., 1992; Wingood & DiClemente, 1998).

These gender-based power imbalances are potentially more salient for Latina women due to the cultural values of a traditionally machista society in which men are defined by their ability to be in control and to assert dominance by being the active sexual partner, the penetrator (Melhuus, 1996). In such a society, type and frequency of sexual behaviors are said to be most often determined by men (Amaro, 1988; Amaro & Gornemann, 1992; Wood & Price, 1997). Findings from a study of over 500 Latina women indicate that feelings of powerlessness and inability to influence risk-reduction decisions and behaviors were perceived as barriers to HIV/STD prevention among the majority of women interviewed (Amaro & Gornemann, 1992).

Moreover, in a recent study of predominately Latina (89%) women, sexual relationship power was positively associated with consistent condom use (Pulerwitz, Gortmaker, & DeJong, 2000). Thus, women's perceived sense of powerlessness and their inability to affect safer sex decisions may be key factors in Latino women's risk for HIV/STDs.

Despite these findings, the predominant theoretical models prevalent in HIV/STD behavior change have been justly criticized as being individualistic in their conceptualization. They often ignore the social and cultural context of women's sexual behaviors and assume that the individual has total control over behavior. They fail to address the diverse contextual factors related to gender, such as power differentials that likely influence behaviors that put women at risk for HIV (Amaro, 1995). Moreover, power in heterosexual relationships has been conceptualized and measured in a multitude of ways, and researchers do not agree on a definition of interpersonal power or on what makes individuals feel powerful in the context of their relationship. In addition, most research on relationship power has failed to include diverse samples of couples, including those from different ethnic and social backgrounds. Yet it would not be surprising to find that the sources, processes, and outcomes of power will differ for diverse groups because of unique sets of values, experiences, and traditions.

Given these concerns, we designed a study to examine power dynamics among couples of Mexican origin. We drew on the theoretical literature in the social sciences that defines interpersonal power (i.e., relationship power) as the ability to influence another person in order to achieve desired ends (Balswick & Balswick, 1995; Huston, 1983). More simply, interpersonal power refers to one person's power over another (Yoder & Kahn, 1992). In contrast to power to (i.e., personal power or empowerment), interpersonal power is an individual characteristic that concerns the relationship between two people (Yoder & Kahn, 1992).

Most work in this area has focused on marital power. Balswick and Balswick (1995) describe what they refer to as the democratic exchange model of marital power derived from the social exchange model promoted by Brickman (1974) and Scanzoni (1979). Power in the social exchange model can best be understood by examining three components of power outlined by Cromwell and Olson (1975): the bases of power (i.e., sources of power), the processes of power, and the outcomes of power. Power bases consist of resources (money, employment, skills, status, knowledge, affection and nurturance, and physical attractiveness); power processes consist of interactions (persuasion, assertiveness, problem solving); and power outcomes have to do with who gets their way and who makes important decisions. In this model the outcomes of power are determined by each partner using his or her resources to negotiate what each needs or wants in the relationship. Two interdependent but different outcomes of power, control over one's partner and ability to make decisions, are supported by findings from validation of the Sexual Relationship Power Scale, one of the only scales measuring relationship power. A factor analysis using oblique rotation revealed two types of relationship power: Relationship Control and Decision Making Dominance (Pulerwitz, Gortmaker, & DeJong, 2000).

Relationship power may also depend on the relative interest in the relationship, with the partner having the least interest possessing more power (Agnew, 1999; Huston, 1983). Studies on couple dynamics predicted early on that relationship power varied in couples and was affected by such things as access to resources and gender roles (Blumstein & Schwartz, 1983). Least interest can be defined in a number of ways, including having less emotional attachment to the relationship, more resources (such as physical attractiveness, money, or employment), or more perceived desirable alternatives to the current relationship. Having children, on the other hand, may influence women to stay in the relationship because of the financial security it provides.

Because of the importance of relationship power to women's ability to protect themselves from HIV/STDs, effective interventions for women must address power differentials among men and women and the overall disempowerment of women. However, in order to design such interventions there must be a clear understanding of the meaning of power and the bases and outcomes of power within the target population. As part of a larger study that examined couple dynamics in reproductive decision making (Harvey, Beckman, Browner, & Rodriguez-Trias, 1997), we conducted a qualitative study to examine how couples of Mexican origin define power in their intimate relationships and where decision making lies in matters of sexual activity and contraceptive and condom use. Our study focused on couples of Mexican origin living in East Los Angeles, California, and explored: (a) how individuals define power in their intimate relationships; (b) what makes men and women feel powerful in their relationships; and (c) the nature of decision making within the dyad, including the role of each partner in decision making about sexual, contraceptive, and condom-use behavior.

METHODS

Participants

Data were collected from 39 sexually active couples of Mexican origin who were primarily immigrants to the United States and lived in a Mexican community in Los Angeles County. Participation was limited to couples in which at least one partner was an immigrant from Mexico and the woman was age 18 to 34 and not currently pregnant. All participants were recruited at a primary health care clinic that offers a wide range of out-patient services to predominantly lower income residents of East Los Angeles. Individuals and couples were approached in the clinic and the objectives of the research project were explained. If the potential respondents were willing to participate in the study, they were then asked a few questions to determine eligibility. If they were eligible and expressed interest in participating, they were asked to talk to their primary partner about the project. The majority of the individuals (93%) who were recruited and screened were women. A member of the research staff called each individual two days later to obtain his or her partner's name and phone number and to confirm the willingness of both partners to participate in the study. In total, 223 individuals were screened. Of those, 146 (65%) were eligible. Of those who were eligible, 39 (27%) participated in the study along with their partners. Thus, 78 individuals (39 women and 39 men) were interviewed.

Participants were primarily in their 20s; women had a mean age of 26.6 years and men had a mean age of 28.6 years. Over 90% were born in Mexico and the majority had lived in the United States for 6 or more years. Although most were predominantly Spanish-speaking, a higher percentage of women (74%) compared to men (55%) spoke only Spanish. About 20% of the respondents had 6 or fewer years of education and men were more likely than women to have completed high school. Whereas the majority of men (77%) were employed full-time, over 75% of the women did not work outside the home. Over two thirds (78%) of the couples had one or two children.

All participants were asked about frequency of intercourse, number of sexual partners and contraceptive use. Over 80% of respondents reported having intercourse once a week or more often. While nearly all individuals reported vaginal intercourse, anal intercourse was reported by four men and three women. Approximately one quarter of both men and women reported having had oral intercourse in the last 3 months.

Over 70% of the respondents reported currently using a method to avoid getting pregnant. Because women were somewhat less likely than their partners to report that a method was currently in use (77% versus 90%), it is unclear exactly how many couples were actually protected. Overall, the most popular methods were condoms (34%), oral contraceptives (17%), and injectable contraceptives (22%).

Procedures

Interviews were conducted with each partner of the 39 couples. All female participants were interviewed by a female researcher and all male participants were interviewed by a male researcher. All interviewers were bilingual and trained in qualitative interviewing techniques. Each person was interviewed in private without the partner present and the interviews were mainly conducted at the respondent's home. Data were collected using a semistructured interview guide. Topics on the interview guide that were relevant to the present study included the meaning of relationship power, what makes men and women feel powerful in a relationship, decision making in heterosexual relationships, contraceptive and condom-use behavior, and background characteristics. The interviews averaged 60 to 90 minutes in length and each participant was paid $20 for their participation. Interviews were audiotaped and text from all open-ended questions was transcribed and translated.

Analysis

The qualitative data collected in the semistructured interviews were analyzed using content analysis. The coding of text proceeded in two stages. First, a topical coding/indexing scheme (topical coding) was developed to identify the text pertaining to particular topics. The software program NUD*IST was used to construct and organize a topical indexing system of codes identifying sections of text that captured the central concepts of interest. Second, a more detailed coding scheme (content coding) was developed to capture the content, themes, or sentiment of responses within topics. Specific themes (i.e., content codes) within central concepts were identified by the research team, and all text pertaining to a specific topic was coded individually by trained coders to illustrate the themes characteristic of that topic and to identify the predominant themes used by different groups (e.g., men and women). Because participants' responses to a particular question may have represented one or more themes in a content area, and/or because some responses failed to provide text that could be coded, the number of responses to some questions varied and did not necessary total 78. Descriptive analyses of responses to the close-ended questions and the sociodemographic characteristics of the sample were conducted using SPSS.

RESULTS

Definitions of Power

Power definitions are described using text that pertains to the term power and its definition and meaning in a heterosexual relationship. An open-ended question specifically asked, "What does power in a relationship between a man and a woman mean to you?" The two most frequent themes that emerged from the transcripts involved power as control and power as decision making. These themes reflect the major dimensions of power identified by Pulerwitz, Gortmaker, and DeJong (2000). Because we found no differences in male and female responses regarding the definition of power, the findings from both genders have been combined.

Power as control was evident in nearly half of the responses and almost always involved one person having control over his or her partner. For instance, one woman stated, "Power, that is having more influence over another person without that person wanting it. It's manipulating others." A second said, "To have the last word, to be the boss more." With regard to power as control, men commonly talked of one person "dominating" the other. Another form of control was the ability to command or order around one's partner. One of the male respondents described it as "the power to give orders." A woman explained it more fully:

   Power can be to order around. Since I recognize that he is the head and if
   he orders me to do something, I know that's the way it has to be. I subject
   myself to his rules because he has more power than I do.

The second most frequently mentioned theme was power as the ability to make decisions without partner interference or involvement. While this theme is associated with the more prevalent theme of power as control, its specific emphasis on decision making ability and concern with personal (i.e., power to) as well as interpersonal power distinguish it from power as control. Moreover, this concept of power as independent decision making was often discussed as a part of two interrelated subthemes. First, power is the ability to make decisions without taking the other person into account. Second, power is the ability to take action and make decisions independently of one's partner. For instance, one man stated that "power means you can make determinations, make any decision ... without taking into account the woman," while a woman defined power as "doing whatever I want without consulting him." These two subthemes are differentially related to power as control. The first subtheme, not taking the partner into account, is more closely related to power as control. Within the context of a relationship, making unilateral decisions on issues of importance to both partners implies control over the partner who has no input into the decisions. In contrast, the subtheme of decision-making independence and autonomy appears to tap into the more personal aspects of power. Here power involves the ability to accomplish one's own aims rather than control over another person.

The concepts of power as control and power as decision making were also evident in responses from several respondents (seven women and seven men) who stated that interpersonal power (power over) need not exist within a loving relationship. One woman said:

   I don't know how to explain it. I think that in a relationship where a
   couple really loves each other, that word doesn't exist or shouldn't exist.
   I see it this way: it's not anymore who is more or who is less, but rather
   both are equal and they complement each other.

They often argued that in their relationships power had no place and cited as evidence the fact that they were equals to one another or made decisions jointly. "I don't think it's love if there's a lot of power, because you're supposed to share things. Be honest and open, share things, not to have control over that person," said one woman while another stated "... but I don't feel that I have any power, I think we are equal. We decide equally."

What Makes A Woman Feel More Powerful

To more clearly understand sources that influence feelings of power, we asked both men and women to describe what makes men and women feel more powerful in a relationship. First, we examined responses pertaining to the topic of "the things that make a woman feel more powerful in a relationship." Two themes surfaced: decision making and economic independence. However, contexts and behaviors that gain power for women also included feeling attractive, providing (or failing to provide) sexual behaviors, and feeling loved and secure.

Both men and women frequently mentioned decision making as an important component of feeling powerful for women, especially decisions in the home and about children or the couples' activities. As one man explained, "making decisions about everything that the couple does" makes women feel powerful in a relationship. The ability to make decisions on one's own or without the consent or approval of her partner was also mentioned. The following statement by a woman illustrates this theme:

   Powerful, how would that be ... for her to be allowed to decide whatever
   she wanted and everything she did, even if it wasn't right, her husband
   would accept it, I think. If he never said anything, even if what she did
   was wrong."

Having the autonomy to make decisions for oneself may be of major importance for women's feelings of power.

It is noteworthy that men often spoke of women's decision making as "letting" women make decisions or "giving authority to the woman that she makes decisions." Such statements raise the issue that decision-making authority may be delegated by men to women. The exercise of power and the feelings of power may differ. Such delegated decision-making authority can lead to the illusion of power for women, suggesting that women may feel powerful even though they do not have the final decision-making authority.

Economic resources and the independence they allow (or more accurately, less dependence on their partners) was central to many male and female respondents' understanding of women's feelings of power within relationships. Work outside of the home (cited by four women and seven men), money (two women, three men) and education (three women, two men) were commonly volunteered as supports. One man said, "When a woman works, the money makes her `climb.' To say I am bringing home my check and I make more than you, makes them go higher [feel more powerful]." As the quote illustrates, men often viewed women working outside the home as having more power than their partners, whereas women framed it in terms of increased independence from their partners. As one woman said:

   Working, because if you don't work, you feel humiliated by the man. Like
   you have to do whatever he says. I have seen it in the marriages of other
   friends, that as long as they don't work, they keep them subjugated, like
   they have to ask for money. And the women who works has more independence.

While both men and women agreed that having a job and bringing in money were associated with women's power in the relationship, men more frequently emphasized women's power over their partners, while women participants more often spoke of women's increased autonomy and ability to make their own decisions as leading to feelings of power.

Both women and men mention sex and attractiveness as ways to gain feelings of power for women. Several women mentioned feeling more powerful through "sexual relations" or when they please their partners sexually. Others mentioned using or withholding sex as a way to "manage the man in some instances." Although men more often than women mentioned attractiveness as related to women's sense of power, the most illustrative quote comes from a woman: "When a woman is very attractive and she feels that she can easily find another relationship besides her husband [she feels more powerful]. They think they can do anything they want, because they feel power due to their beauty."

Women were more likely than men (10 women, 2 men) to state that feeling loved and secure in her heterosexual relationship leads to feelings of power for a woman. One woman explained, "... if your husband loves you, the woman feels like she has power. When the husband changes to another woman, then you stop having power and being important to the man."

What Makes A Man Feel More Powerful

The themes we found when analyzing the text pertaining to "what things make a man feel more powerful in a relationship" were similar to those that had surfaced in the analysis of definitions of power/control over one's partner. In addition, a theme that strongly emerged was having money.

The most commonly mentioned source of men's power was having control over one's partner and ordering or commanding one's partner. This finding is another illustration of how power as control was understood by these respondents. Almost twice as many women as men (11 women, 6 men) believed that controlling a woman made the man feel more powerful. For instance, one woman's response to the question reads:

   When they order the woman around and don't let them go anywhere. My husband
   lets me go anywhere I want. But I have friends who tell me that their
   husbands don't let them go anywhere alone. When the husband controls
   everything, in permission, with money, etc., the men feel more powerful
   when they have the woman locked up doing chores without letting her go
   anywhere.

The subservience of women, cited by seven women and three men, is another illustration of how power imbalance is central to beliefs about men's feelings of power. Subservience includes the woman keeping silent, not saying what she wants, giving up her will and appearing weak and submissive. As a male respondent describes, "[A man feels powerful] when the woman gives into everything that the man asks for."

The second most common theme overall for both men and women was that men feel powerful because they have money (4 women, 11 men) and/or are employed (five women, four men). Compared to women, men more strongly endorsed this theme. One female participant stated, "When he's the only one who brings in money to the house, he knows that the woman is subject to him for economic reasons." Similarly, a man stated, "Not letting the woman work. With this they have more control." These statements suggest that various aspects of controlling money and working enable the male partner to have a dominant position in the relationship and force the female partner into a subservient one. A key point is that both men and women believe that men feel more powerful when they can control their partner's behavior.

The central concept of power over is even more dramatically echoed in text reflecting the roles of machismo and violence. Traditional cultural notions of machismo and the man as machista were also believed to support male feelings of power. Although most individuals renounced this arrangement for their own relationship, five women perceived it as an important factor in maintaining male feelings of power in other relationships. It can be only a short leap from this type of disrespectful relationship to physical violence; not surprisingly, six participants (four men and two women) acknowledged that physical violence can lead to feelings of power for men. As one woman said, a man feels more powerful "... when he hits a woman, when he humbles her."

In a comparison of men's and women's responses to this question, it appears that both genders agree to a great extent about the things that make men feel more powerful in their relationships. However, if there are differences, the importance of money relative to the importance of control itself may explain the differing perceptions. Men may see economic resources as more central to power over their partners than women see them. In turn, women may view men's commanding or ordering their partners as more important, perhaps more strongly endorsing traditional cultural norms and placing less importance on the economic basis of men's feelings of power.

Decision Making Within the Dyad

Participants were asked a number of questions in the interview that pertained to couple decision making. These questions involved the types of decisions that each partner makes and who initiates and makes decisions regarding contraceptive use and sexual behaviors. Because making important decisions has been conceptualized in the literature as a major outcome of power (Cromwell & Olson, 1975) and participants in this study defined power as the ability to make decisions, findings from these questions provide insight into power dynamics across specific domains.

General decisions made by men, by women, and jointly. Respondents were asked about the nature of decision making in their current primary relationship. Specifically, they were queried about decisions that "you leave mostly to your partner," decisions "you make completely or mostly yourself," and decisions that "you try to make together." Text pertaining to decisions made primarily by the respondent, decisions made by the informant's primary partner, and decisions made jointly was coded to identify major themes. For analysis purposes, decisions that men said they made were compared with decisions that women said men made. Similarly, decisions that women said they made were compared with decisions that men said women made.

In general, participants believed that decision-making dominance closely mirrors gender role division of labor. Men and women generally agreed that the women made decisions about household matters and children. Men were rarely mentioned as making unilateral decisions in these two areas. In contrast, participants believed that men made decisions relating to money (13 men and 14 women) more frequently than did women (seven men and eight women).

Although many respondents mentioned male- or female-dominant decision making in specific domains or subdomains, others maintained that they made decisions jointly within these same areas. The decision-making areas in which joint decision making frequently occurred were money (mentioned by 15 men and 8 women), children (10 men and 8 women), household matters (11 men and 6 women) and recreation (nine men and six women). Men appeared more likely to endorse joint decision making than did women, suggesting that men may be less likely than women to believe that one gender is more dominant. Alternatively, men may not have wanted to admit that they dominated decision making and therefore gave a more socially desirable response.

Decision making in sexual and reproductive matters. All individuals were asked several close-ended questions to assess who initiates and makes decisions regarding contraceptive use and sexual behaviors. Responses were collapsed from the original 5-point Likert scale to "only or mostly me," "both of us equally," and "only or mostly my partner."

Two questions addressed sexual behavior. When asked "who decides what type of sex to have or what you will do sexually," two thirds of both the male and female respondents agreed that these decisions were shared equally by both members of the couple. One fourth of the men (28%) and women (25%) responded that the male partner "only or mostly" decides what the couple will do sexually. Only a few male and female respondents agreed that women "only or mostly" make decisions in this arena.

When asked who initiates sexual activities in their relationships, over one half of the men (52%) and nearly two thirds of the women (62%) reported that it was most often the man. A slightly higher percentage of men (44%) compared to women (36%) reported it as a shared activity, stating that they both equally initiate sexual activities in their relationship. Only one man and one women assigned sexual initiation primarily to the woman.

One half of both the male (51%) and the female (49%) respondents stated that decisions "about using a method to prevent pregnancy" were made equally by both members of a couple. Nearly half of the women (49%) and over one third (36%) of the men reported contraceptive decision making as a woman's activity. Only one woman and six men responded that contraceptive decisions were primarily made by the man. Among the 59 individuals who had ever used condoms, the majority (61%) reported that women suggested the use of condoms. The remainder of the sample were split between assigning the suggestion for condom use to the man and seeing it as shared activity.

In summary, gender-specific decision-making power is perceived as varying across sexual domains. While most respondents agree that men are the initiators of sexual behavior, they report that both men and women share responsibility for decisions regarding sexual activities. Participants were equally split between assigning decision making related to contraceptive use to the woman and seeing it as shared decision making. Finally, women compared to men were reported to be more likely to suggest the use of condoms.

DISCUSSION

Taken together, the results of this exploratory study shed light on power dynamics within a small group of heterosexual couples of Mexican origin. The findings indicate that individuals in our sample generally agree on a definition of relationship power. It is noteworthy that the most strongly endorsed definition mirrors a traditional (nonfeminist) definition of power as control, dominance, or perhaps legitimate authority. The other major definition of power seems to be a more feminist one of power to, in this case power to make unilateral decisions. Both definitions focus on the outcomes of power--that is, who makes important decisions and who gets their way. Moreover, these two themes, power as control and power as decision making, mirror the two subscales, Relationship Control and Decision Making Dominance, of the Sexual Relationship Power Scale (SRPS) developed by Pulerwitz, Gortmaker, and DeJong (2000). This concordance is not surprising given that the SRPS was derived from a theoretical perspective that focused on interpersonal power, included a gender-oriented perspective, and was designed and tested using a large sample of Latina women (89%).

Although individuals in relationships use resources to obtain both control and decision making power outcomes, these outcomes are interrelated but not identical. Control is always defined interpersonally as influence over another's behavior; by definition it involves limitation of the partner's autonomy. In contrast, power as decision making also can include elements of personal power--that is, the power to accomplish one's own objectives. In fact, decision-making power, especially the ability to make decisions independently of one's partner, usually is a combination of both interpersonal and personal power. Decisions in a relationship context most often are interpersonal. However, one important objective of decision-making power is to control one's own behaviors and outcomes rather than those of the partner.

Participants reported that women feel more powerful in their relationships with their spouse or main partner when they have economic independence including work outside the home, money, and education, and when they are physically attractive. Both men and women indicated that being physically attractive gives a woman the option of having alternative partners, thereby making her more powerful in her relationship. This finding is supportive of the principle of least interest, which posits that the partner with the least interest in the relationship has more power and, conversely, the partner with the most interest has less power (Agnew, 1999; Huston, 1983). Both men and women reported that men also feel powerful when they have money and are employed. Taken together, these data suggest that within this particular culture, resources are believed to play an important role in men's and women's feelings of power in heterosexual relationships. The findings are consistent with the literature on resource theory which posits that marital power is determined by spousal resources (defined to include money, employment, skills, status, knowledge, affection and nurturance, and physical attractiveness; Balswick & Balswick, 1995; Huston, 1983).

Consistent with the early literature that describes a traditional division of labor by gender, the findings regarding general decision making indicate that both men and women agreed that women make decisions about household matters and children, while men made decisions related to money. However, when examining the results on sexual and contraceptive decision making, a more complex picture emerges and mirrors the more contemporary literature that suggests that some women are active, strategic, and in control of their own destinies (e.g., Amaro, 1988; Kline, Kline, & Oken, 1992). Latino men and women in this sample believe that some women are active participants in the areas of sexuality and contraceptive and condom use. Such findings conflict with previous studies that indicate that women have limited roles in assertiveness and decision making about sexual practices and condom use (e.g., Amaro & Gornemann, 1992; Gomez & Marin, 1996; Wood & Price, 1997). On the other hand, the findings concur with an earlier study of Mexican American women who reported that reproductive decisions should be made by the woman and not the man (Amaro, 1988). At first glance, these results also appear inconsistent with the notion that there are large power differentials in Latino couples with the woman having much less influence than the man. These findings may reflect the changing cultural beliefs about gender roles within sexual relationships (Oropesa, 1997) and/or changes in cultural beliefs that occur with immigration to the United States. The data are consistent with a rather large body of literature that finds that many women from developing countries who immigrate to the U.S. become more independent, assertive, and demanding of egalitarian relationships (e.g., Harvey, Beckman, Browner, & Rodriguez-Trias, 1997; Hondagneu-Sotelo, 1999; Hondagneu-Sotelo & Messner, 1997; Viadro, 1996).

While women appear to be active decision makers in the areas of sexuality and contraceptive and condom use, participants also reported that men actively participate in these arenas. Findings indicate that whereas couples share decision making about sexual activities and contraceptive use, men are seen as initiators of sexual activity and women are more likely to suggest condom use. Collectively these data are consistent with findings from Browner (2000, p. 784) which indicate that in regards to reproductive activities women are neither "agents acting solely on their own free will or completely constrained by the actions of men." These data compel us to focus our efforts on the design, implementation, and evaluation of interventions that focus on changing risk behavior within intact couples and to intervene with both members of a couple. Not surprisingly, the findings from Becker and Robinson's (1998) review of reproductive health interventions in developed and developing countries suggested that reproductive health interventions targeted to couples were more effective than those targeted at only male or female partners.

Although this study allowed us to qualitatively examine relationship power within heterosexual couples of Mexican origin, the results are preliminary and the study has several limitations that need to be considered when interpreting and applying the results. First, because of the small sample size and the nonrandom recruitment strategy, the findings have limited generalizability. Our results may not apply to all Latino groups or to other Mexican populations in the U.S. Second, the content analysis was largely based on the English translation of the Spanish transcripts. Although key Spanish phrases and sentences were retained in the translations and researchers were able to look at the original transcripts in Spanish when questions arose, it is possible that some of the cultural context and content was lost in the translations.

Despite these limitations, the study findings offer important insights into the design of interventions, programs, and policies intended to reduce HIV/STD transmission among young women of Mexican origin. As long as the male condom remains a primary mechanism of STD/HIV prevention for sexually active women, interventions need to target couples and address power dynamics within couples and their role in women's ability to negotiate condom use. While women in this study reported suggesting condom use, it is unclear if they were successful in getting their partners to use condoms. In addition, programs need to: provide support for and role model women suggesting and initiating condom use and other safer sex behaviors; increase women's skills in communicating with their partners and expressing their desire to use condoms; and facilitate couple's communication about their respective sexual needs and desires, including a discussion of strategies to protect one another from HIV/STDs.

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Manuscript accepted May 7, 2002.

S. Marie Harvey
University of Oregon, Eugene

Linda J. Beckman
Alliant University, Los Angeles, CA

Carole H. Browner
University of California, Los Angeles

Christy A. Sherman
Oregon Center for Applied Science

Support for this project was provided by the Contraceptive Research and Development Program (CONRAD) which receives funds for AIDS research from an interagency agreement with the Division of Reproductive Health, Centers for Disease Control and Prevention (CDC). The views expressed by the authors do not necessarily reflect the views of USAID, CONRAD, or CDC.

Address correspondence to S. Marie Harvey, Director of Research, Center for the Study of Women in Society, 1201 University of Oregon, Eugene, OR 974031201; e-mail: [e-mail]. S., Bernat, J A., Clum, G.