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The number of women infected with human immunodeficiency virus is increasing in the United States. In this population, the disease is being spread primarily through heterosexual relationships. Data from the 1988 National Survey of Family Growth reveal that large numbers of American women are changing their behavior in response to the threat of developing AIDS and other sexually transmitted diseases. A sample of 7,619 out of the approximately 51 million sexually active American women between the ages of 14 and 44 were interviewed. Twenty-eight percent of the women have changed their sexual habits to safer practices. Changes included increased use of condoms, fewer sexual partners, reduced frequency of sexual intercourse, changes in the specific sexual activities, and avoidance of sexual relationships with men who are not known, bisexual, or intravenous drug users. Women who are unmarried and had five or more lifetime sexual partners are at a higher risk of disease. Sixty-five percent of these women have changed their sexual habits. The majority of the women have changed their behavior because they were aware of the risks of AIDS. Although these changes are substantial, there are still many women who have not changed their sexual behavior and thus are at high risk for developing AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

The use of condoms is recommended to prevent the transmission of human immunodeficiency virus (HIV) infection during sexual intercourse. However, there have not been clinical studies which have fully analyzed the degree of protection that condoms actually provide. A model was developed to evaluate the protective value of condom use. Data from the National Survey of Family Growth was used for the analysis. It is estimated that among the roughly 3,500,000 women in the United States who are of reproductive age and who are least likely to be protected against HIV infection (those who are sexually active, not married, and have not used professional clinical assistance for birth control), 12 percent rely upon condoms for birth control. Based on assumptions regarding HIV incidence and relative risk, the likelihood of HIV infection in this group of condom users was projected. At the current rate of HIV infection among U.S. women, which is low, the failure rate of condoms for protection against HIV infection is estimated at less than 1 percent per year, which is lower than the 10 percent failure rate when they are used for birth control. It is estimated that as few as 1 percent, but up to 11 percent, of all new HIV cases could be prevented by the current rate of condom use. But, up to 45 percent of all new HIV infections could be prevented if condoms were used more widely. It should be noted that women whose sexual partners are infected with HIV are at much greater risk for infection if the condoms fail to protect them than are other women. For this very high-risk population, the use of condoms cannot be recommended for protection as they may fail to protect adequately against infection. But for the rest of the women who are at low risk, condom use is recommended and should be more strongly promoted. (Consumer Summary produced by Reliance Medical Information, Inc.)

We used data from the National Infant Mortality Surveillance project to examine the effect of older maternal age on infant mortality for the 1980 United States birth cohort. The 1,579,854 births and 14,591 deaths of singletons who were black or white and whose mothers were 25-49 years of age were included. Direct standardization was used to calculate birth-weight-adjusted relative risks of neonatal and postneonatal mortality, using the birth weights of infants with maternal age 25-29 as the standard. We found that the risk of infant mortality was nearly equal for infants born to mothers 25-29 and 30-34 years of age; infants born to mothers 35-39 years of age were at a slightly elevated (18 higher) risk, and those born to mothers 40-49 years of age were at a much more elevated (69 higher) risk. Among whites, the higher neonatal mortality associated with a maternal age of 35-39 was mostly due to an increased prevalence of low birth weight; among blacks, it was due to higher birth-weight-specific risks. Neither white nor black postneonatal mortality risks were much elevated until a maternal age of 40-49, and this last elevation was mostly due to higher birth-weight-specific risks. These findings suggest that infertility and fetal mortality aside, and considering only the effect on infant mortality, it is relatively safe for women to postpone childbearing into their middle, and perhaps late, thirties.