Half of them were white and half were African-American. Young adult women belonged to this broad age-range group. The 146 reasons given were categorized into four, namely method-related, user-related, partner-related, and cost/access-related. This result suggested the need for multidimensional interventions in effectively reducing the rate of unintended pregnancy (Nettleman et al.). Side effects and health-related concerns deterred contraceptive use in many respondents (Nettleman et al., 2007). They experienced these side effects themselves or related to them by friends or family. They avoided a particular method because it did not work for them or for someone they knew. Their erroneous perception needs to be corrected by accurate information not only on an individual level but also through social networks of friends and family. Other respondents refrained from contraceptive use because of less common side effects like cancer and stroke. The rest did not desire pregnancy but did not think it would be a problem if their partners or family would extend economic and emotional support. The variety of reasons showed that intending pregnancy is not an absolute condition (Nettleman et al.).

This collection of findings puts health providers in a special position to help women make informed choices in the use of contraception according to their needs (Nettleman et al., 2007). Health providers can provide accurate information and correct misconceptions about contraception methods. They need to be sensitive to women's concerns about contraception .They also need to consider that interpersonal and social relations and individual life experiences affect the incidence of unprotected sexual intercourse (Nettleman et al.).

Pregnant Women

The Centers for Disease Control and Prevention recently reported that approximately 1.5 million women become victims of intimate partner violence each year (Cox, 2008). The risk is greatest during women's reproductive years at 35.6% higher in pregnant women than in non-pregnant women. The prevalence of intimate partner violence or IPV is 4-8% greater during pregnancy. Pregnant women who are victimized by their intimate partners also tend to delay seeking out prenatal care. They, thus, confront increased risk of poor maternal and infant health, pregnancy complications and pre-term delivery or low birth weight of their child. Pregnancy complications include low maternal weight gain, infections, high blood pressure and vaginal bleeding, The Healthy People 2010 initiative linked IPV with 8 of 10 leading health indicators. Violence both affects and is affected by these leading health issues. In comparison with non-abused women, IPV women victims are less likely to practice responsible sexual behavior. They face increased risk for mental health disorder and substance abuse and have less access to care. These women come from all social strata, races and ethnic groups. They are also likely to be young, unmarried, with little education and have low household incomes (Cox).

The first realistic step towards IPV prevention or intervention is accurate screening, especially by the local health department or LHD (Cox, 2008). The American College of Obstetrics and Gynecology recommended that all healthcare providers should regularly screen patients for violence. Screening should be conducted during routine annual examinations, pre-conception visits, once per trimester of pregnancy and during postpartum examinations. However, there is as yet no universal screening for IPV. And according to a national survey, routine IPV is conducted by only 17% of prenatal providers and only 5% make follow-up visits. Yet LHDs play a crucial role in identifying, intervening into and preventing IPV. That role goes beyond setting up a crisis hotline or shelter for abused women and extends to identifying the risk and offering protection. Common barriers, however, stand on the way to fulfilling this role. These include incomplete data on IPV women victims, lack of enhanced training and education on IPV and related resources, promoting screening and assessment tools, and low-level communication with clients (Cox).

In tackling the problem of incomplete data, LHDs may secure these on a State level or enter into data-sharing agreements with local law enforcement or emergency medical services (Cox, 2008). LHDs need to connect with networks, keep updated information on community resources and maintain and strengthen relationships with partners in the community, such as shelters and advocacy organization. Screening for IPV among pregnant women should be a priority that all healthcare and social service providers should be made to understand as their responsibility. As a consequence, it can be incorporated into settings, such as family planning, primary care, prenatal care and pediatric clinics. In the absence of universal screening protocols, LHDs can make use of community resource guides or pocket reference...

They can look for assessment tools appropriate for the community. LHDs and public health professionals play a critical and key role in preventing IPV during pregnancy, a time of increased risk of violence. It is the best opportunity for both intervention and prevention. Despite insufficient resources, IPV screening is feasible. LHDs must elicit the cooperation of staff, providers and the community to treat IPV prevention as a priority and to establish appropriate policies and procedures. This multi-level cooperation will improve overall maternal and child health conditions in the community (Cox).
The Middle-Aged Woman

A recent cross-section study of the sexual activities and behaviors of 3,005 men and women aged 57-85 across the U.S.A. remained sexually active (Eden & Wylie, 2009). Of this number, 73% were aged 57-64, 53% aged 65-74, and 26% aged 75-85. Respondents reported that the most frequent barrier to sexual activity was a health problem in the male at 64% and the female's lack of interest in sex at 51%. The study concluded that sexual activity seemed to decline with age and that sexually inactive women tend to view sex as less important. The women respondents are beyond the age of menopause but confirmed that most of them remained sexually active, considered sex an important life aspect and expressed satisfaction in their sexual lives. The study led to further investigation into problems, linked with female sexuality, which, in turn, interfere with their sexual activity and well-being (Eden & Wylie).

The most common menopause-linked sexual distresses or FSDs include the lack of desire and low libido, decreased sexual arousal and dyspareunia (Eden & Wylie, 2009). Hormonal physiological changes in menopause, such as decreased serum estrogens, seem to explain these distresses. Stress, relationship status and attitude towards aging affect the overall quality of life of middle-aged. Thus, their sexual life and behavior, far more than physical symptoms linked to menopause, such as vasomotor and urogenital symptoms. Psychological and psychosocial changes in midlife assert significant impact on the quality of sexual life in women. These are personal and cultural attitudes towards menopause and sex, life role changes, and relationship factors. The freedom from menstruation, pregnancy and child care creates a positive attitude that tends to improve the quality of their sexual life. But other factors occurring at this period can bring about either improvement or detriment changes (Eden & Wylie).

The use of estrogen replacement therapy and androgen therapy can improve female sexual function after natural or surgical menopause (Eden & Wylie, 2009; Kuzmarov, 2009). Estrogen replacement improves sexual symptoms, such as vaginal dryness and dyspareunia. Androgen therapy addresses the lack of desire and low libido. Other factors affecting the quality of middle-aged women's sexual life must be tackled in a holistic manner. An integrated approach should be used to manage both physical and psychological or psychosocial factors (Eden & Wylie, Kuzmarov).

Older Women

Nurses are generally uncomfortable in managing sexual issues in older adults (Wallace, 2008). But nurses must be made aware that sexuality is important to older people as sexuality extends beyond the sexual urge and sexual act. It can be an expression of passion or affection, esteem or loyalty. It is an alternate form of self-expression of excitement, romance or the simple delight at being alive. Older adults, such as older women, are, however, as uncomfortable with this reality and as reluctant as their nurses to discuss their sexual needs for a range of reasons. At the same time, sexuality in older adults is not widely tackled in nursing education programs, hence the nurse's own reluctance and discomfort in managing related issues. Nurses must be aware that older women, like other older adults, go through pathological processes as part of aging and affecting their sexual health. It should, thus, be considered a delicate priority in their care (Wallace).

The PLISSIT model has been widely used as an assessment and intervention tool with older adults (Wallace, 2008). The nurse first asks the older person for permission to conduct and begin the assessment. If she agrees, the nurse asks her open-ended questions. The nurse then provides the patient with limited information on normal as well as pathologic changes affecting sexuality in the patient's age level. The nurse also corrects the patient's misconceptions on the matter. Then the nurse offers suggestions to the patient's answers to the open-ended questions. When warranted, intensive therapy is recommended and applied if the older woman patient experiences sexual problems unrelated to normal aging, disease or environmental factors (Wallace).

Method

This study uses the descriptive-normative…