Use of contraception and use of family planning services in the United States: 1982-2002

OBJECTIVE: This report presents national estimates of contraceptive use and method choice based on the 1982, 1995, and 2002 National Surveys of Family Growth (NSFG). It also presents data on where women obtained family planning and medical services, and some of the services that they received. METHODS: Data were collected through in-person interviews with 12,571 men and women 15-44 years of age in the civilian noninstitutional population of the United States in 2002. This report is based on the sample of 7,643 women interviewed in 2002. The response rate for women in the study was about 80 percent. RESULTS: The leading method of contraception in the United States in 2002 was the oral contraceptive pill, used by 11.6 million women; the second leading method was female sterilization, used by 10.3 million women. The condom was the third-leading method, used by about 9 million women and their partners. The condom is the leading method at first intercourse; the pill is the leading method among women under 30; and female sterilization is the leading method among women 35 and older. More than 98 percent of women 15-44 years of age who have ever had sexual intercourse with a male (referred to as "sexually experienced women") have used at least one contraceptive method. Over the 20 years from 1982 to 2002, the percent who had ever had a partner who used the male condom increased from 52 to 90 percent. The proportion who had ever had a partner who used withdrawal increased from 25 percent in 1982 to 56 percent in 2002. Another important measure of contraceptive use is use at the first premarital intercourse: before 1980, only 43 percent of women (or their partner) used a method of birth control at their first premarital intercourse. By 1999-2002, the proportion using a method at first premarital intercourse had risen to 79 percent.     

Trends in sexual activity among adolescent American women: 1982-1995

CONTEXT: The formulation of policies and development of programs regarding adolescent sexual and reproductive health requires up-to-date information on levels of and trends in teenage sexual activity. METHODS: Analysis of three NSFG surveys, carried out in 1982, 1988 and 1995, allows examination of the sexual behavior of teenage women over a 13-year time period, using comparable data for the entire time period. RESULTS: The proportion of adolescent women who ever had sexual intercourse increased somewhat during the 1980s, but this upward trend stabilized between the late 1980s and the mid-1990s. Throughout the period, there has been little change in the proportion currently sexually active: In each of the surveys, about 40% of all 15-19-year-olds had had sexual intercourse in the last three months. The average number of months in the past year in which sexually experienced teenagers had had intercourse declined during the 1980s, with no change in the continuity of sexual intercourse taking place between 1988 and 1995, when the mean remained at 8.6 months. Differences in teenage sexual behavior across poverty and racial and ethnic subgroups were large in the early 1980s, but narrowed over the 13-year period. CONCLUSIONS: Only continued monitoring will tell whether the patterns observed during 1988-1995 signify a temporary leveling off in the trend toward increasing adolescent sexual activity, stability in behavior or the beginnings of a decline. Nevertheless, the sustained level of initiation of sexual activity during adolescence is by now a recognized pattern of behavior, and is an important characteristic of the transition to adulthood in the United States.     

Sexual activity, condom use and AIDS awareness among adolescent males

New data from the 1988 National Survey of Adolescent Males indicate that 60 percent of never-married young men ages 15-19 are sexually active. Among 17-19-year-old males living in metropolitan areas, the rate of sexual activity reported in 1988 was 15 percent higher than that reported in 1979. This increase encompasses a rise of 23 percent among black males and 13 percent among nonblack males. Slightly more than half of the sexually active males in the 1988 survey reported that they had used a condom the last time they had had intercourse. Among both black and nonblack youths aged 17-19 living in metropolitan areas, rates of reported condom use at last intercourse more than doubled between 1979 and 1988. Conversely, reported reliance on ineffective methods of contraception or use of no method at last intercourse was 60 percent lower. When first intercourse occurred within two years of the 1988 survey, the odds of using a condom were increased by 110 percent over the odds when intercourse occurred between 1975 and 1982, after controlling for the effects of age at first intercourse, race and ethnicity. The young men in the sample were very knowledgeable about how the human immunodeficiency virus is transmitted, and over three-quarters of the sample did not dismiss the disease as uncommon, nor did they think that using condoms to prevent the spread of AIDS was too much trouble. The rates of condom use were significantly lower than average, however, among young men who had ever used drugs intravenously or whose partners had done so, young men who had ever had sex with a prostitute and those who had had five sexual partners or more in the past year.     

Differences in teenage pregnancy rates among five developed countries: the roles of sexual activity and contraceptive use.

CONTEXT: Adolescent pregnancy, birth, abortion and sexually transmitted disease (STD) rates are much higher in the United States than in most other developed countries. METHODS: Government statistics or nationally representative survey data were supplemented with data collected by private organizations or for regional or local populations to conduct studies of adolescent births, abortions, sexual activity and contraceptive use in Canada, the United States, Sweden, France and Great Britain. RESULTS: Adolescent childbearing is more common in the United States (22% of women reported having had a child before age 20) than in Great Britain (15%), Canada (11%), France (6%) and Sweden (4%); differences are even greater for births to younger teenagers. A lower proportion of teenage pregnancies are resolved through abortion in the United States than in the other countries; however, because of their high pregnancy rate, U.S. teenagers have the highest abortion rate. The age of sexual debut varies little across countries, yet American teenagers are the most likely to have multiple partners. A greater proportion of U.S. women reported no contraceptive use at either first or recent intercourse (25% and 20%, respectively) than reported nonuse in France (11% and 12%, respectively), Great Britain (21% and 4%, respectively) and Sweden (22% and 7%, respectively). CONCLUSIONS: Data on contraceptive use are more important than data on sexual activity in explaining variation in levels of adolescent pregnancy and childbearing among the five developed countries; however, the higher level of multiple sexual partnership among American teenagers may help explain their higher STD rates.     

Premarital sexual activity and contraceptive use in Santiago, Chile.

The Santiago Young Adult Reproductive Health Survey was conducted in 1988 to examine the sexual behavior of and contraceptive use among young adults in Chile. The survey was based on multistage household probability samples of 865 women and 800 men aged 15-24 who were living in Santiago in 1988. Findings show that 35 percent of females and 65 percent of males had had premarital intercourse. Among those who had done so, the median age at first experience was 18.4 years for women and 16.4 years for men. Only 20 percent of females and 19 percent of males used contraceptives at first premarital intercourse. Use of contraceptives increased with age at the time of that event. Fertility data reveal that 70 percent of first births were premaritally conceived, and more than one-third of these were born prior to union. The high rates of premarital and unintended pregnancy among young women and the low prevalence of effective contraceptive use indicate a need for greater emphasis on sex education and family planning services directed at adolescents and unmarried young adults in Santiago.     

Sex, contraception and pregnancy among adolescents in foster care

Young women aged 13-18 who were surveyed in a 1986 study of child welfare clients were over 50 percent more likely to have had sexual intercourse than those in a comparison group drawn from a national sample of young women; they were also more than twice as likely to ever have been pregnant. The child welfare teenagers also scored significantly lower than their counterparts on a test of sexuality and birth control knowledge. Among the child welfare clients (half of whom were at home and half of whom were in foster care), the young women living in foster homes were less likely than those living with their own families to have ever had sex voluntarily (33 percent vs. 47 percent). However, the foster children were less likely to have used birth control at their most recent intercourse or to have obtained contraceptives from a family planning clinic. Nearly half of the foster care teenagers and 40 percent of the teenagers living at home reported having been sexually abused. Victims of sexual abuse were especially likely to be sexually active. Among blacks, the teenagers in foster care and their national counterparts were similar in the proportions who had had sexual intercourse, who had had voluntary intercourse and who had ever been pregnant. Among whites, however, the foster care teenagers were about four times as likely as their matched peers to have had intercourse and to have had voluntary sex, and they were almost eight times as likely to have been pregnant.(ABSTRACT TRUNCATED AT 250 WORDS)     

Social and environmental factors influencing contraceptive use among black adolescents

In 1979 survey among sexually active unmarried black adolescents from Chicago found that 28 percent of the young women and 18 percent of the young men used a contraceptive at first intercourse. Statistically significant differences in such contraceptive use among teenage women were found for three social and environmental characteristics: social class, parents' marital status and neighborhood quality. Thus, 41 percent of the young women from the highest social class used contraceptives at first intercourse, but only 17 percent of those from the lowest class did so. The proportions were 35 percent for young women from neighborhoods of high socioeconomic status and 17 percent for those from ghetto neighborhoods. Thirty-six percent of teenage women whose parents had intact marriages as of the adolescent's 11th birthday used contraceptives at first intercourse, compared with 23 percent of those from single-parent and divorced families. Among males, social class was the only one of these three characteristics that was statistically significant; 32 percent of adolescents from the highest class and 11 percent from the lowest practiced contraception at first intercourse. For teenagers of both sexes, career aspirations were of marginal statistical significance in the practice of contraception. Thirty-six percent of young women with high aspirations used contraceptives at first intercourse and 19 percent of those with low aspirations did so. Only four percent of the young men with low career aspirations used contraceptives, compared with 25 percent of those with high aspirations. Number of siblings, parental supervision of dating and having a sister who had become a teenage mother showed no association with contraceptive use.(ABSTRACT TRUNCATED AT 250 WORDS)     

American women's sexual behavior and exposure to risk of sexually transmitted diseases.

According to nationally representative data from the 1988 National Survey of Family Growth and the 1988 and 1989 General Social Surveys, 67% of all women aged 15-44 who have ever had intercourse have had more than one partner, 41% have had four or more, 23% six or more and 8% more than 10; 71% have had one or more nonmarital partners. Fewer than 1% of currently married women report having had more than one partner in the previous three months, compared with 13% of formerly married women and 9% of single women who are sexually active. For the most part, women with multiple partners do not have characteristics that set them apart from other women; women in all age-groups and racial or ethnic groups appear equally likely to have multiple partners while unmarried. Fifty-seven percent of women who report multiple partners have never been married, and another one-quarter are currently divorced. Twenty-one percent are teenagers, 46% are aged 20-29 and 24% are in their 30s. Between 27% and 39% of all sexually active women aged 18-44 are estimated to have had direct or indirect contact with more than one sexual partner during the preceding 12 months (including women with only one partner whose partner had multiple partners). About 20% of currently sexually active women reported using the condom, but one in five condom users had not used one at last intercourse. Once social and demographic factors are controlled, condom users with multiple partners are less likely than other condom users to have used a condom at last intercourse.     

Contraceptive use at first premarital intercourse: United States, 1965-1988

The proportion of U.S. women who used a contraceptive method at their first premarital intercourse rose from 47 percent in 1975-1979 to 65 percent in 1983-1988. Overall, and among non-Hispanic white women, this change resulted entirely from an increase in the use of condoms by their partners. The proportion of whites who used a condom at first premarital intercourse, for example, increased from 24 percent to 45 percent. Among blacks, condom use at first intercourse increased from 24 percent to 32 percent during that period, and pill use rose from 15 percent to 23 percent. Among all women, the method most often used at first intercourse during every period in the study was the condom, followed by the pill and withdrawal. The proportion of women using a method at first premarital intercourse varies strikingly according to individual characteristics. Among the various demographic subgroups, the proportion who use a method varies from 32 percent of Hispanic women to 68 percent of Jewish women. Whites are more likely to use a method than are blacks, and fundamentalist Prostestants are less likely to use a method than are other Protestants or Catholics. The proportion using a method is higher among women whose mothers completed high school than among those whose mothers did not. In addition, the proportion rises with age at first intercourse. Multiple logistic regression showed that the independent effects of Hispanic origin, Jewish or fundamentalist Protestant religious affiliation and the education of a woman's mother are large and significant.(ABSTRACT TRUNCATED AT 250 WORDS)     

U.S. women's contraceptive attitudes and practice: how have they changed in the 1980s?

Between 1982 and 1987, favorable opinion of the pill increased steadily among American women (from 65 to 76 percent), and favorable opinion of the condom rose sharply (from 38 to 60 percent). Approval of the IUD dropped during the period (from 26 percent to 19 percent). During the five years, the proportion of married women aged 18-44 who were exposed to the risk of unintended pregnancy remained the same (78 percent), but the proportion among unmarried women rose significantly (from 64 percent to 69 percent). This change was primarily the result of an increase--from 68 percent to 76 percent--in the proportion of never-married women who had ever had intercourse. The overall level of contraceptive use among 18-44-year-olds who were exposed to risk remained stable over the period, at about 93 percent, but use of the most effective methods (sterilization, pill and IUD) went up, from 68 percent to 71 percent. All of the net increase in effective-method use, however, was limited to married women, among whom reliance on both sterilization and the pill increased (from 46 to 51 percent and from 17 to 22 percent, respectively). Pill use also rose among unmarried women (from 43 to 48 percent), but there was no change in the level of sterilization. The prevalence of IUD use declined among both married and unmarried women (to three percent in each case). Condom use remained steady among married women, at about 15 percent, but among the unmarried it increased markedly, from nine to 16 percent.(ABSTRACT TRUNCATED AT 250 WORDS)     

Fertility and family planning in the United States: insights from the National Survey of Family Growth

A review of about 50 studies based on the 1982 National Survey of Family Growth (NSFG) illustrates the ways in which the survey sheds new light on trends and differentials in such areas as fertility, contraceptive use, infertility and the use of family planning services in the United States. The total fertility rate declined by nearly 50 percent between 1960 and 1973, from 3.6 to 1.9 births per woman, and changed little from then until 1982. It would appear that growing use of the pill, the IUD and sterilization--but principally the pill--is the prime factor in the dramatic decline in unwanted and mistimed births among married couples. Their increasing reliance on sterilization between 1973 and 1982 reduced the proportion of unwanted births at ages 35 or older by half, but had little impact on overall birthrates because only about five percent of all births occurred at those ages in 1981. Although overall fertility has declined, the rate of premarital pregnancy has risen since the early 1960s. Research based on the NSFG suggests that this is a result both of the rapid increase in the percentage of women who have premarital intercourse and of the increasing length of exposure to premarital pregnancy. The latter trend is probably related both to earlier intercourse and to delayed marriage. Despite the increasing levels of premarital exposure, however, there was actually a decline in teenage birthrates in the 1970s, which was due in part to the rising abortion rates among teenagers. Finally, although racial differences in fertility have narrowed, black women still have higher fertility than whites. The 1982 NSFG data suggest that four factors are principally responsible for the higher birthrates of black women: Blacks begin having intercourse earlier than whites; black women are one-third less likely to use contraceptives at first intercourse; they are more likely to be currently exposed to the risk of unplanned pregnancy and not using a method; and they have higher pregnancy rates when they are using no contraceptives or less-effective methods, such as the condom, rhythm and withdrawal.     

Contraceptive use, pregnancy and fertility patterns among single American women in their 20s

Eighty-two percent of never-married American women aged 20-29 have had sexual intercourse; black women are somewhat more likely than white women to have had intercourse. In all, 53 percent of never-married women in this age-group had intercourse at least once in the four weeks preceding the 1983 National Survey of Unmarried Women. Black women are more likely than white women to have done so (62 percent compared with 51 percent). Nearly all of the women who ever had intercourse have used a contraceptive method at some time; 78 percent practiced contraception at the time of their most recent intercourse. A high proportion did not start using birth control until some time after first intercourse, however: On average, the delay between first coitus and first contraceptive use was eight months, and one-fifth of the respondents said that they began using a method only after their first pregnancy. Most of the women who did use a method at the time of first intercourse relied on the condom or withdrawal; in contrast, about two-thirds of white women and three-quarters of black women now rely on the pill, IUD or sterilization. Eighty-six percent of the women who had intercourse in the four weeks before the interview were current users--88 percent of the white women and 77 percent of the black women. Catholic women are no less likely than others to have ever had intercourse, to be currently sexually active or to be using contraceptives. However, Catholic women who receive communion at least once a week are less likely to be sexually active and substantially less likely to use medical contraceptive methods. Women who consider themselves very religious are less likely to be sexually active, but the sexually active among them are about as likely as others to use contraceptives. Better-educated women are much more likely than less-educated women to practice contraception, and women who work outside of the home are more likely than those who do not to use contraceptives. Thirty-three percent of unmarried 20-29-year-olds have had at least one pregnancy (about 40 percent of those who have ever had intercourse). Thirty-two percent of sexually active white women have been pregnant, compared with 70 percent of comparable black women. Furthermore, whereas 14 percent of white 20-29-year-olds have had an out-of-wedlock birth, 62 percent of black women have done so.(ABSTRACT TRUNCATED AT 400 WORDS)     

The effects of sex education on adolescent behavior

By age 18, according to the 1982 National Survey of Family Growth, 68 percent of 15-19-year-old women have received formal instruction about pregnancy and contraceptive methods, 16 percent have had instruction about pregnancy only, and another 16 percent have received neither type of education. The age at which formal contraceptive education is first provided has been declining; among 15-year-olds, for example, 47 percent have had instruction by their 15th birthday, compared with 33 percent of 17-year-olds and 26 percent of 19-year-olds. Forty-six percent of adolescent women have had premarital intercourse. Exposure to formal sex education appears to have no consistent effect on the subsequent probability that a teenager will begin to have intercourse. Sex education does influence contraceptive knowledge and behavior, however. Sexually active teenagers who have had formal instruction report knowing how to use more methods than do adolescents who have had no instruction. The former group is also significantly more likely to have practiced contraception at some time. And among ever-users, those who have received pregnancy and contraceptive education before first coitus are significantly more likely to have used a method at first intercourse. Nearly one-third of premaritally sexually active adolescents have had at least one premarital pregnancy. The NSFG data reveal no significant relationship between exposure to sex education and the risk of premarital pregnancy among sexually active teenagers.     

Contraceptive practice among Hispanic adolescents

19% of births to Hispanics in 1980 occurred among women 20 years old, while the out-of-wedlock birth rate among Hispanics aged 15-19 was 40/1000 births (figures for Blacks were 89 and Whites 16/1000). However adolescent pregnancy-related behavior and levels of pregnancy for Hispanics have not been adequately studied. This study is based on data from the 1982 US National Survey of Family Growth. 20% of Hispanic women aged 15-19 are or have been married; 16% are currently living with their spouse or partner; 4% are divorced or separated. The proportion in union is higher than for Whites and Blacks. 30% of Hispanic adolescent women are never-married and have had intercourse, as opposed to 36% of Whites and 55% of Blacks. Although 1/2 of Hispanic women have had sexual experience, only 1/2 are at risk for unintended pregnancy. Almost all sexually active adolescents regardless of race know of the pill; the condom is almost as well known (92% of Hispanics, 95% overall). With most nethods, awareness levels among Hispanics are similar to those among whites. Only 23% of sexually active Hispanic adolescents ever having intercourse used contraception with their 1st intercourse, 1/2 the proportion among Whites. Among sexually active adolescents, 76% of Hispanics and whites, and 83% of Blacks have visited a physician or clinic to discuss or obtain contraceptives. 54% of Hispancis paid for visits with private funds as opposed to 51% overall. 18% of Hispanics' visits were covered by Medicaid. 25% of Hispanics' visits were covered by another program or were free and very few were covered by insurance. It would be useful to differentiate subgroups within the general class of "Hispanics" (i.e. by place of origin, generations in the US), but this was not possible with this small sample.     

Contraceptive practice in the United States, 1982-1988

Use of oral contraceptives by married women declined markedly between 1973 and 1982, but analysis of data from the 1988 National Survey of Family Growth shows that this decline stopped between 1982 and 1988. Reliance on female sterilization continued to increase, however, and it remained the leading method among currently married and formerly married women. Among women of all marital statuses, IUD use dropped by two-thirds between 1982 and 1988, from 2.2 million to 0.7 million women. As the proportion of less-educated, low-income, black and Hispanic contraceptive users choosing the IUD decreased, the proportion relying on female sterilization increased. Among college-educated white women, use of female sterilization did not increase; instead, pill use rose in this group. Condom use increased most sharply among teenagers and rose among never-married white and black women, but the pill was still the leading method by far in these groups, regardless of race. Among never-married black women, reliance on sterilization increased significantly between 1982 and 1988, with female sterilization becoming the second leading method. Use of the diaphragm declined sharply over the same period among never-married white women and among those who intended to have more children, as did use of periodic abstinence (rhythm and natural family planning) and foam.     

Heterosexual genital sexual activity among adolescent males: 1988 and 1995

CONTEXT: Researchers have paid little attention to adolescents' experience with genital sexual activity other than vaginal intercourse, even though oral and anal intercourse expose youth to the risk of sexually transmitted diseases. METHODS: Males aged 15-19 interviewed in 1988 and 1995 as part of the National Survey of Adolescent Males were asked questions about whether they had ever engaged in a series of genital sexual activities. These data were collected in a self-administered questionnaire that respondents completed at the end of the interview. RESULTS: In 1995, 55% of males aged 15-19 reported that they had ever engaged in vaginal intercourse, 53% that they had ever been masturbated by a female, 49% that they had ever received oral sex, 39% that they had ever given oral sex and 11% that they had ever engaged in anal sex. More than three-quarters of males who had had vaginal intercourse reported experience with masturbation or oral sex by a female. Moreover, one in five males who had never had vaginal intercourse reported having been masturbated by a female, and one in seven said they had received oral sex. Between 1988 and 1995, the proportion of males who reported having ever been masturbated by a female increased significantly, from 40% to 53%. There were less sizable shifts in the proportions who had received oral sex: Overall proportions were similar in both years, although levels more than doubled among black teenagers, an increase that brings them in line with levels of oral sex reported by white and Hispanic adolescent males in 1995. CONCLUSIONS: Evidence from the National Survey of Adolescent Males showing that a substantial share of male teenagers engage in genital sexual activity beyond vaginal sexual intercourse underlines the importance of monitoring a broad spectrum of sexual behaviors among teenagers. More detailed data with larger samples of both males and females are needed to determine the frequency and timing of these behaviors. Measuring risk for STD infections among teenagers requires attention to all forms of genital sexual activity.     

Reproductive Health and Sexual Violence Among Urban American Indian and Alaska Native Young Women: Select Findings from the National Survey of Family Growth (2002)

Existing data on American Indians and Alaska Natives (AI/ANs) has indicated high rates of unintended pregnancy, high-risk sexual behavior, and experiences of sexual violence. This study from the first analysis to examine AI/ANs and the urban AI/AN subgroup in the National Survey of Family Growth (NSFG) reports new findings of reproductive health and sexual violence among urban AI/AN young women. We examined 2002 NSFG data on urban AI/AN women ages 15–24 years for pregnancies/births, unintended pregnancy, sexual initiation and contraceptive use. We also examined non-voluntary first sexual intercourse among urban AI/AN women ages 18–44 years. Prevalence estimates and 95 % confidence intervals were calculated. Findings include prevalence rates of risk factors among urban AI/AN women ages 15–24 years including unprotected first sex (38 %), first sex with much older partners (36 %), three or more pregnancies (13 %) and births (5 %) and unintended pregnancies (26 %). Seventeen percent of urban AI/ANs ages 18–44 years reported experiencing non-voluntary first sex. Sixty-one percent of urban AI/AN women ages 15–24 years were not using any method of contraception. Current contraceptive methods among those using a method included: injections/implants (23 %), contraceptive pills (32 %) and condoms (25 %). Findings describe reproductive health risk factors among young urban AI/AN women and highlight the need for enhanced surveillance on these issues. Those working to improve AI/AN health need these data to guide programming and identify resources for implementing and evaluating strategies that address risk factors for this overlooked population.     

Patterns of HIV risk and preventive behaviors among teenage men.

Analyses of the 1988 National Survey of Adolescent Males indicate the prevalence of risk behaviors related to acquired immunodeficiency syndrome, including sexual, contraceptive, and drug use behaviors, among 15- to 19-year-old men. About three-fifths had sexual intercourse, indicating that a majority of teenage men have at least some potential exposure to the human immunodeficiency virus (HIV) or sexually transmitted disease. From a behavioral perspective, the average sexually active teenage man used a condom more than half the time in the 12 months before the interview. Those with most experience with sexual intercourse, however, used condoms least frequently. More important from an epidemiologic perspective, a third of all acts of intercourse in the prior year were protected using condoms. Further, behaviors with the greatest direct risks for HIV infection, such as homosexual intercourse, use of intravenous drugs, and sex with intravenous drug users or prostitutes, appear to be relatively uncommon. Teenage men who demonstrate high-risk behavior, including both sexual and substance abuse, compound their risks, because risks generally are correlated. Condom use is a preventive behavior that is negatively correlated with most risk behaviors; those who have multiple partners, or who are substance abusers, tend to use condoms least. The convergence of risks for multi-problem teenage men indicates the relevance of interventions directed to high-risk youths.     

Patterns of contraceptive use within teenagers' first sexual relationships

CONTEXT Teenagers have a high unintended pregnancy rate, in part because of inconsistent use or nonuse of contraceptives. It is important to determine how partner and relationship characteristics are related to contraceptive use and consistency within adolescents' first sexual relationships. METHODS Logistic and multinomial logistic regression analyses of data from 1,027 participants in the first two waves of the National Longitudinal Study of Adolescent Health examined the influence of relationship and partner characteristics on ever‐use and consistent use of contraceptive methods during teenagers' first sexual relationships RESULTS Teenagers who had waited a longer time between the start of a relationship and first sex with that partner, discussed contraception before first having sex or used dual contraceptive methods had significantly increased odds of ever or always using contraceptives. Adolescents who had taken a virginity pledge, had an older partner, had a greater number of close friends who knew their first partner, or reported having a relationship that was not romantic but that involved holding hands, kissing and telling their partners they liked or loved them had decreased odds of contraceptive use or consistency. As relationship length increased, teenagers were more likely to ever have used a method, but less likely to always have used a method. CONCLUSIONS Parents and programs should encourage teenagers to delay sexual intercourse, discuss contraception with partners before initiating sex and be vigilant about contraceptive use, particularly in long‐term sexual relationships and in relationships with older partners.     

Choice of female-controlled barrier methods among young women and their male sexual partners

CONTEXT: Little is known about the factors associated with the choice of female-controlled, over-the-counter barrier contraceptive methods among women and their male sexual partners. METHODS: Predictors of method choice were assessed following an educational presentation on contraceptive use and risk reduction among 510 sexually active females aged 15-30 who were recruited in the San Francisco Bay Area. In addition, the primary partners of 160 of these women participated in the survey RESULTS: Twenty-two percent of women who enrolled in the study alone, 25% of those who enrolled with their main partner and 18% of these male partners chose female-controlled, over-the-counter barrier methods alone. The strongest predictor of this choice was current use of a hormonal contraceptive both for women who participated in the study on their own (odds ratio, 2.1) and for those who enrolled their partner in the study (odds ratio, 6.3). Female-controlled methods were also chosen significantly more often by teenagers than by older women; for example, among those who enrolled with a male partner, the odds ratio for selection of a female-controlled barrier method by women younger than 18 was 6.0. Among women who enrolled without a partner, those who had had multiple partners in the previous six months and those who were current users of male condoms were less likely to choose female-controlled methods (odds ratios, 0.7 and 0.5, respectively). CONCLUSIONS: Although the majority of participants did not choose female-controlled, over-the-counter barrier methods without also choosing male condoms, such female-controlled methods appear to offer an acceptable alternative for prevention of sexually transmitted infections. They may be a particularly attractive option for individuals using hormonal contraceptives and for teenage women.