SEXUALITY IN ADOLESCENCE: CONTRACEPTIVE PRACTICE AND PREGNANCY
Since our interest in sexual behavior is in the context of its consequences for adolescent women, a pertinent question is: To what extent do sexually experienced adolescent women at–tempt to avoid pregnancy through use of contraception?
Although most sexually experienced unmarried adolescent women interviewed in 1971 had used contraception at some time, they took many chances. Over half of them had not used any contraception at their most recent coitus, and only two out of ten used contraception consistently. Younger sexually experienced women (fifteen- and sixteen-year-olds) were more likely to have never used contraception than older adolescents (seventeen- to nineteen-year-olds). Those adolescents who did use contraception generally began using it sometime after the first coitus. The earlier the age was at the first coitus the wider the gap was between first intercourse and first contraception. For most adolescent women, sex is a sometime thing and this may be an important factor in the low levels of consistent use of contraception. Sex is either unanticipated or it is not proper to go “prepared.” The data on the use of contraception as well as on the methods of contraception by frequency of intercourse were consistent with this line of interpretation. About forty-six percent of the women who had intercourse less than three times a month had used contraception at last intercourse compared to two-thirds of those who had intercourse six or more times a month. The choice of contraceptive methods also depended a great deal on the frequency of intercourse. Among the women who had not had intercourse in the month prior to interview, over half had used either the condom or withdrawal at their most recent experience, and only fourteen percent used the pill. In contrast, half the women with the highest frequencies of intercourse (six or more times a month) had used the pill at their last intercourse.
There is also considerable misconception about the risks of pregnancy. Seven out of ten sexually experienced women did not use contraception because they did not think they could become pregnant, because they had intercourse at a time of the month when they could not become pregnant, because they were too young to become pregnant, or because they had sex too infrequently to become pregnant. Some who believed they could not become pregnant because of the time of the month were correct in their judgment, but many were clearly misinformed about the risk of unprotected coitus.
One in ten of all fifteen- to nineteen-year-old women (married as well as unmarried) interviewed in 1971 had become pregnant before marriage. The overwhelming majority (about three-fourths) of the women indicated that the pregnancy was unintended. Yet, about nine out of ten of those who did not intend the pregnancy had not used contraception at the time of conception. A premarital pregnancy very often precipitates marriage, at least among whites. Over half the white young women who became pregnant premaritally married before the outcome of the pregnancy. The divorce rate among such marriages is reported to be much greater than among other marriages of young people (Schofield).
A comparison of the contraceptive use of sexually experienced, never-married women interviewed in 1971, with those interviewed in 1976 shows a dramatic increase in the proportion using contraception both consistently and at last intercourse. The increased use was seen for adolescent women of all ages and among both blacks and whites. In 1976, the younger respondents, those aged seventeen and under were more likely to have used contraception at last intercourse than were those over seventeen in 1971. Moderating this picture of improved contraceptive practice is the fact that there was also an increase in the proportion who never used contraception.
Along with the increased use of contraception there was a change in the methods of contraception. The pill was the most commonly used method by both blacks and whites and for all groups. About half the sexually experienced women in the 1976 survey named the pill as the method most recently used compared to less than a fourth in 1971. The condom, withdrawal, and douche, popular in 1971, were not as much in demand in 1976.
The increased permissiveness in sexual behavior has been paralleled by the increased effort at avoiding a premarital pregnancy, both by greater use of contraception and also by use of more effective methods. In 1976 the sporadic engaging in sex did not seem to be as great a deterrent to the use of contraception as it did in 1971. The greater use of oral contraception also suggests an increased willingness by adolescent women to be “prepared” for the occasion. Another factor in the greater use of birth-control pills may be that they are more readily available to young unmarried women now than they were in 1971.
Although the use of contraception has increased considerably, about half the sexually experienced adolescent women interviewed in 1976 had not used contraception at their first intercourse, and the gap between age at first intercourse and age at first contraception was wider in 1976 than it was in 1971. However, those who do not use contraception the first time but do so subsequently, tend to use more sophisticated methods like the pill and the IUD. In 1976, of the women who had not used contraception at their first intercourse but did so subsequently, six out of ten used the pill or IUD as their first method, and only three out of ten used the condom or withdrawal. In contrast, six out of ten women who used contraception at their first intercourse used the condom or withdrawal. This difference in the quality of contraception between those who delayed first use and those who did not was not a matter of age at the time contraception was first used or of experience with pregnancy, although pregnancy was frequently an incentive to more effective contraception.
Although the increasing use of the pill and the IUD among adolescent women should help prevent undesired pregnancy, the desirability of early and continued use of these contraceptives is questionable because of known and suspected risks of serious side effects. A question may also be raised about the increased prevalence of venereal diseases among adolescents which seems to coincide with the decline in use of the condom. The detrimental effects of the present contraceptive practices of adolescents, combined with the likelihood that the prevalence of sexual intercourse will continue to increase, suggest a need for the development of contraceptives suitable for young adolescents.
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