Contraceptive use patterns within females' first sexual relationships: the role of relationships, partners, and methods

Journal of Sex Research, Feb, 2007 by Jennifer Manlove, Elizabeth Terry-Humen

The prevalence of teenage pregnancy and childbearing is high in the United States, especially in comparison with other industrialized countries (Abma, Martinez, Mosher, & Dawson, 2004; Alan Guttmacher Institute, 2004; Martin, Hamilton, & Sutton, 2005; Singh, Darroch, & Frost, 2001; UNICEF, 2001). Public concern and prevention efforts over unintended pregnancies have focused primarily on teens because the vast majority of teen pregnancies and births are unintended (Abma et al., 2004; Henshaw, 1998), few births to teenage mothers occur within marriage (Franzetta, Ikramullah, Manlove, Moore, & Cottingham, 2006), and teenage mothers and their children have poorer economic, cognitive, and behavioral outcomes than do women who delay childbearing (Maynard, 1997; Terry-Humen, Manlove, & Moore, 2005). Racial and ethnic minorities are at an especially high risk of unintended pregnancy and childbearing during the teen years. For example, Black and Hispanic females aged 15-19 have birth rates that are two to three times the rates of non-Hispanic White teen females, with the highest birth rates occurring to Hispanics, followed by Black and White teens (Franzetta et al., 2006; Martin et al., 2005). The especially high rates of adolescent childbearing among racial and ethnic minorities contribute to higher rates of poverty in these communities (National Campaign to Prevent Teen Pregnancy, 2002, 2004).

The prevalence of unintended pregnancy and childbearing also is high among females in their early 20s. In fact, the highest rates of nonmarital childbearing occur to women aged 20-24 (Martin et al., 2005). Nonmarital pregnancy and childbearing in the early 20s is also high among racial and ethnic minorities (Martin et al., 2005), and young women who have a first birth outside of marriage are less likely to marry and are more likely to receive public assistance than are young women who delay childbearing until marriage (Driscoll et al., 1999; Lichter & Graefe, 2001; Martin et al.; Upchurch, Lillard, & Panis, 2001).

Unintended and nonmarital pregnancies can be avoided either through abstaining from sexual intercourse or by using contraception effectively and consistently. However, teens and young adults are typically not consistent users of contraception, including condoms, hormonal methods, and other methods (Abma, Chandra, Mosher, Peterson, & Piccinino, 1997; Abma et al., 2004). Providing a better understanding of factors associated with contraceptive use and consistency among females, including among racial and ethnic subpopulations, potentially could further reduce unintended teen pregnancy in the United States.

Contraceptive consistency is a more accurate predictor of unintended pregnancy than are single-time measures of contraceptive use at first sex or last sex (Glei, 1999). However, although extensive research has addressed factors associated with the timing of first sexual intercourse and contraceptive use at first sex (Kirby, 2001; B. Miller, 2002), relatively little research has assessed factors associated with contraceptive use and consistency over time and within first sexual relationships. Because contraceptive use decisions are made between both partners in a sexual relationship, it is also important to consider how characteristics of sexual relationships and partners may influence contraceptive use patterns. How- ever, previous research has highlighted family, peer, and even community influences on contraceptive decisions, often without considering sexual relationships (Giordano, 2003; Kirby, 2001). In addition, despite a strong focus on relationship type in condom use literature (Noar, Zimmerman, & Atwood, 2004; Sheeran, Abraham, & Orbell, 1999), there has been limited research on the association between a broad range of characteristics of sexual relationships and partners and their association with contraceptive use and consistency.

This article expands upon previous research to examine the association between relationship and partner characteristics and contraceptive use and consistency within a nationally representative sample of females involved in first sexual relationships. We analyze retrospective month-by-month event history data on sexual experiences and contraceptive use patterns among females under age 25 from the 1995 National Survey of Family Growth (NSFG). Because of data availability, the focus of this article is on contraceptive use broadly defined for pregnancy prevention rather than condom use for disease prevention. We focus on first sexual relationships (most of which occur during the teen years) because decision making in early sexual relationships can influence subsequent contraceptive use and the risk of unintended pregnancy (Manlove, Ryan, & Franzetta, 2004, 2005). Using a life-course approach, we address the following research questions: (a) Are characteristics of females' first sexual partners and relationships associated with contraceptive use patterns? (b) Are contraceptive method type and method-switching within a first sexual relationship associated with contraceptive use and consistency? and (c) Are there racial and ethnic differences in factors associated with contraceptive use in females' first sexual relationships?