Factors associated with the odds of contraceptive use at first sex

CONTEXT: Despite the growing body of knowledge about teenager's sexual and contraceptive behavior in the United Kingdom, much quantitative work has failed to consider the broader social contexts in which this behavior occurs.

RESULTS: Three factors were significantly associated with the odds of contraceptive use at first sex among young men—discussing contraception beforehand (odds ratios,5.7-13.8), giving an intimate reason for having sex the first time (6.4) and having parents who portrayed sexuality positively during childhood and the early teenage years (1.2).

For young women, five factors significantly predicted use—communication (odds ratios, 6.2-15.0), age at first sex (1.8), not having visited a service provider (5.0), feeling comfortable interacting with teenage males(1.2) and "sort of" or not expecting to have sex (0.2 and 0.4, respectively).

Among young men, the factors significantly associated with the odds of having discussed contraception were the level of social deprivation, the length of the relationship and parents' openness to talking about sex; among young women, the factors were the number of intimate reasons given for having sex and the warmth andavailability of parents.

CONCLUSIONS: Efforts to increase young people's ability to negotiate sexual and contraceptive decision-making should be multifaceted. It is essential that parents provide a supportive climate throughout childhood and adolescence, where discussions of sexual issues are acceptable and where families feel comfortable talking openly.

Perspectives on Sexual andReproductive Health, 2002, 34(4):
The teenage birthrate in the United Kingdom is the highest in Western Europe and shows few signs of experiencing any sustained declines. In 1999, some 42,000 women younger than 18 in England and Wales became pregnant (yielding a rate of 45 pregnancies per 1,000 women aged 15-17), and 43% of these young women decided to terminate their pregnancy.

Although early pregnancyand motherhood can be a positive experience for some British young women, childbearing during the early teenage years often results from social exclusion, causes social exclusion or both. In Britain, low socioeconomic status, poor educational achievement and being in foster care or in a group home are risk factors for teenage parenthood. Furthermore, teenage parents and their children face greaterrisks of adverse medical, educational and socioeconomic consequences (including having poorer housing, fewer employment opportunities and less-adequate nutrition) than do older parents and their children. In response, the current British government has targeted young people's sexual health as a key area for improvements.

The last decade has seen a growing body of knowledge about teenagers'sexual behavior and relationships in the United Kingdom. Although much is now known about how teenagers view sexual activity and sex roles, gender dynamics, communication strategies and risk-limitation practices, the complex natures of young people's sexual lives and the diversities of their practices are only just beginning to be understood. Failing to take into consideration these complexities canlead to a narrow view of both the explanatory factors behind early sexual activity and the efforts needed to reduce the incidence of unintended conceptions.
Research needs to move beyond simple models of health behavior to explore more fully the dynamics associated with the timing of early sexual activity, as well as the factors associated with effective contraceptive use.

EARLY SEXUALACTIVITY

Large-scale quantitative surveys in the United Kingdom—the 1990 and 2000 National Survey of Sexual Attitudes and Lifestyles (Natsal)9—that have investigated contraceptive use among young people show that the proportion who had unprotected first coitus declined over the past decade. Possible reasons for the decline include extensive safer-sex campaigns, the growth in young people's sexual...