Joyce C. Abma

Young women's degree of control over first intercourse: an exploratory analysis.

CONTEXT While policymakers and researchers alike often seem to believe that young womens decision to initiate sexual intercourse is conscious and free of ambiguity, the actual degree of control that such young women exert over first intercourse has rarely been explicitly examined. METHODS The 1995 National Survey of Family Growth asked all women who had experienced intercourse to rate, on a 1-10 scale, the wantedness of their first intercourse; they were then asked whether the experience was voluntary. Logistic regression analysis of data for women aged 15-24 who had experienced first premarital intercourse was performed to test the effect of background factors and wantedness scores on contraceptive use at voluntary first intercourse. RESULTS Twenty-four percent of women aged 13 or younger at the time of their first premarital intercourse report the experience to have been nonvoluntary, compared with 10% of those aged 19-24 at first premarital intercourse. About one-quarter of respondents who reported their first intercourse as voluntary chose a low value (1-4) on the wantedness scale. Women whose first partner was seven or more years older than themselves were more than twice as likely as those whose first partner was the same age or younger to choose a low value (36% vs. 17%). Women whose partner had been seven or more years older were also less likely than other women to have used contraceptives at first intercourse. After the introduction of controls for demographic and background factors, partner age discrepancy and relationship status, wantedness of voluntary first intercourse was not independently related to the odds of contraceptive use at that intercourse. CONCLUSION Characterizing womens first intercourse as simply voluntary or nonvoluntary is inadequate. Measures that take into account degrees of wantedness may help elucidate relationships between sexual initiation, contraceptive use and teenage pregnancy. The fact that substantial numbers of young women voluntarily participated in a first sexual experience about which they felt ambivalent or negative deserves the attention of program planners and service providers.

Adolescent sexual behavior: estimates and trends from four nationally representative surveys.

CONTEXT Accurate information about trends over time in adolescent sexual behavior is essential to understand changes in adolescent pregnancy and sexually transmitted diseases and to monitor the progress of health promotion activities in the United States METHODS Estimates from the National Survey of Family Growth (NSFG), the National Survey of Adolescent Males (NSAM), the Youth Risk Behavior Survey (YRBS) and the National Longitudinal Study of Adolescent Health (Add Health) were compared. While methodologies and populations varied by survey, adolescents aged 15-17 who attend high school were a common subpopulation among all four. For each survey, the prevalence of sexual intercourse, contraceptive use and multiple sexual partners was measured in this population. RESULTS Trend comparisons fell into four categories. First, some similar significant trends were found across surveys. The proportion of all males and of white males who reported ever having had sexual intercourse decreased significantly, while condom use rose significantly among males in both the NSAM and the YRBS. For such behaviors as ever having had sexual intercourse (among Hispanic males and black females), using the pill and using the condom (among all females) and having four or more lifetime sexual partners (among white males), a significant trend was found in one survey while a similar but nonsignificant trend was found in another. Several trend comparisons were not significant in any survey. Finally, having had intercourse in the past three months (among all males and all females), having had two or more partners in the past three months (for males) and having had four or more lifetime sexual partners (among white females and all males) showed a significant trend in one survey but lacked a parallel nonsignificant trend in another. Prevalence estimates in 1995 differed significantly in at least one comparison of surveys for all behaviors except having four or more lifetime sexual partners (both genders) and having two or more recent sexual partners (females). Gender differences within the YRBS and between the NSFG and the NSAM generally were consistent. CONCLUSIONS Trends over time and gender differences were similar across surveys, underscoring their value for tracking adolescent sexual behaviors. Differences in prevalence estimates across surveys probably result from differences in question wording, diverse interview settings and modes of data collection, and varying statistical power. These findings suggest a need to increase our understanding of how methodologies influence survey response in research on adolescents.

The correspondence between intention to avoid childbearing and subsequent fertility: a prospective analysis.

CONTEXT Retrospective studies of pregnancy intendedness have revealed some characteristics that can help identify which women are more likely than others to experience an unintended birth. A comparison of these findings with those from a prospective analysis may shed greater light on the characteristics associated with unintended pregnancy. METHODS Data were taken from the 1988 National Survey of Fertility Growth and a telephone reinterview of respondents conducted in 1990. Separate analyses were conducted of women intending to postpone childbearing for at least three years and of women intending to forgo all future childbearing. Logistic regression models were used to identify the effects of social and demographic characteristics, as well as change in marital status and certainty of intentions, on the odds of experiencing a birth in the interval between interviews. RESULTS Only 10% of women intending to postpone pregnancy for more than three years and 8% of respondents seeking to forgo future childbearing had a birth in the interval between interviews. (These births, referred to as unpredicted births in this article, are roughly analogous to those labeled unintended in retrospective analyses.) Women with incomes below the poverty level were 2-3 times as likely as women with incomes between 100% and 199% of poverty to experience an unpredicted birth. Race was not a significant factor among women intending to avoid future childbearing, and became nonsignificant among those intending to postpone when change in marital status and contraceptive status were taken into account. Women aged 35 and older who wanted no more children were significantly less likely than women aged 20-29 to have an unpredicted birth. Women aged 30-34 who wanted to postpone childbearing were roughly 70% less likely than women aged 20-29 to experience an unpredicted birth. Overall, women who were at risk for a pregnancy but not practicing contraception were 2-3 times more likely than women using an effective method to have an unpredicted birth. CONCLUSIONS There are at least two potential explanations for instances where the correlates of unintended births in the prospective analysis differ from those identified in retrospective studies. Certain subgroups of women may be more likely to classify births as wanted when they are asked retrospectively; alternatively, they may be more likely to experience changes in their living conditions that alter their fertility intentions.

Birth wantedness reports: A look forward and a look back

Abstract A number of checks can be done to assess reliability of attitudinal data pertaining to fertility. We ascertain how births that would be considered unintended, based on Time 1 reports of fertility intentions, are classified by respondents at a second interview after the birth occurred. The 1988 National Survey of Family Growth and a telephone reinterview allow us to identify respondents who initially intended to postpone or stop childbearing, but who then had a birth, and to analyze the reports they gave of the wantedness of the pregnancy leading to the birth. We also examine wantedness responses of women who claimed in 1988 that they intended to conceive within the next few years. Reports are compared across a range of respondent characteristics and circumstances, including changes in marital status since the initial interview. The analysis reveals nontrivial inconsistency between womens stated birth intentions and their reports about the wantedness of subsequent births. Details across subgroups are examined. Results also provide new information about effects of duration since birth on intention reports.

Nonuse of contraception among women at risk of unintended pregnancy in the United States

OBJECTIVE This paper seeks to determine factors associated with nonuse of contraception by women at risk of unintended pregnancy in the United States. This nonuse may be associated with about 900,000 unintended births in the US each year. STUDY DESIGN The 2002 and 2006-2010 National Surveys of Family Growth were combined to yield a nationally representative sample of 9,445 women at risk of unintended pregnancy. Logistic regression analyses identified factors associated with nonuse of contraception. RESULTS This analysis reveals previously undocumented patterns of nonuse: controlling for confounding variables, cohabiting women [adjusted odds ratio (AOR)=2.3, 95% confidence interval (CI)=1.45-3.52] had higher odds of nonuse than married women; women who reported a difficulty getting pregnant (AOR=2.5, 95% CI=2.01-3.01) had higher odds of nonuse than those who did not. Nonuse was also more common among women with a masters degree or more (AOR=1.5, 95% CI=1.11-2.08) compared with those with some college or bachelors degree, and it was more common among women in their first year after first intercourse than after the first year (AOR 1.6, 95% CI=1.12-2.22). Among women who had a recent unintended birth, the most common reason for not using contraception prior to conception was that she did not think she could get pregnant. CONCLUSIONS This study establishes national estimates of reasons for nonuse of contraception and identifies some new subgroups at risk of nonuse. IMPLICATIONS These results may help better understand factors affecting nonuse of contraception and develop strategies for preventing unintended pregnancy in the United States.

Substance Use and Prenatal Care During Pregnancy Among Young Women

Data on a cohort of young mothers from the National Longitudinal Survey of Youth were examined for use of alcohol, cigarettes and marijuana during pregnancies leading to first births. A substantial proportion of women (45 percent) were found to have used at least one of these substances. White women were more likely to use a substance during pregnancy than were Hispanic or black women; women with the prospective father present in the household were less likely than other women to use a substance. Compared with well-educated and older women, less-educated and younger women were more likely to smoke cigarettes or marijuana during pregnancy, but were less likely to drink alcohol. Only about 13 percent of women used more than one substance. Nineteen percent of the women received no prenatal care in the first trimester of pregnancy. Less-educated and younger women were least likely to receive early prenatal care. Multivariate analysis found no association between neglect of prenatal care and substance use. Rather, the analysis revealed that the two behaviors shared likely antecedents, such as whether the prospective father was in the home prior to the pregnancy.