Relationship factors impact young adults' decisions related to contraceptive use

The dynamics of a couple’s relationship, including the exclusivity of the partnership, the level of commitment to the partnership and participation in sexual decision-making with their partner, impact young adults’ decisions related to contraceptive use, new research from Oregon State University shows.

Young adults who reported greater exclusivity with a partner and great relationship commitment were more likely to use hormonal or long-acting methods of birth control or a less effective or no birth control, rather than condoms, the study found.

Individuals who indicated they had played a strong role in sexual decision-making in their relationships were more likely to use condoms alone or both condoms and a hormonal or long-acting method of birth control.

The findings indicate that the qualities and dynamics of a specific relationship are significant predictors of contraceptive use, said the study’s lead author, S. Marie Harvey, associate dean and distinguished professor in the College of Public Health and Human Sciences at OSU.

“Decisions regarding whether to use any contraceptive method, as well as the use of specific methods, are influenced by an individual’s perceived risk of pregnancy and risk of acquiring a sexually transmitted infection,” Harvey said. “These perceptions likely differ depending on how individuals feel about a particular partner.”

The findings were published recently in The Journal of Sex Research; the study was supported by the National Institute for Child Health and Human Development.

Unprotected sex can lead to both unintended pregnancy as well as transmission and acquisition of sexually transmitted infections, or STIs. Young adults are at the greatest risk for contracting STIs and young women have the highest rates of unintended pregnancy.

Condoms are unique in their ability to both protect against unintended pregnancy and STIs. Long-acting contraceptives such as intrauterine devices (IUDs) or hormonal implants or pills are highly effective methods of preventing pregnancy. Dual use of both condoms and a long-acting contraceptive method provides the best defense against both unintended pregnancy and STIs.

Researchers examined data from a longitudinal study of at-risk young adults whose relationships were tracked over a year through a series of structured interviews every four months. In all 1,280 interviews from 470 young adults were conducted.

The participants answered questions about their sexual activity, partners, contraceptive use, and relationship factors such as duration of sexual relationship, frequency of sex and perceived exclusivity with a partner. Relationship commitment levels and sexual-decision making – an individual’s perceived role in the couple’s decisions around use of contraceptives – were also measured.

Over the course of the study, 41 percent of participants reported using only condoms; nearly 25 percent used only a hormonal/long-acting form a birth control, and 13 percent reported using dual methods. The remainder used either no method or a less effective method of birth control.

Participants’ choices were influenced by their perceived vulnerability to pregnancy and perceived vulnerability to STIs, as well as the qualities and dynamics of a specific relationship, such as commitment and sexual decision-making.

“It has to do with how much you trust your partner and how committed you feel in that relationship,” Harvey said. “As relationships become more trusting and committed, individuals may be less likely to protect themselves from disease transmission and condom use will decline. As commitment develops between sexual partners, trust in one’s partner may become a substitute for safer sex behavior for both disease and pregnancy prevention.”

Understanding how young adults make decisions about birth control use can assist healthcare providers with tailoring their conversations about birth control choices and risks to meet the needs for each individual, said Lisa Oakley, a co-author of the paper and a post-doctoral researcher at OSU.

The findings indicate that public health educators and medical clinicians may benefit from understanding their patient’s relationship status, because an individual’s behavior and decisions may be affected by those of his or her partner(s), their role in decision-making and their perceived levels of commitment, Harvey said.

“If it is a committed relationship and the couple is sharing in decision-making about birth control, it may be wise to involve the partner in those discussions,” she said. “If it’s not a committed relationship, then it’s really important to talk to the patient about being proactive in protecting themselves from unintended pregnancy or STIs.”