1. A total of 1 in 5 women in the US reported delayed contraceptive initiation (>1 month after sexual debut), with higher rates of delayed use reported among African American, Hispanic, or low-income women.
2. Delayed contraceptive initiation was associated with an almost 4 times higher risk of unintended pregnancy within 3 months of sexual debut.
Evidence Rating: Level 4 (Below Average)
Study Rundown: Current literature suggests rates of unintended pregnancies are highest among women aged 18 to 24 years, as well as among African American, Hispanic, and low-income populations in the United States. Unintended pregnancies have been associated with increased rates of prematurity and low birth weight, and that behaviors related to contraceptive use at the time of sexual debut may be predictive of future contraceptive use and unintended pregnancies, as well as long-term reproductive health disparities. In this study, researchers analyzed data from 4 cycles of the National Survey of Family Growth (representing a 45-year span of contraceptive trends) to describe the timing and methods of contraceptive initiation, and the effect of contraception initiation trends on unintended pregnancy rates. Researchers focused specifically on differences in behavior based on income and race and/or ethnicity. Results showed that the average age of sexual debut was about 17 years. Overall, 20% of women reported delayed contraceptive initiation, with higher rates among African American, Hispanic, or low-income women. Delayed contraceptive initiation was associated with an almost 4 times higher risk of unintended pregnancy within 3 months compared with timely contraceptive initiation. This study is limited by recall and response bias. Results from this study suggest the need for increased focus of pediatricians on providing adolescent women with the resources and education necessary for timely contraception initiation before sexual debut.
In-depth [cross-sectional]: Researchers in this study analyzed data from 26 359 female respondents from 4 cycles of the National Survey of Family Growth (2002-2015) to describe the timing and method of contraception initiation among women with sexual debuts (heterosexual) between 1970 and 2014. Investigators also looked at unintended pregnancy within 3 months of sexual debut. Timely contraceptive initiation was defined as any contraceptive use before or within 1 month of sexual debut. Contraceptive methods were separated into 3 categories of effectiveness based on average failure rates. Results showed the average age of sexual debut was 17.2 years. A total of 20% of women and 25% of African American, Hispanic, or low-income respondents report delayed contraceptive initiation. Rates of timely contraception improved over time in all subgroups, however timely effective contraception only increased significantly among white respondents (21% to 40% in the 2000s, p < .001), and respondents from the 2 highest income brackets. Timely effective contraception decreased among African American respondents (31% to 17%, p = .13) and the lowest income group (24% to 20%, p < .001). Women with sexual debuts between 2010-2014 had 2 to 4 times higher odds of timely contraceptive initiation compared with those with sexual debuts between 1970-1980s (adjusted odds ratio [aOR] 2.1-4.3). Maternal high school graduation was associated with lower rates of delayed contraceptive initiation (aOR 0.6-0.8). Overall, 1.8% of women reported unintended pregnancies within 3 months of sexual debut. Women reporting delayed contraceptive initiation had significantly higher risk of unintended pregnancy compared with those reporting timely contraception (risk ratio 4.8, 99.9%CI 3.0-7.6).
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