1. Women who initiated contraceptive use before first intercourse were more likely to be using a hormonal method of contraception.
2. Women who initiated contraceptive use after first intercourse were more likely to experience unintended pregnancy and abortion.
Evidence Rating Level: 2 (Good)
Study Rundown: In spite of abundant evidence showing the superiority of hormonal methods in preventing pregnancy, many women under age 30 use these methods incorrectly and/or inconsistently or choose other less effective methods. As such, unintended pregnancy and abortion rates have remained high. Existing literature suggests that women initiating contraceptive use after first intercourse are more likely to experience poorer reproductive health outcomes. The present work is the first to examine the influence of beginning contraceptive use prior to first sexual intercourse. The authors found that early initiation, or initiation before first intercourse, may promote use of more effective methods later in life. However, this did not extend to a decrease in likelihood of unintended pregnancy or abortion, compared to those initiating at the time of first intercourse. Late initiators were more likely to have an unintended pregnancy or abortion, which is consistent with past studies.
Limitations of this study include retrospective design and recall bias. Study participants may have incorrectly remembered timing of contraception initiation; furthermore, those who experienced an unintended pregnancy or underwent an abortion may be more likely to recall initiation of contraception at a later age. Generalizability of the present findings to the U.S. population may be limited, as social norms and access to contraception differ. Future prospective cohort studies in the U.S. are needed to better characterize the relationship between timing of contraception initiation and rates of unintended pregnancy and abortion.
Relevant Reading: Disparities in rates of unintended pregnancy in the United States
In-Depth [retrospective cohort study]: This study evaluated sexual and reproductive health outcomes in French women under age 30 initiating contraceptive use before first intercourse (n=455), at the time of first intercourse (n=872) and after first intercourse (n=211). Outcomes evaluated included current method of contraception, unintended pregnancy, abortion and sexually transmitted infections.
Using women who initiated contraceptive use at the time of first intercourse as the reference group, early initiators were more likely to be using more effective contraceptive methods, defined as hormonal methods or IUD (OR 1.8, CI 1.1-2.9). Late initiators were more likely to experience unintended pregnancy (OR 1.8, CI 1.1-3.0) and abortion (OR 1.9, CI 1.1-3.4). Early initiators were more likely to report feeling comfortable talking to their mothers about sex at age 15 (p<0.005).
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