Influence of Current Contraceptive Use on the Abortion and Sexually Transmitted Disease Rates among Adolescents and Young Adults in the United States

Richard J. Fehring
Reproduced with Permission

There has been a significant decrease in the birth rates among adolescents and young adults in recent years.1 This decrease is attributed to the greater use and greater effectiveness of contraceptive methods. Sexually transmitted diseases, however, have continued to increase even with greater use of contraception.2 There was an increase in sexually transmitted diseases from 2012 to 2013 in all four reported categories among young people aged 15-24, i.e., a 2.8% increase in chlamydia, a 5.1% increase in gonorrhea, and a 15.1% increase in primary and secondary syphilis.3 Other researchers at the Center for Disease Control found that one in four female adolescents have a sexually transmitted disease.4

Healthcare providers (i.e., physicians, physician assistants, and advanced practice nurses) are the main gateway for prescribing contraception to adolescents and young adults. Furthermore, healthcare providers often treat common adolescent health problems with oral hormonal contraceptives as a way to prevent unintended pregnancies.5 By doing so, health professionals may be contributing to lowering the barriers to risky sexual behaviors like early sexual debut and multiple sexual partners. Fear of pregnancy and not wanting to catch a sexually transmitted disease are frequent reasons why adolescents and young adults delay sexual intercourse.6 From a behavioral model standpoint, taking away these two consequences of sexual intercourse will likely encourage the behavior. Furthermore, the authority of the healthcare provider will send the message that sexual intercourse is expected. From an anthropologicalstance, the provision of contraception issending a message that a woman’s fertility is something to be avoided and not something to be integrated into a healthy lifestyle. Fertility becomes like a disease that needs to be treated rather than like something that indicates health.7 When healthcare providers use this approach with patients, the unexpected consequence of pregnancy is often viewed as an “adverse event” that needs to be dealt with, and abortion is commonly seen as the solution.

There are, however, protective factors that help adolescent and young adult women to remain virgins and to reduce sexual risk. Past research has shown that those adolescents and young women who hold religion to be very important in their lives and attend church at least once a week have an older age of sexual debut, less sexual intercourse, and fewer male sexual partners than those who are lessreligious.8 Having intact families, good communication with parents, private school, and simply pledging to remain a virgin until marriage are also factors that lead to less sexual risk among adolescents and young adult women.9

In opposition to the prevailing consensus that the use of contraception is necessary to prevent unintended pregnancy and the use of condoms to prevent sexually transmitted diseases among adolescents and young adults, we theorized that the use of contraception to treat health problems and/or to avoid unintended pregnancy actually leads to unhealthy sexual activity. Furthermore, unhealthy sexual activity, such as multiple sexual partners and early sexual debut, can lead to significant health problems like unintended pregnancy, abortion, and sexually transmitted diseases.