ONTRACEPTION CALLING. Why Aren t More Young Women Listening? JUNE. Refill Prescription

Transcription

1 ONTRACEPTION CALLING Why Aren t More Young Women Listening? Refill Prescription up Condoms JUNE

2 Introduction MOST YOUNG SINGLE WOMEN are having sex and most have used some form of birth control at some point. Nearly all say they are trying to avoid pregnancy at this time in their lives. Still, 49 percent of unmarried women age do not use contraception consistently. i Nearly two million of them get pregnant every year and most say the pregnancy was unplanned. ii Despite more birth control options than ever before, despite an Internet full of information about birth control (see Bedsider.org, for example), and despite their own desire to avoid pregnancy, young women aren t as good at using contraception as they should be. It seems that many young single women who are not trying to get pregnant are not trying hard enough not to. Why do so many young women say they don t want to get pregnant and yet use birth control so sporadically? Why don t more young women who are trying to avoid pregnancy use the most effective methods of contraception? What causes them concern? What are the barriers to better use? What kinds of feelings do they associate with using birth control? Why do single young women who are not trying to get pregnant not try harder to avoid it? The National Campaign to Prevent Teen and Unplanned Pregnancy teamed up with Cosmopolitan magazine often considered the bible for sexually active, single, young women to examine these very issues. The results presented here are from a nationally representative survey conducted by TRU, a worldwide leader in research on teens and twenty-somethings. This online survey was administered in March 2013 to more than 1,000 unmarried women, age 18-29, none of whom have had children, all of whom have had sex, and none of whom are trying to get pregnant. Among the women who were surveyed: Even though more than eight in 10 say they would be upset if they got pregnant, nearly half (48%) say it is at least a little bit likely they will have unprotected sex in the next year; one in five say it is very likely. More than half (58%) admit to not using contraception all the time. of women surveyed have used some method of contraception in their lives Readers should note that those who participated in the survey represent a specific slice of the millennial universe to be sure. As noted previously, the responses presented here are entirely from unmarried women who do not have children, who do have sex, and who don t want to get pregnant right now. By comparison, among all American women age 18-29, only 33% fit this description. iii Not surprisingly, this specific profile is more likely to describe those in the younger part of the age bracket. Among all year-old women in the United States, 44% fit the description of our survey respondent. On the older end of the spectrum women age only 19% do. For this reason, younger women are given particular focus in this report. One in three (30%) have used emergency contraception (also known as the morning after pill). One in four (24%) have let a partner talk them out of using contraception. More than eight in 10 (82%) of those who have had a pregnancy scare say that experience made them more careful about using protection and more than half (54%) say it made them switch to a more reliable method of birth control. And yet 78% say they are totally satisfied with their current method of contraception. 1

3 Pregnancy Intention vs. Behavior ALL OF THE WOMEN IN THIS SURVEY every last one of them say they do not want to get pregnant at this time in their lives. In fact, more than eight in 10 (82%) say they d be upset if they found out today that they were pregnant. More than half 56% say they d be very upset. Among those age 18-22, two out of three (65%) would be very upset. Yet despite their stated intention to avoid pregnancy, fully one in five (20%) admit it is very likely they will have unprotected sex in the next year; nearly half say it is at least a little bit likely. Three out of four (74%) say they ve had unprotected sex in the past and nearly six in 10 (58%) have done so in the past couple of years. Many of those age (44%) and 56% of those age say they are often nervous they are pregnant and relieved when they learn that they are not. In addition, about one in three (30%) have used emergency contraception, making it the third most commonly used form of birth control after condoms and the pill. More than women say they would be upset if they got pregnant, yet: have had unprotected sex in the past say it is likely they will have unprotected sex in the next year admit to not using contraception all the time 2

4 Contraception: What Single Young Women Use NEARLY EVERYONE IN THIS GROUP (99%) HAS ALREADY USED SOME METHOD OF CONTRACEPTION TO PREVENT PREGNANCY at some point in her life. More than nine out of 10 (92%) have used condoms and three out of four (74%) have used the pill. Half (50%) say the pill is their preferred method of birth control and one-third (32%) say that condoms are. Less than one in 10 have used other hormonal methods of birth control such as the shot (8%), the ring (8%), or the patch (6%). Even fewer have used the most effective forms of birth control just 5% have tried the IUD and 2% the implant. It is worth noting that the majority of those who have tried these long-acting, effective, and reversible methods say they are their favorites. Condom use is widespread among young single women. Nearly six in 10 (56%) of those age and 62% of those age say that condoms are the method they ve used most recently. However, this doesn t necessarily mean condoms are the only method they re using nearly the same number of respondents overall say they used the pill most recently (53%), and 15% cited other methods as well. Put another way, an appreciable proportion of young women are using condoms and some other method of contraception (not surprising given the important role condoms play in preventing sexually transmitted infections or STIs). of women surveyed have used emergency contraception The majority of those who have tried IUDs and implants say they are their favorite methods of contraception 3

5 Contraceptive Concerns ALTHOUGH ORAL CONTRACEPTIVES ARE POPULAR MORE THAN HALF HAVE RECENTLY USED THE PILL many have concerns about side effects. Among the women surveyed again, every one of them actively seeking to avoid pregnancy right now fully one-third (33%) are uneasy about what taking the pill might mean for their fertility in the future. One in four (26%) are scared by the medical warnings they see in TV commercials, and 17% say they re uncomfortable taking birth control pills because doing so is unnatural. Proper use of the pill also presents challenges. One in four (25%) women in the survey say that having to take something every day doesn t work for me, and 38% say that when they discuss birth control with friends, forgetting to take the pill is one of the things they talk about. One in 10 (11%) say the fact that they sometimes forget to take their pill is the most common topic of birth control conversation among friends. Still, nearly half of respondents (47%) say that a method being easy to use is one of the most important factors in their contraceptive selection process, and the pill is by far their most preferred method. 1 in4 respondents say they are scared by the medical warnings about birth control pills that they see in TV commercials 1 in 4 respondents say taking something every day doesn t work for me 4

6 Contraception: How Single Young Women Choose EVEN THOUGH THE MOST EFFECTIVE CONTRACEPTIVE METHODS and those least prone to error like the IUD, implants, etc. are not the most popular, efficacy is paramount to the women surveyed. More than three out of four (77%) say one of the most important factors in choosing a method is how effective it is. Affordability is also key nearly half (49%) cited cost as an important variable in deciding what method to use. In addition, nearly half (47%) consider ease of use one of the most important factors. More than one-quarter (27%) of the women surveyed say they rely on a health care provider s suggestion when deciding what method of birth control to use. It is also the case that some women say their doctor experience is less than ideal, including 36% of those who say talking to their health care provider about contraception is usually uncomfortable. One in four women surveyed (25%) say they choose a method primarily because it s easy to get, and one-third (32%) say where and how to get it is something they talk about with friends. More than half (54%) of respondents say they have had a pregnancy scare. Of those, more than eight in 10 (82%) say that experience made them more careful about using protection. More than half (54%) of those who have had a pregnancy scare say it made them switch to a more reliable method of birth control. We do not know from this survey whether that means that a pregnancy scare caused women to go from using nothing some of the time to using something most of the time, or whether it provided the impetus for moving from a less effective method to a more effective one. Even so, the large proportion of women who take action and move toward a better method of contraception, or begin using a particular method more consistently and carefully after a pregnancy scare, is notable. of respondents say they have had a pregnancy scare of respondents who have had a pregnancy scare say it made them switch to a more reliable method of birth control 77% of respondents say effectiveness is the most important factor when choosing a method of contraception 5

7 Sex Without Protection: Why? SOME OF THE REASONS WOMEN SAY THEY ARE HAVING UNPROTECTED SEX seem to stem from in the moment decision making (or non-decision making, depending on your perspective), including: One-third say they just weren t thinking (32%) or they didn t plan on having sex so they weren t prepared (30%) to use birth control. One in five (20%) say they were drunk or high at the time. Nearly half (44%) say they ve trusted a partner to pull out. Nearly four in 10 (39%) say that sex just feels better without protection. One in four (24%) say they ve let a partner talk them out of using protection. One in five (20%) say they ve had unprotected sex because their partner didn t want to use anything. About one in 10 (13%) say that not using condoms was a way for us to show that our relationship was more serious. There are also reasons why women choose not to use a particular method of contraception, which obviously often leads to unprotected sex. Chief among these reasons is a fear of side effects. One in four (25%) women say that fear of long-term side effects is a key reason for their decision not to use a particular method. One in five (19%) are afraid of more immediate possible side effects like weight gain. Potential side effects like weight gain and mood swings also dominate conversations about birth control between friends. More than half (54%) say they talk about side effects with their friends, and one in four (23%) say that s what they talk about most. Affordability is also a key concern, especially for women without health insurance. Among uninsured women in the survey, half (50%) say cost has kept them from using a more effective yet more expensive method. When respondents were provided with a list of 15 possible reasons for why they had decided not to use or to discontinue using a certain method, more women (regardless of insurance status) selected too expensive (26%) than any other answer option. When they discuss birth control with their friends, 43% of the single young women surveyed say cost is one of the things they talk about. of respondents have trusted a partner to pull out of respondents have let a partner talk them out of using contraception of respondents say they have had unprotected sex because their partner didn t want to use anything 6

8 Contraception: What Young Women Want DESPITE THEIR CONCERNS ABOUT AFFORDABILITY AND DAILY COMPLIANCE, and even though a majority of women in the survey say they have experienced pregnancy scares (and nearly as many are often nervous about the possibility of being pregnant), more than three-quarters (78%) of those surveyed say they are totally satisfied with their current method of contraception. Whether that s a reflection of simple acceptance or something else entirely is unknown. What is known is that there are more effective contraceptive methods than the ones most commonly used by the young women we surveyed in particular, there are a variety of methods that don t require a daily obligation or a game-time decision every time one has sex. LARCs (long-acting reversible contraceptives) like the IUD and the implant, are increasingly available and are becoming more affordable, too. They require little maintenance once they re in place and are the most effective methods of contraception available, in part because they practically eliminate the chance of imperfect use. LARCs need to be inserted by a medical professional; some other forms of contraception require a prescription. Consequently, there s a real opportunity for more proactive input from the medical community about the factors most important to women, such as efficacy and ease of use. One-third (33%) of the women we surveyed say a method being a healthy option is important to them. Who better to tell them about the safety and health benefits than their doctor or other qualified medical professional? As it is, one-third (35%) of women in our survey say they wish their doctor was more helpful in finding the right birth control for me. Women in the survey also say they want to hear more positive talk about birth control in general. Nearly seven in 10 (68%) say they wish the TV shows and movies they liked portrayed contraceptive use as a normal part of sexual relationships and encounters. More than half (52%) say they wish celebrities and other high-profile people talked more openly about contraception. In fact, nearly half (46%) of respondents overall say they themselves would be more comfortable using contraception if more people talked about it in a positive way. Among the 18- to 22-year-olds in this study those newest to the whole enterprise of contraception and whose habits and ideas are most rapidly developing 55% feel this way. of respondents wish celebrities and other high profile people talked more openly about contraception 68% of respondents say they wish the TV shows/movies they like portrayed using contraception as a normal part of sexual relationships 7

9 Conclusion, Insights, and Recommendations The good news is that contraception is not an entirely foreign concept to single young women, though use of the most modern and effective methods is not as extensive as one might hope. And despite a wide range of emotional and practical obstacles, almost everyone uses some kind of protection at least some of the time. While young women have very real complaints and worries about birth control, they also have generally positive feelings about using it. An overwhelming majority (84%) of the women we surveyed say that using contraception makes them feel responsible because it s part of being an adult. Six in 10 respondents (60%) say using contraception makes them feel grateful and glad because they can enjoy sex without getting pregnant. But their feelings and their behavior don t exactly match. Certainly, the say one thing, do another strategy can pertain to a range of issues at any age. However, the stakes are quite high when pregnancy is involved. Young women in particular who themselves say they are not ready for pregnancy and parenthood could benefit greatly from a birth control upgrade. Assuaging without dismissing their fears about hormonal methods and introducing them to easier, more effective methods could lead to better contraceptive experiences for many and reduce unplanned pregnancy among those who say they aren t yet ready to become parents. WHAT CAN BE DONE TO HELP YOUNG WOMEN MAKE BETTER CONTRACEPTIVE CHOICES AND DELAY THE PREGNANCIES THEY SAY THEY AREN T READY TO HAVE? Get clear about what not trying to get pregnant really means. It s more than using contraception sometimes or even most of the time. It means using it correctly every time or better yet, switching to a long-acting, reversible method that doesn t require women to do anything at all until they actively want to get pregnant. Educate young women and dispel myths that keep them from using birth control methods that would better meet their needs. Young women are using contraception, but barriers large and small often trip them up. These barriers are real and shouldn t be trivialized, but most can be overcome. Health care providers have a real opportunity to educate young women, introduce them to new methods, and support them as they keep trying different types of birth control until they find the one that best suits them. Doctors and nurse practitioners are already a trusted source for this information and are well positioned to set the tone for open, informative conversations. Getting lost in the moment happens, and there are methods that let you do that without risking pregnancy. Let s help young women learn about and get more comfortable with using long-acting, effective contraceptives so that giving in to the moment doesn t mean giving up on birth control. 8

10 CONTRACEPTION CALLING DATA SUMMARY Demographics/Qualifying Criteria Male - Female Single Married Net Net Net Yes Yes No - Yes - No No - White African American Hispanic or Latino Asian or Pacific Islander Native American or Alaskan Native Other race Yes - No 9

11 Protected/Unprotected Sex Boyfriend(s) Friend(s) you hook up with Ex-boyfriend(s) Every single time Most times About half the time Random guy(s) Rarely Other Never I haven t had sex in the past year I haven t had sex in the past year Yes No Very likely Somewhat likely A little bit likely Total Who Have Ever Had Unprotected Sex n=752 Not at all likely I trusted my partner to pull out Sex feels better without protection I just wasn t thinking I didn t plan on having sex so I wasn t prepared My partner did not want to use protection I was drunk or high I thought it was a safe time of the month Not using condoms was a way for us to show that our relationship was more serious I don t like how the hormones in birth control make me feel I didn t bring it up with my partner because I didn t want to ruin the mood I hadn t gotten pregnant before, so I assumed I wouldn t that time either I wasn t in a relationship at the time so I wasn t on birth control I wouldn t have minded getting pregnant at the time I couldn t afford contraception Going to a doctor or clinic to get birth control is a pain I was embarrassed to discuss protection with my partner I was too embarrassed to buy protection I was too embarrassed to talk to my doctor about birth control I didn t want to seem promiscuous by bringing protection I don t think protection is really all that effective anyway I was trying to get pregnant at the time None of these 10

12 Pregnancy 14 Have you ever had a pregnancy scare? Yes No Have you ever had an unplanned pregnancy? 15 Yes No 16 A B C D E If you found out today that you were pregnant, how would you feel? Please select one response. Very upset A little bit upset A little pleased Very pleased 17 How much do you agree or disagree with each of the following statements? Please select one response per statement. I am often nervous that I am pregnant and relieved when I get my period ( ) It is likely that I ll have an unplanned pregnancy while I m single (Total who have never had an unplanned pregnancy n=928) It doesn t matter whether you use contraception or not, when it is your time to get pregnant, it will happen ( ) My pregnancy scare made me more careful about using protection when I have sex (Total who have ever had a pregnancy scare n=547) My pregnancy scare made me switch to a more reliable method of birth control (Total who have ever had a pregnancy scare n=547) Strongly agree Somewhat agree Somewhat disagree Strongly disagree 11

13 Contraception Which method of contraception have you EVER used? Please select all that apply. Condoms Birth control pill Emergency contraception/morning after pill Depo-Provera shot NuvaRing Spermicide The patch IUD (intrauterine device) Female condom Implant Diaphragm Cervical Cap Sponge - I have never used any of these 19 Which method of contraception is your FAVORITE one to use? Please select one response. Birth control pill Condoms IUD (intrauterine device) Depo-Provera shot NuvaRing The patch Implant Emergency contraception/morning after pill Total Who Have Used Any Contraception Method n=1002 Sponge - Spermicide - Diaphragm - Cervical Cap - Female condom - None of these Condoms Which method(s) are you currently using or have you used most recently? Please select all that apply. Birth control pill IUD (intrauterine device) NuvaRing Depo-Provera shot Spermicide Emergency contraception/morning after pill The patch Implant Which, if any, of the following are most important to you when choosing a method of contraception? Please select no more than THREE responses. It s effective It s affordable Easy to use I think it s a healthy option for me My doctor/health care provider suggested it Easy to get I ve heard/read good things about it My partner suggested it My friends like it/use it None of these Total Who Have Used Any Contraception Method n=1002 Sponge - Diaphragm - Cervical Cap - Female condom - None of these 21 12

14 22 What are the MAIN REASONS you have decided NOT to use a certain method of contraception, or to discontinue using a method? Even if all of these reasons apply, please only pick the most important ones. Please select no more than TWO responses. Too expensive I m afraid of long-term side effects I m afraid of weight gain I had a bad reaction to it I m afraid of putting hormones in my body Hard to use correctly My friend had a negative experience with it Hard to get My doctor/health care provider suggested I stop using it Embarrassing to purchase I m afraid of mood swings My partner discouraged me from using it I don t trust pharmaceutical companies I had a pregnancy scare/got pregnant while using it None of these 23 When you and your friends have talked about contraception or birth control, what do you talk about? Please select all that apply. Side effects like weight gain and mood swings How effective it is What we like about it What we dislike about it How much it costs How we sometimes forget to take it Where and how to get it Whether it s safe to take hormones every day The political controversy about it How ineffective it is Whether birth control causes cancer How confusing it is My friends and I never talk about birth control 24 What do you and your friends talk about MOST? Please select ONE response only. Total Who Discuss Contraception or Birth Control with Friends n=883 Side effects like weight gain and mood swings How effective it is What we like about it How we sometimes forget to take it What we dislike about it How much it costs Whether it s safe to take hormones every day Where and how to get it The political controversy about it How ineffective it is How confusing it is Whether birth control causes cancer None of these 25 The main reasons I use contraception are: Please select no more than TWO responses I m not ready to be pregnant I m waiting until I get married to have kids I can relax more during sex when I m not worried about getting pregnant It would disappoint my parents too much if I got pregnant right now Medical reasons not related to pregnancy prevention I m not in a serious relationship The guy I m having sex with is not the guy I want to have kids with My partner expects me to None of these 26 Which of the following makes you feel uneasy about taking birth control pills? Please select all that apply. I m afraid it will mess with my fertility in the long run The medical warnings in the commercials scare me Having to take a pill every day doesn t work for me It s unnatural I ve had a bad experience with the pill It s unhealthy I just don t trust that it works My friends have had bad experiences with the pill I have reservations based on religious or moral concerns None of these make me feel uneasy 13

15 27 A B C D E F G H I J K L M N O P How much do you agree or disagree with each of the following statements? Please select one response per statement. I am totally satisfied with my current method of contraception Talking to my doctor/health care provider about contraception is usually uncomfortable Talking to my partner about contraception is usually uncomfortable I wish my doctor/health care provider was more helpful in finding the right kind of birth control for me I wish my partner was more interested in/supportive of what kind of protection we use I m not really sure where to go for the kind of birth control information I want I wish the TV shows and movies I liked portrayed using contraception as a normal part of sexual relationships and encounters I wish celebrities and other high-profile people talked more openly about contraception Most of what I hear/read/see in the news or media about birth control is negative Birth control should not be a political issue Cost has kept me from using a more effective, but more expensive method of contraception Cost has prohibited me from using any kind of contraception Drug companies probably don t care if a method of contraception is safe, they just want people to use it so they can make money When I hear people on the news criticizing birth control and the people who use it, it makes me less likely to use it I have let a partner talk me out of using protection I d feel more comfortable using contraception if more people talked about it in a positive way Strongly agree Strongly agree Somewhat agree Somewhat agree Somewhat disagree Somewhat disagree Strongly disagree Strongly disagree Not applicable Not applicable Which of the following words would you use to describe how you feel about using birth control? Please check all that apply. Responsible: It s part of being an adult Grateful: I m glad I can enjoy sex without getting pregnant Annoyed: The whole topic is a pain Burdened: I wish my partner cared more about it None of these A B C D E 30 Are these tasks easier or harder than using birth control consistently? Please select one response per statement. Doing my taxes is Going to the gym is Bathing suit shopping is Finding the right bra is Staying on top of my finances is EASIER than using birth control consistently HARDER than using birth control consistently Which is more embarrassing...? Please select one response. Buying condoms Talking to a new sex partner about protection 14

16 Demographics Continued 31 Northeast Midwest South West 32 What is your zip code at home? Which best describes the community in which you live? A large or medium-sized city The suburb of a large or medium-sized city A small town or rural area 33 What is the highest level of education you ve completed? Less than high school diploma High school diploma or GED Some college Two-year college degree Four-year college degree Advanced degree 34 Yes No Do you currently have health insurance? Notes and Methodology Note: Contraception, protection, and birth control are all terms used to describe something that prevents pregnancy. Some people equate birth control with the pill, think that protection means condoms, or that other methods (the ring, the shot, the patch, IUDs, etc.) are called contraceptives. However, for the sake of clarity and for the purposes of this survey it was made clear to respondents that we used those terms interchangeably. It was also made clear that withdrawal, or the pull out method, did not count as a method of birth control. So throughout this report contraception = birth control = protection, and unprotected sex = having sex without any of them, regardless of withdrawal. TRU conducted 1,011 online interviews among females age 18-29, yielding a margin of error of +/- 3.1% percentage points. Interviews were conducted March 5-17, 2013 and were collected using quotas to ensure even distribution by age and strong ethnic representation. 20% of respondents identified themselves as African-American and 18% identified themselves as Hispanic. References i Kaye, K., Suellentrop, K., and Sloup, C. (2009). The Fog Zone: How Misperceptions, Magical Thinking, and Ambivalence Put Young Adults at Risk for Unplanned Pregnancy. Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy. ii The National Campaign to Prevent Teen and Unplanned Pregnancy. iii Jones, J. Mosher, W., & Daniels, K. (October 2012). Current Contraceptive Use in the United States, , and Changes in Patterns of Use Since National Health Statistics Reports (60). Washington, DC: National Center for Health Statistics. Retrieved from (October 2012). Briefly: Unplanned Pregnancy Among Unmarried Young Women. Washington, DC: Author. Retrieved from 15