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Why Aren’t Teens Using More Effective Birth Control?

Sex Stories

By Kait Scalisi, MPH

Earlier this year, the CDC released a new report addressing the lack of long acting reversible contraceptives (LARCs) use by teens (15-19 years old). While teen birth rates are at a historic low, increased use of LARCs would reduce this number even more. Unfortunately, healthcare providers serving teens aren’t always prepared to offer this option.

The CDC brief uses data from the Title X Family Planning Annual Reports compiled between 2005-2013. It offers a lot of good news: Teens are waiting to have sex; they’re reporting more birth control use; and the rate of LARC use has increased 6% over the years studied. Even with this increase, LARC use among teens remains low (about 7% nationally) and there are nearly 300,000 children born to teens each year.

The benefits of using LARCs are plentiful—no remembering to take or change anything, a less than 1% chance of pregnancy, and coverage lasting three to ten years. Unfortunately, so are the barriers, especially for federally-funded clinics like those represented in this report. Three major barriers include:

  • high upfront costs for supplies.
  • providers’ lack of awareness about the safety and effectiveness of LARC for teens.
  • providers’ lack of training on insertion and removal.

These factors inform the recommendations provided in the report. Specifically, providers should:

  • recognize LARCs as safe and effective birth control choices for teens.
  • offer a variety of birth control options to teens, including LARCs.
  • create the infrastructure to support LARCs, such as seeking training on insertion and removal, having supplies available, and exploring funding options to cover cost.

Beyond these barriers, some of the variation in teen LARC use is geographic. Traditionally, “blue” states, such as those in the Northeast and on the West Coast, have above-average rates while “red” states hover at or below average. That being said, there were a few surprises including Iowa, Oklahoma, and Texas. This variation may have to do with the states’ sex education and birth control access policies. It would also be interesting to compare abortion laws and LARC use to see if there is a connection between the two. My hunch is that one exists.

A major limitation of this report is that it only covers teens getting healthcare at a Title X clinic. This means the data is not totally nationally representative; however, it does cover populations that typically have higher rates of unplanned pregnancy. While we need truly nationally representative data, it also is important to ensure there is information about the most at-risk populations. This enables public health policy, education, and communication campaigns to be better tailored and ultimately more effective.

LARCs alone cannot bring the teen pregnancy rate down to zero. For some teens, they won’t be a good fit, either due to the cost or personal preferences related to contraception (e.g., some people don’t like having something in them). Additionally, the larger societal factors which influence teen pregnancy cannot be solved simply through contraception. However, LARCs are an important part of the larger strategy. The recommendations in this report are the next best step towards making them more universal.

Other Sexual Health News

The Evidence on VA.’s Abortion Clinics (Washington Post)

New York Teens FINALLY Get Schooled On Condom Use (Refinery 29)

Oregon Legislature Votes to Expand Access to Birth Control (Fox News) A similar bill also was unveiled in Congress. (USA Today)

Big Study Finds Autism Risk Higher If Teen Mom Or Parental Age Gap (WBUR)

Apple Inc. Updated Health App Will Monitor Sexual Activity (ValueWalk)

The Search for the Best Estimate of the Transgender Population (New York Times)

Existing Same-Sex Marriage Licenses in Ark. Ruled Legal (THV11)

Upcoming Conferences

Center for Research and Education on Gender and Sexuality(CREGS) 2015 Summer School, June 19-26

RSOL National Conference, June 25-28

International Conference on HIV Treatment and Prevention Adherence

Texas Prevention Summit, Jun 29- Jul 1

Becoming a Sexually Permissive Society

Sex Stories

By Kait Scalisi, MPH

Over the last 50 years attitudes towards sexuality have shifted dramatically. A recent study published in the Archives of Sexual Behavior probes the questions of how and why these shifts occurred.

The study uses data from the General Social Survey, a nationally representative survey of over 33,000 American adults. In short, attitudes towards sex have become more flexible. As the study’s authors summarize:

Between the 1970s and the 2010s, American adults became more accepting of premarital sex, adolescent sex, and same-sex sexual activity, but less accepting of extramarital sex.

Most of the shifts in attitudes and behaviors were small but statistically significant.

On the one hand, this feels disheartening because we often need a critical mass of people in order for there to be true societal-level changes. For example, acceptance of adolescent sex remains rather low. This undoubtedly impacts individuals’ attitudes towards comprehensive sex education and, in turn, rates of unplanned pregnancies and STIs. The lack of larger acceptance of this topic may partially explain why Congress recently and quietly sneakily increased funding for abstinence-only sex education.

On the other hand, these shifts offer hope because we already can see some of their impacts. For example, acceptance of sex between adults of the same sex shot up starting in 1993. A few weeks back, we learned that acceptance of same-sex marriage is at its highest rate ever. Though not the same exact measures, they’re related. I certainly wish progress happened more quickly but it is heartening to reflect on the effects of slow and steady change.

Extramarital sex is still a big no-no.

Acceptance of extramarital sex also remained low. In fact, unlike the small increase in acceptance of adolescent sex, this topic saw a small decrease. This is interesting given the recent focus on “monogamish” a term coined by Dan Savage and recently featured in a Tedx Talk by Jessica Reilly as well as the rise of hook-up apps (while marketed towards single people, individuals in relationships likely use them as well).

Our sexual behaviors have also changed.

Adults in the 2000s have had more sexual partners (since age 18) than in past years. They also are more likely to have sex with someone who is not their partner, such as a casual date, hook-up buddy, or acquaintance.

Age, generation, and time period matter.

For all of these factors, there were variations by age, generation, and time period. Generation explains the bulk of this variation. As the researchers noted:

The generational trend was somewhat curvilinear, with the largest difference between those born in the 1900s and Boomers born in the 1940s and 1950s, a slight decline between the 1950s-born Boomers and 1960s-born GenX’ers, and a rise in acceptance between GenX’ers born in the 1960s and Millennials born in the 1980s–1990s

Age also played a role as, generally speaking, older individuals had slightly but significantly less accepting views on all topics. New York Magazine featured an infographic highlighting the significant differences in the last 20 years, showing that even Millennials attitudes and behaviors have shifted.

Gender, race, education level, US region, and religiosity also matter.

Acceptance and behaviors also varied by individual variables. Generally speaking, people are more accepting if they are male, white, from a traditionally blue state, have a college degree, and did not attend religious services regularly. Interestingly, shifts in attitudes and behavior nearly absent for black Americans.

Ultimately, however, these individual characteristics were moderated by generation:

“…generations born later in the twentieth century (compared to those born earlier) held significantly more permissive attitudes toward non-marital sex and had sex with a greater number of partners.”


The authors explored some additional factors that may have influenced this overall change in views and behaviors. They conclude that four societal factors likely played a role. These include:

  • rising cultural individualism
  • rejection of social norms
  • shifting norms around marriage
  • changes in relationship and dating patterns towards sexual relations

Taken together, this research shows us that views on sex are becoming increasingly permissive with the exception of cheating. Many factors come into play from individual to societal to generational differences. The breadth of influences reminds us that we must educate on multiple levels. Each also offers and opportunity to create future impact on sexual attitudes and behaviors.

Other Sexual Health News This Week

Why Caitlyn Jenner’s Transgender Experience is Far From the Norm (CNN)

Bullied Teens Often Become Depressed Adults (MedPage Today)

Groups Wait for SCOTUS Ruling on Same-Sex Marriage (Fox 6)

Permanent Contraception Pushed by Gates Foundation (Baptist Press News)

Minnesota Sex Education Teacher Takes Students to Adult Store (Fox News)

Oregon Women Could Skip Doctor’s Visit for Birth Control (ABC News)

Upcoming Conferences

Center for Research and Education on Gender and Sexuality(CREGS) 2015 Summer School, June 19-26

RSOL National Conference, June 25-28

International Conference on HIV Treatment and Prevention Adherence

Texas Prevention Summit, Jun 29- Jul 1