Condom Pregnancy Rates Among High School Students

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The most reliable way to prevent pregnancy is to use a condom every time. Condoms also reduce the risk of sexually transmitted diseases (STDs) and HIV infection.

Results from the 2019 YRBS show that among students who reported having sexual contact with someone of opposite sex, use of highly or moderately effective contraceptive methods was rare. These methods include reversible IUD and implant; shot, patch, or ring; and birth control pills.

Prevalence of Condom Use at Last Sexual Intercourse

Using questions added to the YRBS, students were asked about condom use at their last sexual interaction. As a result, the analytic sample included only students who reported having sexual contact with someone of opposite sex (n = 2,698). Among these sexually active students, 89.7% used a condom with their primary contraceptive method at the last sexual encounter, and approximately half of those used a highly or moderately effective pregnancy prevention method. Condoms were most commonly used, followed by birth control pills and then withdrawal or other method.

Respondents were also asked about their number of partners and their perception of the risk of contracting STD/HIV from each partner at the time of their last sexual interaction. As expected, the more partners that one had and the higher perceived risk of contracting an STD/HIV from a partner, the less likely one was to report condom use with a highly or moderately effective pregnancy prevention measure.

It is important to note that these findings are based on self-reports, which can be subject to social desirability bias and may not accurately reflect reality. Nevertheless, they underscore the importance of meeting adolescents’ needs for both pregnancy and HIV prevention. Consistent and correct use of a condom is the most effective way to prevent unintended pregnancy and the transmission of STIs/HIV.

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Prevalence of Condom Use with a Primary Contraceptive Method

Preventing unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus/acquired immune deficiency syndrome (HIV) infection, is a critical public health goal. The current report provides nationally representative estimates of condom use and other methods for pregnancy and STD/HIV prevention among sexually active U.S. high school students based on data from the 2019 Youth Risk Behavior Survey (YRBS).

Overall, 11% of sexually active high school students reported using a primary contraceptive method other than male condoms with their most recent sex partner. These results are consistent with those from previous YRBS reports and reflect the importance of promoting and supporting use of highly effective, reversible contraceptive methods for pregnancy and HIV prevention among adolescents.

Although a small percentage of adolescents use only a condom as their primary method for pregnancy and STD/HIV prevention, most use a combination of methods: female condoms with spermicidal cream or gel or oral contraceptive pills, or female condoms with an injectable or implant. However, the proportion of adolescents who used a combination of methods is still low and needs to be increased.

This YRBS supplement presents notable differences in condom and other method use patterns by demographic characteristics and sexual risk behaviors that warrant further study and implementation of targeted interventions. For example, racial/ethnic differences indicate that black and Hispanic students have lower prevalence of any condom use at last sexual intercourse than white students and are less likely to report using highly effective reversible contraceptive methods such as intrauterine devices (IUDs and implants) or birth control pills.

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Prevalence of Condom Use with a Secondary Contraceptive Method

Condoms are a highly effective pregnancy prevention method when used consistently and correctly. Despite their effectiveness, however, a significant proportion of sexually active adolescents do not use condoms in combination with another form of contraception (5). Inconsistent condom use leaves women vulnerable to unintended pregnancy and STIs, including HIV.

This study, based on the 2019 Youth Risk Behavior Survey (YRBS), examined the prevalence of any condom use at last sexual intercourse among adolescents aged 14–19 years. This data was combined with responses to a distinct item on primary pregnancy prevention methods to estimate prevalence estimates for the following dichotomies: condoms and no other primary method; highly or moderately effective contraceptive methods only; no primary method at all; withdrawal or other method only; or IUD/implant/shot, patch, or ring only.

Overall, only 23% of adolescent girls reported using any type of contraceptive method at last sexual intercourse. The most common primary methods were birth control pills (34.3%), male condoms (24.9%), and vaginal diaphragms (13.6%). Notably, the prevalence of any primary method was much lower among black and Hispanic students than white students. Given documented racial/ethnic disparities in birth and STD rates, meeting the needs of these groups through targeted, culturally appropriate education is vital.

Almost half of the female participants who reported any condom use in the YRBS used them with a secondary form of contraception, with most combining them with oral contraceptives (i.e., a combination of condoms and the pill). Most women who used male condoms with a secondary form of contraception also reported being very satisfied with their use of condoms (58%, 188/325).

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Prevalence of Condom Use with a Third Contraceptive Method

Using a third contraceptive method is a key preventive measure to reduce unintended pregnancy and sexually transmitted infections (STDs), including HIV. However, not all students report using a third method with condom use. The likelihood of using a third method varies by demographic characteristics, and may reflect the presence of enabling factors that facilitate use of these methods.

In this study, student gender was a significant predictor of condom use with a secondary method; female students were more likely to report using a shot, patch, or ring or birth control pills in addition to condoms than male students. This finding is consistent with other studies that find that girls are more likely than boys to report using a secondary method with condoms (8).

These findings also indicate that students with higher socioeconomic status are more likely to use a third method of pregnancy prevention in addition to a condom, and that these students are more comfortable with using these methods. This suggests that more needs to be done to improve younger adolescents’ knowledge of, comfort with, and access to the most effective methods of pregnancy and STD/HIV prevention.

It is important to remember that although condoms have an effectiveness rate of 87%, this number only reflects typical use; in reality, the majority of pregnancies result from errors such as couples forgetting to use a condom or a condom breaking or tearing. Therefore, promoting the use of highly effective reversible methods such as IUDs and implants, and less effective methods such as condoms, diaphragms, and spermicides is critical for the prevention of both unintended pregnancy and sexually transmitted diseases, including HIV (5).

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