Barriers To Contraceptive Use Among Adolescents
Social Factors:
For the many women who feel it is their role to remain chaste with little knowledge about sex and contraception, it is not surprising that they do not feel comfortable carrying, purchasing, or owning contraceptive pills and condoms. The perception of sex as an unforseen romance makes it acceptable for women to not plan for sexual intercourse and not be prepared with contraception, although men clearly view contraception as a woman’s responsibility [4].
Many women will feign ignorance of contraception in order to preserve their reputations of sexual inexperience, although it is possible these women are also quite limited in their knowledge if they live in this type of social environment [4].
While pregnancy can be very stigmatizing and completely unacceptable in the social context of some families, it might be an opportunity to make money or escape a parental home in other environments [4].
Access:
Many Canadians do not have good access to family planning clinics and do not know where to go to seek out contraception. While the hope is that many family doctors are asking their adolescent patients about sexual activity and counselling them on contraception, it is not unusual for adolescents to engage in sexual intercourse without appropriate contraception.
Now that Plan B is available behind the counter at pharmacies across Canada, there is hope that adolescents have better access to emergency contraception, although it is possible that adolescents feel uncomfortable asking a pharmacist for emergency contraception. A recent randomized control trial found that women who receive advance provision of emergency contraception are more likely to use it, and use it within 24 hours, than those with pharmacy access or clinic access [5].
The pregnancy rates of 15-19 year olds has steadily declined from the 1970’s to the 1990’s, but there is still a relatively high number of unintended pregnancies and abortions being performed in Canada relative to other developed countries in the world [9]. This suggests a lack of appropriate use of contraceptives for the prevention of pregnancy in Canada, and many of the teenagers having babies are choosing to bring up their child as a single parent which comes with its own set of challenges [9].
When discussing contraception and sexual activity with patients, it is also important for physicians to ask about sexual orientation. In one study, 49% of gay youth said that a physician had never discussed sex or sexual health with them but 66% thought it was important that their doctor know their sexual orientation [13]. Of the physicians in this study who were aware of their patient’s sexual orientation, in only 21% of these situations had the physician raised the topic. Females were more likely to say they did not know how to raise the topic with their doctors. To make disclosure more comfortable, 64% thought their doctor should just ask [13].
To learn more about LGBT (Lesbian/Gay/Bisexual/Transgendered) issues, please visit the Sex and Sexuality Module
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4. Marston, C, & King, E. Factors that shape young people’s sexual behaviour: a systematic review. Lancet. 2006: 368; 1581-1586
5. Rocca, C.H., Schwarz, E.B., Stewart, F.H., Darney, P.D., Raine, T.R., Harper, C.C. Beyond access: Acceptability, use and nonuse of emergency contraception among young women. American Journal of Obstetrics and Gynaecology. 2007: 196; 29e1-29e6.
9. Maticka-Tyndale, E., Barrett, M., Mackey, A. Adolescent sexual and reproductive health in Canada: A review of national data sources and their limitations. The Canadian Journal of Human Sexuality. 2000: 9(1); 41-65.
13. Meckler, G.D., Elliott, M.N., Kanouse, D.E., Beals, K.P., Schuster, M.A. Nondisclosure of sexual orientation to a physician among a sample of gay, lesbian, and bisexual youth. Arch Pediatr Adolesc Med. 2006: 160; 1248-1254.
