A study of Texas high school students’ information on sexual and other risks revealed that 11% of the adolescents surveyed reported experiencing physical or sexual dating violence. Those who reported violence were more likely to report not using contraception.1
“We wanted to see how many adolescents were experiencing violent relationships, and if so, what impact did that have on their contraceptive use,” says Nimisha Srikanth, senior public health major and bachelor’s of science in public health candidate at Texas A&M University. Srikanth conducted research for the study at UT Health Houston.
Investigators analyzed data from 9th- to 12th-graders from 2011, 2013, 2017, and 2019. Student responses were analyzed according to their reported ethnicity, including a broad category of multiple races. Nearly 40% of adolescents identified as multiple-race individuals, and 13% of adolescents identified as Hispanic/Latino. This corresponds with United States Census data, where a larger proportion of the population identifies as multiple races, Srikanth says. Adolescents who identified as Hispanic were 63% more likely than other groups not to use contraception. Overall, some contraception use increased over the decade studied.
“We found that there was an increase in the use of hormonal contraceptives over the decade,” Srikanth notes. “We did see that those who reported dating violence were more likely to not use contraception. If they were using contraceptives, they were using hormonal contraception, condoms, and withdrawal.”
These methods are more reliant on correct usage than LARC. “Adolescents may not be as skilled at using the withdrawal method,” Srikanth adds.
The data on contraception use came from these two questions:
- “The last time you had sexual intercourse, did you or your partner use a condom?”
- “The last time you had sexual intercourse, what one method did you or your partner use to prevent pregnancy?”
Respondents could select from seven options, including no method; no sex; birth control pills; condoms; IUDs; shots, patch, or birth control ring; withdrawal; and “not sure.”
Teen dating violence was measured based on a biannual self-administered questionnaire that asked youths how many times in the last 12 months they were forced to perform sexual acts they did not want and whether they were dating or going out with someone who intentionally hurt them physically. Of adolescents who reported at least one incident of physical dating violence, 35% said they had used a condom at the last intercourse, and that method ranked first in the contraceptive methods they used. Sixteen percent of the youth experiencing dating violence reported using no contraception in 2019. But this had ranged from 28% in 2017 and 20% in 2013. Also, the withdrawal method increased from 9% to 16% of adolescents experiencing physical dating violence. Adolescents who experienced any dating violence were significantly more likely to say they did not use contraception than were those who did not experience dating violence.
Since the surveys were completed before Texas’ total abortion ban went into effect, it is possible future surveys will produce different results. When Roe v. Wade was overturned in June 2022, a pre-Roe trigger law was enacted, banning all abortions and with no exceptions in Texas.1 This was in addition to the restrictive law that allows anyone in the United States to sue anyone who helps a woman obtain an abortion, even if all they did was give her a ride to a clinic.
More research is needed to see how the total abortion ban affects Texas adolescents’ interest and access to contraception, including LARC. “I work at a Texas abortion fund that no longer gives out funds to help youth obtain abortions,” Srikanth says. “I deliver emergency contraception to youth in the Bryant and College Station area.”
There are no Title X family planning clinics within 85 miles of this area, so young people have to travel to Houston if they want birth control. “We see a notable increase in requests for emergency contraception,” Srikanth says.
For high school and college students, a one- to two-hour drive to obtain contraception is not feasible, so the nonprofit provides emergency contraception that can delay or prevent ovulation but does not end a pregnancy.
“Students and youth in general are worried because they don’t feel they have the right to have health autonomy, and they want to stockpile [contraception], and they don’t want to end up with an unplanned pregnancy,” Srikanth explains. “You do see an increase in worries among youth about reproductive health autonomy.”
Srikanth and colleagues also studied sexually transmitted infections (STIs) because of current increases in STI rates and how this is affected by trends in contraceptive use. “STI rates are becoming a major area of focus in adolescent reproductive health,” she adds.
Texas A&M college students have access to condoms, including internal condoms that women can use autonomously. “Internal condoms are not the most popular, and you don’t hear much about them, but we have a large supply of them, and we do give them out when requested,” Srikanth says. “We offer a wide variety of reproductive health products, including emergency contraception, pregnancy tests, and condoms.”
The study results suggest the need for better education for adolescents on sexual and reproductive health as well as increased access to contraception — particularly in areas with no Title X facilities.
“These findings can help inform better health education and more culturally informed messages,” Srikanth says. “We can provide information on how to deal with youth who are in a dangerous relationship.”
In reproductive coercion framework, one partner is in complete control of the other’s reproductive health — either by forcing contraception use or denying its use. It is important for medical providers to be aware and better informed about these situations.
“Young people need to obtain the contraception they want, safely and confidentially, so their violent partner or parents don’t know and so its confidential and safe,” Srikanth says. For instance, reproductive health providers could offer contraception outreach, access, and education at college campuses.
Many young people in Texas would benefit from a Title X facility nearby, or even receiving services from a mobile Title X van visit.
“They could guide young people to make proper decisions and create new programs using medically correct information,” Srikanth suggests. “They could find ways to get them access to the health product they need. This empowers them to access these resources.”
REFERENCE
- Srikanth N, Weerakoon SM, Mathew MS, et al. Relationship between dating violence and contraceptive use among Texas adolescents. J Interpers Violence 2022 Aug 24;8862605221119519.
A study of Texas high school students’ information on sexual and other risks revealed that 11% of the adolescents surveyed reported experiencing physical or sexual dating violence. Those who reported violence were more likely to report not using contraception.
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