By Melinda Young
A new study using self-reported data from the national Youth Risk Behavior Survey found that overall use of reliable contraceptives by sexually active U.S. female high school students was low, especially for Black, Hispanic, and Asian female students.1 Researchers also found that male students were less likely to report contraception use.1
“There’s a male-female gap, but also a race-ethnicity gap,” says Nancy Pontes, PhD, RN, FNP-BC, FAAN, an associate professor at Rutgers University School of Nursing, Camden Campus, Camden, NJ. “Being able to better target and having cultural competence is important,” she says. “We should have curiosity to listen to moms and dads and adolescents and find the best alternative for them.”
Sixty-one percent of male students reported using condoms at last sexual encounter compared to 52% of female students, suggesting neither group reported a high level of condom use, despite condoms being one of the best ways to protect people from developing a sexually transmitted infection (STI).1
“We were surprised that females were less likely to report condom use than were males,” says Jamille Nagtalon-Ramos, EdD, WHNP-BC, FAANP, an assistant professor at Rutgers University School of Nursing, Camden Campus. “I was expecting females to say they were using condoms more often [than] — or at least equal to — males,” she adds. “We were thinking, perhaps, that males were overreporting their use of condoms versus female students’ reporting.”
The overall picture of low condom use among young people is concerning. “Regardless of what kind of contraception they use, a condom should be included in that age group,” Pontes notes.
“The other thing we found was 25% of males and females said they had no reliable use of contraception,” she adds. “What that means is they either didn’t use contraception, or they used a withdrawal method, or would say they could not remember. The withdrawal method is not reliable.”
One of the benefits of the national survey data on students was that by using these data over a period of years, from 2015 to 2019, researchers were able to capture meaningful information on the contraceptive use among small ethnic groups, including Asian Americans. The use of oral contraception and long-acting reversible contraception (LARC) among Asian American females was as low — 23% — as it was for Black females, Nagtalon-Ramos notes.
By contrast, 43% of white females reported use of oral contraceptive pills or LARC, she adds. “There is this overall assumption of the model minority and that all Asians are doing well, so we don’t have to look at [their contraception use],” she says.
But this does this population a disservice, especially when studies like this one show that there is a problem of low contraception use among sexually active Asian female students. “Having data that proves Asian high school students are not using reliable contraception compared to white counterparts is very powerful,” Nagtalon-Ramos says.
Cultural taboos may play a role in why contraceptive use is so low in this population. “The focus of my research is Filipino women, talking to participants, and there’s a stigma of having a discussion within families about sex and reproductive health,” Nagtalon-Ramos says. “In the Philippines, 89% of people are Catholic, and because of colonialism, it’s embedded in our culture.”
It is apparent that sexual and reproductive health are not discussed in the home of this population, she says. “It’s avoided, and any discussion about sex is avoided because the thought is that talking about sex means a green light to have sex,” Nagtalon-Ramos explains. “So, the common thing Filipino mothers will say is, ‘Just don’t do it.’”
Investigators also found that Black females were much less likely than white females to use oral contraceptives, LARC, and other contraceptives, including the Depo shot, the patch, and cervical ring, Pontes says. “About 10% would use the pill compared with almost 30% of white females,” Pontes says. “And, if you looked at the pill or LARC-plus [the shot, patch, ring], only 23% of Black females used these, compared to 43% of white females, who used a reliable form of contraception.” Unintended pregnancy rates among Black and Latina women were double the rates of white women.1
About 29% of high school students reported having sex with at least one partner in the three months before the survey, and among those who reported being sexually active, 13.8% said that they did not use any contraceptives at their last sexual intercourse, and neither did their partner.1 “Overall, the use of contraception and pregnancy prevention is really quite low,” Fontes says. Although unintended pregnancies declined among adolescents from 1991 to 2021, there remain disparities in who is more likely to have an unintended pregnancy, with Hispanic and Black females still having the highest rates.2
One of the paper’s findings was that Hispanic females were more likely than white females to report condom use only.1 “What is interesting is they also have a very high percentage that use no reliable contraception,” Pontes says. “That’s the weak spot. Compared to white females, it was also quite noticeable.”
Having the teens’ data broken down into demographic groups was an eye-opener for Nagtalon-Ramos. “It makes me want to pause to make sure the education I provide my patients is culturally informed and comprehensive,” she says. “I’m offering the whole gamut [of contraceptives] to my patients, and the first thing my patients will ask is for a pill — especially for adolescents. That’s what their friends are using.”
Patients often lack knowledge about other options, such as LARC, even when this option could be one that makes pregnancy prevention easy to use. There is nothing they must remember to do each day or week or month, and it could be protection against pregnancy through their high school and college years, Nagtalon-Ramos explains.
Providers can tell patients that there are other reasons they might want to use a contraceptive; there are benefits for menstrual relief and controlling acne, she adds. “This makes it a little more palatable and acceptable, if they can give other reasons for it besides, ‘I want an implant because I’m having sex,’” Nagtalon-Ramos explains. “They can say, my periods are really irregular, and I would like to use the pill to make them more regular.”
Clinicians also can educate adolescents’ parents about the reality of teen sex and unintended pregnancies, Pontes notes. “There’s the whole not-my-child scenario,” Pontes says. “It’s helpful if you can help patients understand the distress a young woman or her partner might have if she has an unplanned pregnancy.”
Providers can talk about the trauma adolescents could experience if they had to make decisions about their pregnancy and what to do when they give birth. From a mental health perspective, pregnancy prevention can help young people with their mental health. “As someone who worked in school health, we have to think about having this really culturally grounded sort of way of addressing schools, according to the communities that they’re in and the cultural makeup of that school and include that in culturally informed education with students when we’re providing reproductive health information,” Pontes explains.
“This should be included more into the curricula, and I think school nurses can have a very important part of this,” she adds. “School nurses in New Jersey are certified as health educators, and, so, it’s a beautiful intersection — as a school nurse — to provide education about sexual activity and reproductive health.”
Contraceptive counseling and sexual health education for adolescents need to be done intentionally and include information for parents when appropriate. “It’s one of the starting places of [adolescents’] adult activity and to advocate for themselves and to make decisions,” Pontes says. Reproductive health providers also can talk about a potential benefit of not dating during the high school years.
An interesting finding in some of Pontes’ other research into high school students, contraception, and sexual activity was that teens who did not date were happier and had fewer depressive symptoms and suicidality than those who did. “We have to think about data that shows that delaying your dating, and this is not even a sexual discussion, but delaying it during the developmental period when a lot of change is going on is a viable option we can give students,” Pontes says. “We can tell them that delaying dating and especially delaying sexual activity and not having multiple sexual partners can be a positive thing.”
These findings might be related to how break-ups can be distracting and devastating for young people, and dating could lead to bullying, she explains. “Girls might turn against you when you’re dating, and there is underlying drama that happens during adolescence,” Pontes adds.
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Nagtalon-Ramos J, Saffold TL, Pontes N, Pontes M. Race-ethnicity and sex disparities in the use of pregnancy prevention methods among U.S. high school students. Contraception. 2025; Feb 26:110857. doi: 10.1016/j.contraception.2025.110857. [Online ahead of print].
2. Centers for Disease Control and Prevention. About teen pregnancy. CDC Reproductive Health. May 15, 2024. https://www.cdc.gov/reproductive-health/teen-pregnancy/index.html
A new study using self-reported data from the national Youth Risk Behavior Survey found that overall use of reliable contraceptives by sexually active U.S. female high school students was low.
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