Although research suggests that young people are more likely to have unprotected sex than adults, their reasons for doing so are not well-understood. Among a sample of young people accessing no-cost contraceptive services, we explored their reported reasons for having unprotected sex and their willingness to have unprotected sex in the future.
Most young people (69%) had recently engaged in unprotected sex and 41% were willing to in the future. The most common reported reasons for having unprotected sex included not planning to have sex, a preference for unprotected sex, and difficulty using contraception. Worrying about contraceptive side effects and a preference for unprotected sex were significantly associated with a willingness to have unprotected sex in the future . Age group was not associated with most reasons for having unprotected sex.
Person-centered care should give attention to the range of reasons that may influence young people’s sexual and contraceptive decision-making.
A limited body of evidence suggests that unprotected sex is common, even among those not desiring pregnancy. A national survey of people seeking family planning services found that nearly one-half (46%) of those not desiring pregnancy had recently engaged in unprotected sex, mostly owing to personal preference, ambivalence toward pregnancy, and barriers to accessing contraceptive methods.
This same study also found that youth under age 25 were more likely than their older counterparts to have recently engaged in unprotected sex . Similarly, a national survey of people seeking abortion found that young people ages 19 and under were more likely, compared with those in their 20s or 30s, to intend to have unprotected sex in the future.
Adolescents and young adults experience many structural barriers to accessing reproductive health care services, including confidentiality concerns, limited options for transportation to a clinic, and cost of services that impact their contraceptive use and decision-making. Youth may also be influenced by personal preferences, pregnancy desires, concerns or experiences with contraceptive side effects, and relationship status .
However, experiencing these barriers to care does not account for all the reasons young people who do not desire pregnancy may have sex without contraception.