Skip to main content
NCBI home page
International Journal of Sexual Health logoLink to International Journal of Sexual Health
. 2021 Apr 24;33(3):268–282. doi: 10.1080/19317611.2021.1908477

Investigating College Women’s Contraceptive Choices and Sexuality

Vimbayi S Chinopfukutwa 1, Elizabeth H Blodgett Salafia 1,✉
PMCID: PMC10929579  PMID: 38595741

Abstract

Objective

This study examined the link between sexuality and contraceptive choices among college women after controlling for their relationship status. Additionally, the relationship between responsibility for contraception and women’s contraceptive choices was investigated. Method: Online self-report surveys of sexuality and contraception were collected from 455 college women in the United States. Results: Women mostly preferred dual-method contraception. Sexual esteem and sexual depression predicted women’s contraceptive choices. Finally, having personal or shared responsibility for contraception predicted women’s contraceptive choices. Conclusion: Our findings suggest that women’s psychological well-being empowers them to make contraceptive choices that allow them to experience sexuality in healthy ways.

Keywords: Emerging adulthood, contraception, sexual attitudes, responsibility

Introduction

Emerging adulthood is a developmental period when individuals begin to take control of their health and establish lifelong health behaviors (Habel et al., 2018). During this period, between 18 and 25 years, individuals explore sexuality and continue to develop their sense of sexual self, as there are many opportunities for sexual activity through dating and sexual relationships (Arnett, 2000; Lemer et al., 2013; Maas & Lefkowitz, 2015). With increased sexual exploration common during this period, college women in the United States who constitute a large proportion of sexually active emerging adults may be at greater risk of contracting Sexually Transmitted Infections (STIs) and unintended pregnancies (Habel et al., 2018). This makes the accessibility of multiple types of contraception essential for emerging adult women’s sexual health. Having contraceptive choices and using contraception can promote positive sexual health outcomes for women. Research highlights that contraceptive use among emerging adult women is linked with their psychological well-being; for example, less consistent condom use is related to feelings of high sexual guilt (Maas & Lefkowitz, 2015; Schick et al., 2008).

Women may engage in sexual behaviors with their partners to increase intimacy and commitment in their relationships (Grello et al., 2006). Hence, commitment in relationships may account for the shared responsibility for contraception among couples in sexual relationships (Huber & Ersek, 2011). Other factors such as the perception of contraception responsibility and the use of gender-specific contraception may also account for contraception responsibility (Brown, 2015; Wigginton et al., 2018). Men in committed relationships tend to assume that their female partners will ensure that they use contraception effectively. Women are also likely to assume the responsibility of female-related contraception such as the birth control pill. Therefore, as women explore sexuality in their relationships, they also consider their responsibility for contraception, which in turn shapes their contraception choices.

However, existing research examining contraceptive use and sexuality either focuses on contraceptive use broadly or condom use only (e.g., Hynie et al., 2006; Maas & Lefkowitz, 2015). Additionally, contraceptive use has been studied somewhat extensively but sexuality and holistic sexual health warrant further investigation. Therefore, it is important to consider sexuality as a broad aspect of sexual health encompassing physical and psychological elements and not sexual behavior alone (Bedree et al., 2020). The current study aimed to examine multiple types of contraception and various components of sexuality; specifically, we examined the link between heterosexual college women’s preferred type of contraception and their positive and negative feelings about sexual experiences and ability, including sexual esteem, preoccupation, and depression (Snell & Papini, 1989). This study also explored how partnerships in using contraception, including having personal, shared or no responsibility for contraception, may contribute to college women’s contraceptive choices. Understanding the factors associated with the contraceptive choices of college women as well as their responsibility for contraception may help promote the sexual well-being of emerging adult women.

College women and contraceptive choices

There is evidence suggesting that women may choose contraceptive methods based on their different attributes. For example, college women in the United States considered it to be very important for contraceptive methods to be effective in the prevention of pregnancy and STIs as well as being hormone-free (Marshall et al., 2016). Women who considered the effectiveness of contraceptive methods against pregnancy to be important were more likely to choose the most effective methods such as intrauterine devices and implants (Steiner et al., 2018). Women who stated that contraceptive methods should be effective at preventing STIs as well as being hormone-free were more likely to rely on condoms alone. In addition, the birth control pill may be preferred by college women because it is accessible (Mosher & Jones, 2012) or because it is cheap or covered by health insurance when compared to other contraceptive methods (Sonfield, 2010).

Furthermore, college women may engage in contraceptive decision-making processes that are influenced by peers based on shared goals, such as effectiveness, convenience, and safety of contraceptive methods (Melo et al., 2015). Research involving women participating in the Contraceptive CHOICE Project in the United States shows that having heard of a positive experience from peers about a specific type of contraceptive method may be associated with increased usage of that specific type of contraceptive method (Madden et al., 2015). For example, having a friend who used the intrauterine device and liked it was strongly associated with increased chances of choosing the same contraceptive method (Schaefer et al., 2012). Although peers may be partially influential in contraceptive method decision-making processes, college women tend to balance the perceived risks and benefits of the birth control methods portrayed by their peers based on their personal needs (Melo et al., 2015).

Finally, social and cultural factors contribute to college women’s perception of contraceptive choices. A recent comparative study among college students in Vietnam and the United States demonstrated that college students in the United States reported higher levels of positive perceptions, knowledge, and awareness of contraceptive health than Vietnamese college students (Kamimura et al., 2020). Although Vietnamese students rely on informal networks for information about contraceptives, discussing sexual health topics with partners or parents is challenging because these issues are of a sensitive nature. In another study with Vietnamese students, Vo (2018) reported their unwillingness to use contraceptives in the future due to fear of health complications or a perceived lack of effectiveness. These findings support Kamimura and colleagues (2020) who state that the gap between Vietnamese knowledge and the use of contraceptives is attributed to the sensitive nature of sexual issues. Our study expands on research on the college setting, which is an important context in population-based family planning since this is where reproductive-aged women enroll for higher education. The college environment is important in increasing contraception-related awareness and fostering positive perceptions through continuous sexual education. Hence, women who understand the effectiveness of various contraceptives make informed choices.

Sexuality and contraceptive choices

Understanding the importance of sexuality for college women’s sexual well-being is essential (Bedree et al., 2020). Sexual well-being is not only related to physical well-being but also involves emotional and mental well-being. For example, a study by Bedree et al. (2020) showed that college women in the United States stated that emotional stress may impact their preparedness in engaging in sexual behaviors. The current study examined sexuality as both positive and negative feelings about sexual experiences and ability, including sexual esteem, sexual preoccupation, and sexual depression (Snell & Papini, 1989). Sexual esteem is defined as an individual’s ability to experience sexuality in a satisfying way and having confidence in one’s prowess as a sexual partner. Sexual preoccupation is when an individual has persistent tendencies to have thoughts about sexual activities. Sexual depression is experienced when an individual feels sad and discouraged about not feeling sexually connected to another individual.

Additionally, research conducted among college women in the United States showed that contraceptive use was associated with psychological well-being, including sexual attitudes (Maas & Lefkowitz, 2015). Such findings suggest that less consistent contraceptive and condom use are related to feelings of sexual guilt, while condom use self-efficacy is related to feelings of sexual safety and sexual pleasure among college women (Hynie et al., 2006; Schick et al., 2008). Further, college women with high sexual esteem were highly motivated to avoid unprotected sexual behavior (Schick et al., 2010; Maas & Lefkowitz, 2015). However, some of the existing research on sexual esteem does not differentiate between the type of contraception used and instead examines contraceptive use broadly; for example, a study by Maas and Lefkowitz (2015) explored the associations between sexual esteem and contraceptive use. Participants in this study did not report any specific forms of contraception but were asked to report the frequency at which they used any form of contraception preventing STIs or pregnancy. Therefore, the current study aimed to examine multiple types of contraception and sexuality to fill this knowledge gap.

Furthermore, studies among women in the United States demonstrate that body image and self-esteem play a role in their contraceptive use. For example, among a sample consisting of mostly young White women, a positive body image was associated with preventive sexual health behavior such as contraceptive use (Ramseyer Winter, 2017). Another study found that a positive body image was linked with a greater frequency of hormonal contraceptive use (Gillen et al., 2006). Ramseyer Winter and Ruhr (2017) also reported that college women with a positive image were more likely to use male condoms and dual methods (male condom and a hormonal contraceptive). Hence, having a positive opinion and respecting one’s body as the contributing factors of positive body image promotes women’s sexual health.

Finally, there is research among college women in the United States suggesting that there is an association between heterosexual women’s psychological aspects of sexual health and their relationship status. For example, a study by Grello et al. (2006) found that women with multiple sex partners reported high depressive symptoms compared to those who did not have multiple sexual partners. Having multiple sexual partners may be socially unacceptable for women and may be perceived as shameful (Tolman, 2002). Another contributing factor of sexual depression discussed previously is body image. Wiederman and Hurst (1998) showed that women rated as less attractive and who were relatively heavier were more likely to be involved in casual dating relationships and had decreased opportunities for heterosexual dating as they avoided social settings when compared to their average weight peers. In contrast, being in a committed romantic relationship is associated with high sexual esteem (Maas & Lefkowitz, 2015). Committed relationships provide opportunities for women to develop their sexual esteem as partners reinforce positive views of one’s sexual self. College women in the current study had different types of relationships, hence we controlled for their relationship status when examining the relationship between sexuality and contraceptive choices.

Responsibility for contraception and contraceptive choices

There is an established link between gender and responsibility for contraception. For example, women are typically considered as the primary contraception users and considered to be responsible for the prevention of pregnancy (Brown, 2015). This may shape the perceptions of contraceptive responsibility among college women (Huber & Ersek, 2011). A study by Huber and Ersek (2011) examining college women’s perceptions about contraceptive responsibility showed that 90% of the women in the study felt that contraceptive responsibility should be shared but only 50% of the participants actually shared contraceptive responsibility with their sexual partners. Another study in England by Brown (2015) examining the role of gender and relationship status in contraceptive responsibility showed that in established relationships, men desired to prevent pregnancy but trusted their female partners to use contraception effectively. This study further suggested that men reported that they were committed to using condoms because they viewed contraception as a shared responsibility. Therefore, the attitudes of contraception for women are potential indicators of their responsibility for contraception. This in turn shows that relationships play a role in women’s contraception choices and practices.

Contraceptive responsibility may also be related to gender-specific contraception (e.g., Granzow, 2007; Wigginton et al., 2018). For example, condom use or withdrawal is associated with men’s contraceptive responsibility (Fennell, 2011; Jones et al., 2009). On the other hand, women’s contraceptive responsibility relates to using women’s contraceptive methods such as the birth control pill (Granzow, 2007). A recent study by Wigginton et al. (2018) examining Australian emerging adult women showed that women who had high personal responsibility were more likely to use long-acting contraception and short-term hormonal contraception. Women who had their sexual partners take responsibility were more likely to be using male condoms. Finally, women who reported joint contraceptive responsibility were more likely to be using dual methods while women who reported that no one took responsibility were likely to be using natural methods or no contraception.

Women’s perceptions of responsibility for contraception may be influenced by gendered sexual scripts (Brown, 2015; Levin, 2010). For example, women may experience stigma for carrying condoms as this behavior may be portrayed as a desire for sexual experiences, which is viewed as socially unacceptable for women (Brown, 2015). Additionally, women are encouraged to please their boyfriends without showing their own sexual desire (Tolman, 2002). Such gendered sexual scripts may contribute to women’s perceptions of responsibility for contraception because they have to ‘control’ their sexual desires and prevent STIs and pregnancies (Brown, 2015; Gubrium & Torres, 2013). Because women are socialized to be partner-oriented through the gendered sexual scripts described above, they are concerned about their partner’s sexual functioning and pleasure (Higgins & Hirsch, 2008). For instance, a woman in a heterosexual relationship may use condoms to protect her partner’s sexual esteem if she is concerned that he may not be able to sustain an erection (Ekstrand et al., 2011). This demonstrates that women’s desire to increase their partner’s sexual pleasure instead of their own may play a significant role when they take the responsibility to make choices on contraception (Higgins & Hirsch, 2008) Clearly, these studies indicate that heterosexual women have a greater responsibility for contraception. Moreover, these studies examined responsibility for contraception and actual contraceptive use (e.g., Ekstrand et al., 2011; Higgins & Hirsch, 2008). Hence, the current study aims to expand existing knowledge by investigating partnership factors and their impact on college women’s contraceptive choices. Specifically, having a personal sense of responsibility, joint responsibility, or no responsibility for contraception may provide insight on college women’s preferred type of contraception. These factors are potential precursors to college women’s engagement in decision-making processes that promote safe sex practices among heterosexual women.

The current study

Although a few studies provide evidence highlighting that sexuality and contraceptive responsibility may be associated with contraceptive choices among college women, there is a need for further investigation on these issues for a comprehensive understanding. As indicated previously, research that examines sexuality and contraception does not adequately provide an overview of specific types of contraception but instead addresses the issue of frequency of contraceptive use (e.g., Maas & Lefkowitz, 2015). Other studies focus on aspects of sexuality as predictors of contraceptive use but do not address how similar aspects of sexuality may be linked with women’s contraceptive choices (e.g., Hynie et al., 2006; Schick et al., 2008). The current study aims to address the limitations in the research highlighted above to provide a comprehensive understanding of women’s sexual well-being. A better understanding of factors associated with college women’s contraceptive choices will help to provide recommendations for services such as comprehensive sexual health programs designed to meet their needs. Additionally, providing insight on different aspects of sexuality and responsibility for contraception in relation to contraceptive choices may also provide justification for reasons why women may decide to choose specific types of contraception. The present study answers the following research questions: First, which method of contraception is preferred most by female college students? Second, does sexuality predict the contraceptive choices among college women? Third, does contraceptive responsibility predict the contraceptive choices among college women?

Method

Participants and procedures

Participants were 455 heterosexual college women at a public university in the Midwest between the ages of 18–25 years (M = 20.68, SD = 1.77). Of the 455 participants, 92% were undergraduate students and 8% were graduate students. Most of the participants identified as White (95%), as is reflective of the student body at this university; 5% included other races/ethnicities such as Latina/Chicano/Hispanic, Asian/Asian American, and other. See Table 1 for additional demographic characteristics of the sample of college women.

Table 1.

Frequency Data for Background Characteristics of College Women.

Variable N %
Race/ethnicity    
White 428 94.1
Asian/Asian American 15 3.3
Latina/Chicano/Hispanic 2 0.4
African American 1 0.2
Biracial/Multiracial 3 0.7
Other (e.g., Russian) 6 1.3
Sexual orientation    
Heterosexual 434 95.4
Bisexual 18 4
Lesbian 2 0.4
Missing 1 0.2
Relationship status    
Single but currently not dating anyone 138 30.3
Single but currently dating 187 41.1
Partnered (e.g. engaged, married, cohabitating) 128 28.2
Missing 2 0.4
Education level    
Undergraduate 418 92
Graduate 36 7.8
Missing 1 0.2
Socioeconomic status (SES)    
Low 32 7
Middle 397 87.3
High 23 5
Missing 3 0.7
Open in a new tab

Participants were part of a larger institutional review board-approved study investigating body image and women’s sexuality during the spring college semester. Interested participants were recruited through email invitations through the university listserv. The research team also sent PowerPoint slides with information on the study via email to instructors in various departments including Human Development and Family Science. These instructors in turn made in-class advertisements of the study to potential participants. Posters and flyers of the study were also used to advertise the study. Participants completed an anonymous online survey with consent forms and were invited to complete a separate form online to be considered for a random prize drawing of one of three $50 gift cards or a flat-screen television.

Measures

Contraceptive choices

An item created for this study was used to examine participants’ self-reported contraceptive choices. Participants checked all options applying to them. The contraceptive choices presented to participants were: condom, vaginal ring (e.g., NuvaRing) birth control pill, morning after pill (e.g., Plan B), shot (e.g., Depo Provera), diaphragm, patch, IUD, other (with a space to specify), or none.

Sexuality

The 30-item Sexuality Scale (SS, Snell & Papini, 1989) was used to generate three dimensions of sexuality: sexual esteem, sexual preoccupation, and sexual depression. These three dimensions of sexuality reflected positive and negative feelings about sexual experiences and ability. Each dimension had 10 items that were summed. Five items in each dimension were reverse-scored to show that higher scores in each dimension corresponded to greater agreement with the statements. Participants responded to items including, “I would rate my sexual skill quite highly,” “I think about sex all the time” and “I feel down about my sex life” on a 1 (disagree) to 5(agree) Likert–type scale. Cronbach’s alphas for sexual esteem, sexual preoccupation, and sexual depression were .89, .78, and .80, respectively. The Sexuality Scale was adapted for this study by recoding each dimension of sexuality to ordinal (low, medium, and high. The following cut-off points were created for each sexuality dimension based on the distribution of the frequency data of our sample of college women on the 5-point Likert-type scale described above; low ≤ 2.4; medium = 2.5–3; and high ≥ 3.1. Please see Table 2 for the frequency data of categories of sexuality dimensions. Hence, the Sexuality Scale was recoded to ordinal for chi-square tests of association and multinomial logistic regression analyses to be performed accurately with the contraceptive choices categories. Construct validity in each of the dimensions has been established in a study by Snell and Papini (1989) with college students where most participants were female. This measure has also demonstrated adequate reliability in previous studies specifically with emerging adult women (Maas & Lefkowitz, 2015; Schick et al., 2008).

Table 2.

Frequency Data for Sexuality Dimensions.

Categories of sexuality dimensions N %
Sexual esteem    
Low 57 12.6
Medium 99 21.8
High 295 64.8
Missing 4 0.8
Sexual preoccupation    
Low 191 42
Medium 135 29.7
High 126 27.6
Missing 3 0.7
Sexual depression    
Low 286 63
Medium 106 23.3
High 60 13
Missing 3 0.7
Open in a new tab

Low = ≤ 2.4; Medium = 2.5–3; and High ≥ 3.1.

Controlling for relationship status

Relationship status was a control variable. This was assessed by asking participants to report their type of relationship with categories ranging from 1= Single but not dating, 2= Single but dating to 3= Partnered (e.g., engaged, married, cohabitating).

Responsibility for contraception

A single item was created for this study to assess participants’ perceptions about their responsibility for contraception. Participants responded to the question “Who is usually responsible for birth control/contraception?” Participants checked a response applying to them such as me, my partner, both my partner and me, or neither my partner nor me.

Data analysis plan

Analyses were conducted using SPSS Version 27. Frequency data were classified into four categories based on the contraceptive choices of college women in the current sample: dual-method contraception (both birth control pills and condoms), no contraception preference, birth control pills, and condoms. These categories were then compared on sexuality and responsibility for contraception variables.

Chi-square tests of independence were used to examine the association between college women’s sexuality (sexual esteem, sexual preoccupation, and sexual depression) and their contraceptive choices categories. Hence, significantly associated factors were used in the multinomial logistic regression models. The dependent variable had four categories based on the contraceptive choices: dual-method contraception, no contraception preference, birth control pills, and condoms. College women’s sexuality (sexual esteem, sexual preoccupation, and sexual depression) were the independent variables while their relationship status served as our control variable. As indicated earlier, each sexuality variable was recoded to ordinal (low, medium, and high) before chi-square tests of independence were performed with the contraceptive choices categories. Additionally, multinomial logistic regression models were tested to find the effect of sexuality on no contraception preference, birth control pill preference, and condom preference when dual-method contraception preference was considered as the reference category with the control variable included. Odds ratios were used to interpret the findings.

A chi-square test of independence was used to examine the association between college women’s responsibility for contraception characteristics (me, my partner, both my partner and me, and neither my partner nor me) and their contraceptive choices categories. If a significant association was evident, a post-hoc test was conducted to determine significant differences indicating the type of responsibility for contraception.

Results

Sexuality and college women’s contraceptive choices

As indicated in Table 3, descriptive statistics showed that 35% of college women preferred the dual-method contraception while 25% had no contraception preference. Additionally, 23% of women preferred birth control pills and 17% preferred condoms.

Table 3.

Frequency Data for College Women’s Contraception Choices.

Category of contraception choices N %
Dual-method contraception 160 35.2
No contraception preference 114 25.1
Birth control pills 103 22.6
Condoms 78 17.1
Open in a new tab

A chi-square test was used for selecting the independent variables for multinomial logistic regression models. Results from this test demonstrated that college women’s sexuality, including sexual esteem χ2 (6, N = 451) 38.3, p < .001 and sexual depression χ2 (6, N = 452) 20.6, p < .001 were significantly associated with their contraceptive choices. Hence, these factors were selected for multinomial logistic regression models. Sexual preoccupation was excluded from the analyses because it was not significantly associated with college women’s contraception choices.

Additionally, a multinomial logistic regression model was performed to examine the relationship between sexuality and college women’s contraceptive choices categories (dual-method contraception, no contraception preference, birth control pills, and condoms). As indicated earlier, the reference category group was college women who preferred dual-method contraception. The .05 criterion of statistical significance was used in all tests. After controlling for the type of relationship, the association between college women’s sexuality and their contraceptive choices categories remained. The addition of sexual esteem improved the fit between the model and the data χ2 (6, N = 449) 54.42, Nagelkerke R2 = .12, p < .001. Furthermore, the addition of sexual depression also improved the model fit χ2 (6, N = 450) 45.92, Nagelkerke R2 = .10, p < .001.

As indicated in Table 4, when comparing categories of birth control pills and the reference category, women with high sexual esteem were more likely to select birth control pills while women with high sexual depression were less likely to select them.

Table 4.

Parameter estimates comparing the dual-method contraception versus the birth control pill categories.

Predictors B SE Birth Control Pill
OR (CI; Lower, Upper)
Sexual esteem .58 .22 1.78 (1.15–2.75)**
Sexual depression −.55 .22 .58 (.38–.88)**
Open in a new tab

OR: odds ratio and CI: confidence interval. **p < .01.

Responsibility for contraception and college women’s contraceptive choices

Descriptive statistics highlighted that 29% of college women reported being personally responsible for contraception while 4% stated that their partners were responsible. Results also indicated that 61% of women perceived a shared responsibility for contraception compared to 6% who stated that neither their partners nor themselves were responsible for contraception.

Chi-square tests of independence were conducted to examine the relationship between college women’s responsibility for contraception characteristics and their contraceptive choices categories. Results indicated that there was a significant relationship between college women’s contraceptive choices and responsibility for contraception, χ2 (9, N = 437) 184.5, p < .001. A post-hoc analysis after the chi-square test using Bonferroni correction from a standard alpha level of .05 was used to determine significant differences. The results in Table 5 showed significant differences for college women such that women indicating no partner had responsibility for contraception had no contraception preference (89%), with very few participants selecting birth control pills (7%) and condoms (4%) and none selecting both birth control pills and condoms.

Table 5.

Chi-square Test and Descriptive Statistics for Responsibility for Contraception and College Women’s Contraception Choices.

Predictors No contraception Preference Birth control pills Condoms Both birth control pills and condoms
Neither my partner nor me 24 (89%)* 2 (7%)* 1 (4%)* 0 (0%)*
Me 35 (27%) 64 (50%)* 6 (5%)* 23 (18%)*
My partner 3 (19%) 0 (0%)* 8 (50%)* 5 (31%)
Both my partner and me 35 (13%)* 37 (14%)* 63 (24%)* 131 (49%)*
Open in a new tab

*p < .05 Results indicate significance level after conducting a post-hoc analysis using Bronferoni correction from a standard alpha level of .05.

Additionally, significant differences were also observed among college women who mentioned that they had personal responsibility for contraception. Fifty percent of the women in this category selected birth control pills while 18% chose the dual-method contraception and 5% selected condoms. Significant differences were also observed among college women who mentioned that their partner was responsible for contraception. None of these women selected birth control pills while 50% selected condoms. Finally, women who had shared responsibility for contraception also demonstrated significant differences. Most women in this group were more likely to select the dual-method contraception (49%) and condoms (24%) while others selected either birth control pills (14%) or no contraception preference (13%).

Discussion

The current study assessed college women’s contraceptive choices and connections with both sexuality and responsibility for contraception. In general, we found that college women preferred the dual-method contraception most. This study controlled for college women’s relationship status as reflected in previous studies indicating that a type of relationship contributes to sexual esteem and sexual depression (e.g., Grello et al., 2006., Maas & Lefkowitz, 2015). After controlling for college women’s relationship status, sexuality, including sexual esteem and sexual depression, predicted college women’s contraceptive choices. Additionally, our results highlighted the role of partnership (e.g., having shared responsibility for contraception) in predicting contraception choices of college women.

College women’s contraceptive choices

The results of the current study suggest that providing women with contraception that meets their needs and preferences is essential (Marshall et al., 2018). Most college women in our study preferred dual-method contraception. These results are consistent with prior research highlighting that the prevalence of dual-method contraception among emerging adult women has increased (e.g., Raidoo et al., 2020). Motivating factors cited in previous studies for dual-method contraception include the need to improve effectiveness of pregnancy and STI prevention (often apparent at the beginning of a relationship), in situations in which they did not trust their partners or in non-monogamous relationships (Harvey et al., 2018; Lemoine et al., 2017). High level of educational attainment also plays a role in college women’s decision-making process when selecting the dual-method contraception (Raidoo et al., 2020). It is possible that the college women in our study were aware that it is necessary to use birth control pills or any non-barrier contraception with condoms to prevent STI risks as well as the importance of STI testing. Hence, continuous sexual education promoting safe sexual practices is needed. Specifically, providing education that reinforces the importance of preventing STI transmission by encouraging communication between sexual partners about dual- method contraception.

Additionally, approximately 25% of college women in our study had no contraception preference. Women may be choosing to engage in natural family planning such as fertility awareness-based methods (Freundl et al., 2010). These methods may have the advantage of a lack of hormones. However, this form of contraception has high failure rates as women cannot engage in spontaneous sexual activity during periods of peak fertility. As a result, unintended pregnancy can hinder college women’s academic goals and delay their graduation (Blunt-Vinti et al., 2018). Hence, college women are an important population in pregnancy prevention.

Women may also select birth control pills because of their specific attributes (Marshall et al., 2016). At least 23% of college women in our study preferred birth control pills. Women may consider the effectiveness of the birth control pills against unintended pregnancy as well as being highly accessible to college women due to low cost (Mosher & Jones, 2012; Sonfield, 2010).

Finally, at least 17% of the college women preferred condoms. Although some studies document the negative effects of condom use among women such as sexual discomfort or pain (e.g., Fennell, 2014; Higgins &Wang, 2015), it is possible that women in our study chose condoms because they are hormone-free and are effective in preventing both unintended pregnancy and STIs (Marshall et al., 2016). Previous studies also showed a decline in condom use among college women, specifically in committed relationships (Lefkowitz et al., 2019). Therefore, our study highlights the importance of exploring college women’s contraception choices based on their attributes, thus allowing them to choose specific types of contraception that will meet their personal values and needs (Wyatt et al., 2014). This is likely to reduce rates of inconsistent and nonuse of contraception while also reducing the rate of intended pregnancies and STIs.

Sexuality and contraceptive choices

The current study considers the contraceptive choices of college women to be an important part of sexual health, which encompasses physical, emotional, and mental well-being (Bedree et al., 2020). Additionally, sexual pleasure experiences, which are linked to sexual rights and sexual health, include consent, privacy, safety, and the ability to negotiate with sexual partners (Gruskin et al., 2019). College women may experience sexual pleasure in contraceptive decision-making processes. The results of our study showed that a positive approach to sexuality predicted college women’s contraceptive choices. Specifically, college women with high levels of sexual esteem were more likely to choose birth control pills when compared to those who preferred dual-method contraception. Previous research suggests that sexual esteem is linked with low levels of sexual risk-taking behaviors, thus favoring the use of contraception (Adler & Hendrick, 1991). Our findings indicate that contraceptive choices facilitate positive aspects of sexuality such as sexual pleasure, sexual rights, and sexual health, which are fundamental to individual health and wellbeing (Ford et al., 2019).

Further women with a more positive sexual self-concept will be more assertive in sexual situations and will insist on using contraception (Maas & Lefkowitz, 2015). Often, studies focusing on contraceptive use and psychological aspects of sexuality in emerging adults fail to differentiate between their specific contraception choices (e.g., Maas & Lefkowitz, 2015). Our study aimed to address this knowledge gap as well as provide reinforcing evidence that sexuality and sexual identity are important aspects in emerging adulthood. College women form perceptions of the sexual self and value to their sexual partners in sexual experiences, thus integrating sexuality and solidifying their self-concept during this developmental period. Therefore, positive sexual self-concepts such as sexual esteem allow college women to experience sexuality in satisfying and healthy ways (Brassard et al., 2015).

Furthermore, the results from the current study showed that women with high sexual depression were less likely to choose birth control pills when compared to women who preferred dual-method contraception. Women experiencing sexual depression have a poor perception of their physical attractiveness, which reduces their sexual contacts (Snell & Papini, 1989). Women with high levels of sexual depression may be reluctant to engage in sexual activity at all, which may be viewed as a sign of neglect, thus affecting intimate relations negatively (Pujos et al., 2010). This may account for their reduced number of sexual partners and low frequency of sexual activity (Amos & McCabe, 2017). In addition, sexual guilt which may contribute to sexual depression is related to the lack of sexual satisfaction (Hynie et al., 2006). Sexual guilt in turn is related to less consistent contraception use. Although women with sexual depression in the current sample demonstrate low sexual risk, our findings provide evidence supporting the fact that there is a need for a respectful and positive approach to sexuality to facilitate the process of making contraception choices.

Responsibility for contraception and contraceptive choices

Research has shown that women may choose contraception either independently or with their partners (Higgins & Smith, 2016). Results of the current study demonstrated that more than half of the college women in the sample (61%) perceived a shared responsibility for contraception by considering their partners to share knowledge and help them in the contraception decision-making process. Some women on the other hand (29%), assumed personal responsibility for contraception and actively engaged in this process independently. Finally, fewer women in the sample reported either their partners’ responsibility (4%) or no responsibility for contraception (6%). This study provides information highlighting the importance of assessing partner roles in the contraception decision-making processes, which tends to predict college women’s actual use of contraception.

The current study demonstrates the importance of sexual empowerment and contraceptive practices (Crissman et al., 2012). Results indicated that women who felt personally responsible for contraception were more likely to choose birth control pills (50%), condoms (5%), and dual-method contraception (18%). This shows that women who are sexually and socially empowered are more likely to use contraception of their choice. More successful use of contraception has been associated with women’s ability to advocate on their own behalf for sexual pleasure; for example, a positive view of sexual health and sexuality was linked with the use of birth control pill in Spain and general contraception use in the United Kingdom among women (Carrasco‐Garrido et al., 2011; Free et al., 2005). It is important to improve women’s sexual perceptions of themselves as it increases their use and freedom to choose a variety of contraceptives.

There is evidence from previous research suggesting that contraceptive choices are related to relationships (Braun, 2013). This is consistent with the results of the current study that showed that 50% of college women who reported that their partners were primarily responsible for contraception were more likely to choose condoms. Women may prefer to use condoms at the beginning of a partnership because of the need to establish trust (Harvey et al., 2018). In the context of heterosexual relationships, women may also choose condoms to protect men’s sexual esteem if they have concerns that their partner may not be able to sustain an erection (Ekstrand et al., 2011). Women may choose a specific type of contraception with the intent to increase their partner’s pleasure instead of their own (Higgins & Hirsch, 2008). Our findings, which are similar to previous research described above, provide reinforcing evidence suggesting that gendered sexual scripts where women are socialized to be partner-oriented continue to constrain contraceptive decision-making processes in the context of heterosexual relationships. Although relationship length was not ascertained in the current study, our results show that relationships play an important role in women’s contraception choices and practices.

Additionally, our results indicated that college women who shared the responsibility for contraception with their partners were more likely to choose dual-method contraception, condoms, birth control pills, and no birth control preferences respectively. Many women may want to use contraception in collaboration and consultation with their partners (Higgins & Smith, 2016). Forty-nine percent of women in this category chose dual-method contraception. Research suggests that sexual partners may prefer the dual-method contraception with new partners, to prevent STIs and unintended pregnancy (Harvey et al., 2018). Having a shared responsibility for contraception between partners provides couples with opportunities to improve their sexual communication skills as they navigate through the process of choosing a specific type of contraception that addresses their needs as a couple. Twenty-four percent of women in this category also chose condoms. Previous research suggests that couples with strong sexual communication skills use condoms often (Norman, 2013).

Furthermore, fewer women who shared the responsibility for contraception with their partners chose birth control pills (14%) and no contraception preference (13%). With 69% of the women in this study reporting that they were single, it is possible that less commitment in a relationship may contribute to less preference for birth control pills or any contraception (Harvey et al., 2018). Both partners are more likely to protect themselves from STI transmission, hence condom use and dual-method contraception increased. Moreover, as commitment increases between sexual partners, trust tends to be a substitute for safe sex behavior for preventing STIs and unintended pregnancies. Health care providers can incorporate issues related to relationship quality and commitment when communicating with emerging adults, including college women on sexual health. Furthermore, our findings are consistent with Harvey et al. (2018)’s study that suggest that there is a need for more interventions targeting STI testing and promoting communication and awareness of sexual risks linked with non-contraception use. Therefore, shared responsibility for contraception and the relationship context provides opportunities to increase positive contraceptive practices.

Finally, college women who had no responsibility for contraception demonstrated differences in the type of contraception they preferred. Eighty-nine percent of the college women in this category had no contraception preference. Since our sample did not discriminate between women engaging in sexual activity and those not engaging in sexual activity, it is possible that some women demonstrate low sexual risk because of low engagement in sexual activity. Our findings also show that few women in this category also chose birth control pills (7%) and condoms (4%), and none chose the dual-method contraception. Financial strain may also contribute to less contraception preferences, specifically the most effective contraception (Lyons et al., 2019). Emerging adult women are vulnerable to the effects of financial strain because this is a developmental period when roles and responsibilities including finances are not adequately defined. Emerging adults may take on new responsibilities to establish their independence, which can be a potential stressor. Hence, college women may experience financial strain because they are still developing financial independence as they rely on family support. Chances of not selecting any contraception, specifically effective contraception also increase in situations when other financial stressors such as housing and food as considered as immediate needs (Mullinathan & Shafir, 2013). Lyons and colleagues (2019) suggest that using screening tools will help health care providers to identify women experiencing financial strain at each medical visit to improve patient-provider communication and services. This may positively affect contraceptive use and awareness of effective contraception among emerging adult women. Therefore, it is important to incorporate financial strain when making decisions related to contraception.

Limitations and future directions

Limitations of this study may be methodological in nature; thus, our findings should be interpreted with caution. All measures for this study were self-reported, and the data was collected at a single time point. Despite the fact that this study was anonymous, there may have been social desirability. It is possible that women may not provide accurate descriptions of their sexuality to avoid feeling shameful about their true feelings because of potential acceptable ‘norms’ surrounding women’s sexual behaviors. Additionally, there may have been selection bias as there is an increased chance that women agreeing to complete the surveys online were women who were open to sharing their viewpoints regarding their sexuality and contraceptive choices.

The sample used for the current study was homogeneous in regard to race/ethnicity. With the majority of the participants identifying as White (95%), racial and ethnic differences could not be ascertained fully. We also limited our sample to heterosexual college women because of a small sample size of college women identifying as lesbian or bisexual. Our sample is based on college women in the United States, hence our findings cannot be generalized to other college women outside of the United States due to cultural differences. Future research should continue to consider more diverse samples as they may share experiences and opinions related to sexuality, partnership, and contraception choices. Longitudinal data with diverse samples will also make research in this area more comprehensive and inclusive.

Strengths and implications

This study makes several contributions to the literature. We considered contraceptive choices to be an important aspect of sexual health for all women, regardless of sexual activity. Moreover, the findings of this study demonstrate that emerging adulthood is a period when women continue to develop their sexual identity whether they are sexually active or not. Incorporating a holistic approach to sexuality provided a deeper understanding of college women’s contraceptive choices. We focused on the psychological aspects such as sexual esteem to reinforce the findings that psychological wellbeing is a significant contributor to emerging adult women’s sense of sexual self.

To strengthen our study, we also considered partnership factors to provide more insight into college women’s contraceptive choices. Our results indicated that women can be empowered to make contraceptive choices, hence allowing them to experience sexuality in healthy ways. A sense of responsibility for contraception allows women to be active agents in the decision-making process. This promotes health education as women gain knowledge on STI and pregnancy prevention before selecting contraceptive methods of their choice. Overall, our study captures a wide range of college women’s experiences related to their sexuality and provides information that could guide health practitioners to assist women to make contraception choices that meet their needs.

Conclusion

Our study provides supporting evidence that demonstrates that sexual esteem and sexual depression are important psychological aspects of sexual health among heterosexual emerging adult women. Most importantly, our findings significantly contribute to research on health and well-being by examining holistic sexual health and contraceptive decision-making processes among college women. Additionally, a sense of responsibility for contraception provides women opportunities to engage in decisions that promote safe sex practices. Moreover, this study clearly demonstrates the need for more research to assess multiple aspects of contraceptive use and sexuality to enhance women’s positive sexual attitudes and experiences.

Conflict of interest

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no conflicts of interest to declare.

Ethical approval

This study was conducted in line with the ethical research guidelines of and approved by the Institutional Review Board at North Dakota State University (#HE09228).

References

  1. Adler, N. L., & Hendrick, S. S. (1991). Relationships between contraceptive behaviour and love attitudes, sex attitudes, and self-esteem. Journal of Counseling & Development, 70(2), 302–308. 10.1002/j.1556-6676.1991.tb01601.x [DOI] [Google Scholar]
  2. Amos, N., & McCabe, M. (2017). The importance of feeling sexually attractive: Can it predict an individual's experience of their sexuality and sexual relationships across gender and sexual orientation? International Journal of Psychology, 52(5), 354–363. 10.1002/ijop.12225 [DOI] [PubMed] [Google Scholar]
  3. Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480. 10.1037/0003-066X.55.5.469 [DOI] [PubMed] [Google Scholar]
  4. Bedree, H., Moller-Mullen, M., Rose, E., & Flanders, C. E. (2020). Sexual well-being among college students: A qualitative study. Sexuality & Culture, 24(1), 140–156. 10.1007/s12119-019-09631-5 [DOI] [Google Scholar]
  5. Blunt-Vinti, H. D., Thompson, E. L., & Griner, S. B. (2018). Contraceptive use effectiveness and pregnancy prevention information preferences among heterosexual and sexual minority college women. Women’s Health Issues, 28(4), 342–349. 10.1016/j.whi.2018.03.005 [DOI] [PubMed] [Google Scholar]
  6. Brassard, A., Dupuy, E., Bergeron, S., & Shaver, P. R. (2015). Attachment insecurities and women's sexual function and satisfaction: The mediating roles of sexual self-esteem, sexual anxiety, and sexual assertiveness. Journal of Sex Research, 52(1), 110–119. 10.1080/00224499.2013.838744 [DOI] [PubMed] [Google Scholar]
  7. Braun, V. (2013). “Proper sex without annoying things”: Anti-condom discourse and the “nature” of (hetero)sex. Sexualities, 16(3–4), 361–382. 10.1177/1363460713479752 [DOI] [Google Scholar]
  8. Brown, S. (2015). ‘They think it’s all up to the girls’: Gender, risk and responsibility for contraception. Culture, Health & Sexuality, 17(3), 312–325. 10.1080/13691058.2014.950983 [DOI] [PubMed] [Google Scholar]
  9. Carrasco‐Garrido, P., De Andrés, A. L., Hernández Barrera, V., Jiménez‐Trujillo, I., Santos‐Sancho, J., & Jiménez‐García, R. (2011). Predictors of contraceptive methods among adolescents and young women residing in Spain. The Journal of Sexual Medicine, 8(9), 2431–2438. 10.1111/j.1743-6109.2011.02346.x [DOI] [PubMed] [Google Scholar]
  10. Crissman, H. P., Adanu, R. M., & Harlow, S. D. (2012). Women’s sexual empowerment and contraceptive use in Ghana. Studies in Family Planning, 43(3), 201–212. 10.1111/j.1728-4465.2012.00318.x [DOI] [PubMed] [Google Scholar]
  11. Ekstrand, M., Tydén, T., & Larsson, M. (2011). Exposing oneself and one’s partner to sexual risk-taking as perceived by young Swedish men who requested a Chlamydia test. The European Journal of Contraception & Reproductive Health Care, 16(2), 100–107. 10.3109/13625187.2010.549253 [DOI] [PubMed] [Google Scholar]
  12. Fennell, J. L. (2011). Men bring condoms, women take pills: Men’s and women’s roles in contraceptive decision making. Gender & Society, 25(4), 496–521. 10.1177/0891243211416113 [DOI] [Google Scholar]
  13. Fennell, J. L. (2014). “And Isn’t that the point?”: Pleasure and contraceptive decisions? Contraception, 89(4), 264–270. 10.1016/j.contraception.2013.11.012 [DOI] [PubMed] [Google Scholar]
  14. Ford, J. V., Corona Vargas, E., Finotelli, I., Jr., Fortenberry, J. D., Kismödi, E., Philpott, A., Rubio-Aurioles, E., & Coleman, E. (2019). Why pleasure matters: Its global relevance for sexual health, sexual rights and wellbeing. International Journal of Sexual Health, 31(3), 217–230. 10.1080/19317611.2019.1654587 [DOI] [Google Scholar]
  15. Free, C., Ogden, J., & Lee, R. (2005). Young women’s contraception use as a contextual and dynamic behaviour: A qualitative study. Psychology & Health, 20(5), 673–690. 10.1080/08870440412331337110 [DOI] [Google Scholar]
  16. Freundl, G., Sivin, I., & Batár, I. (2010). State-of-the-art of non-hormonal methods of contraception: IV. Natural family planning. The European Journal of Contraception & Reproductive Health Care, 15, 113–123. 10.3109/13625180903545302 [DOI] [PubMed] [Google Scholar]
  17. Gillen, M. M., Lefkowitz, E. S., & Shearer, C. L. (2006). Does body image play a role in risky sexual behavior and attitudes? Journal of Youth and Adolescence, 35(2), 230–255. 64-005-9005-6. 10.1007/s109 [DOI] [Google Scholar]
  18. Granzow, K. (2007). De‐constructing ‘choice’: The social imperative and women’s use of the birth control pill. Culture, Health & Sexuality, 9(1), 43–54. 10.1080/13691050600963948 [DOI] [PubMed] [Google Scholar]
  19. Grello, C. M., Welsh, D. P., & Harper, M. S. (2006). No strings attached: The nature of casual sex in college students. Journal of Sex Research, 43(3), 255–267. 10.1080/00224490609552324 [DOI] [PubMed] [Google Scholar]
  20. Gruskin, S., Yadav, V., Castellanos-Usigli, A., Khizanishvili, G., & Kismodi, E. (2019). Sexual health, sexual rights and sexual pleasure: Meaningfully engaging the perfect triangle. Sexual and Reproductive Health Matters, 27(1), 1593787. 10.1080/26410397.2019.1593787 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Gubrium, A. C., & Torres, M. I. (2013). The message is in the bottle: Latino youth communicating double standard ideologies through PhotoVoice. American Journal of Health Education, 44(3), 146–155. 10.1080/19325037.2013.767735 [DOI] [Google Scholar]
  22. Habel, M. A., Coor, A., Beltran, O., Becasen, J., Pearson, W. S., & Dittus, P. (2018). The state of sexual health services at US colleges and universities. Journal of American College Health, 66 (4), 259–268. 10.1080/07448481.2018.1431896 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Harvey, S. M., Oakley, L. P., Washburn, I., & Agnew, C. R. (2018). Contraceptive method choice among young adults: influence of individual and relationship factors. Journal of Sex Research, 55(9), 1106–1115. 10.1080/00224499.2017.1419334 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Higgins, J. A., & Hirsch, J. S. (2008). Pleasure, power, and inequality: Incorporating sexuality into research on contraceptive use. American Journal of Public Health, 98(10), 1803–1813. 10.2105/AJPH.2007.115790 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Higgins, J. A., & Smith, N. K. (2016). The sexual acceptability of contraception: Reviewing the literature and building a new concept. The Journal of Sex Research, 53(4–5), 417–456. 10.1080/00224499.2015.1134425 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Higgins, J. A., & Wang, Y. (2015). The role of young Adults’ Pleasure Attitudes in Shaping Condom Use. American Journal of Public Health, 105(7), 1329–1332. 10.2105/AJPH.2015.302567 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Huber, L. R. B., & Ersek, J. L. (2011). Perceptions of contraceptive responsibility among female college students: An exploratory study. Annals of Epidemiology, 21(3), 197–203. 10.1016/j.annepidem.2010.11.006 [DOI] [PubMed] [Google Scholar]
  28. Hynie, M., MacDonald, T. K., & Marques, S. (2006). Self-conscious emotions and self-regulation in the promotion of condom use. Personality & Social Psychology Bulletin, 32(8), 1072–1084. 10.1177/0146167206288060 [DOI] [PubMed] [Google Scholar]
  29. Jones, R. K., Fennell, J., Higgins, J. A., & Blanchard, K. (2009). Better than nothing or savvy risk-reduction practice? The importance of withdrawal. Contraception, 79(6), 407–410. 10.1016/j.contraception.2008.12.008 [DOI] [PubMed] [Google Scholar]
  30. Lefkowitz, E. S., Vasilenko, S. A., Wesche, R., & Maggs, J. L. (2019). Changes in diverse sexual and contraceptive behaviors across college. Journal of Sex Research, 56(8), 965–976. 10.1080/00224499.2018.1499854 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Lemer, J. L., Blodgett Salafia, E. H., & Benson, K. E. (2013). The relationship between college women’s sexual attitudes and sexual activity: The mediating role of body image. International Journal of Sexual Health, 25(2), 104–114. 10.1080/19317611.2012.722593 [DOI] [Google Scholar]
  32. Lemoine, J., Teal, S. B., Peters, M., & Guiahi, M. (2017). Motivating factors for dual-method contraceptive use among adolescents and young women: a qualitative investigation. Contraception, 96(5), 352–356. 10.1016/j.contraception.2017.06.011 [DOI] [PubMed] [Google Scholar]
  33. Levin, D. S. (2010). Let’s talk about sex education: Exploring youth perspectives, implicit messages, and unexamined implications of sex education in schools [Doctoral dissertation, University of Michigan]. Deep Blue. (2027.42/75809) [Google Scholar]
  34. Lyons, S., Arcara, J., Deardorff, J., & Gomez, A. M. (2019). Financial strain and contraceptive use among women in the United States: Differential effects by age. Women’s Health Issues : official Publication of the Jacobs Institute of Women's Health, 29(2), 153–160. 10.1016/j.whi.2018.12.006 [DOI] [PubMed] [Google Scholar]
  35. Kamimura, A., Trinh, H. N., Hurley, J., Izampuye, E., & Nguyen, H. (2020). Knowledge and perceptions of contraceptive health among college students in Vietnam and the United States. International Journal of Sexual Health, 1–9. 10.1080/19317611.2020.1846655 [DOI] [Google Scholar]
  36. Maas, M. K., & Lefkowitz, E. S. (2015). Sexual esteem in emerging adulthood: Associations with sexual behavior, contraception use, and romantic relationships. The Journal of Sex Research, 52(7), 795–806. 10.1080/00224499.2014.945112 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Madden, T., Secura, G. M., Nease, R. F., Politi, M. C., & Peipert, J. F. (2015). The role of contraceptive attributes in women’s contraceptive decision making. American Journal of Obstetrics and Gynecology, 213(1), 46.e1–46.e6. 10.1016/j.ajog.2015.01.051 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Marshall, C., Guendelman, S., Mauldon, J., & Nuru‐Jeter, A. (2016). Young women’s contraceptive decision making: Do preferences for contraceptive attributes align with method choice? Perspectives on Sexual and Reproductive Health, 48(3), 119–127. 10.1363/48e10116 [DOI] [PubMed] [Google Scholar]
  39. Marshall, C., Kandahari, N., & Raine-Bennett, T. (2018). Exploring young women’s decisional needs for contraceptive method choice: A qualitative study. Contraception, 97(3), 243–248. 10.1016/j.contraception.2017.10.004 [DOI] [PubMed] [Google Scholar]
  40. Melo, J., Peters, M., Teal, S., & Guiahi, M. (2015). Adolescent and young women’s contraceptive decision-making processes: Choosing “The best method for her”. Journal of Pediatric and Adolescent Gynecology, 28(4), 224–228. 10.1016/j.jpag.2014.08.001 [DOI] [PubMed] [Google Scholar]
  41. Mosher, W. D., & Jones, J. (2012). Use of contraception in the United States: 1982–2008. National Center for Health Statistics . Vital and Health Statistics, 23, 1–52. [PubMed] [Google Scholar]
  42. Mullainathan, S., & Shafir, E. (2013). Scarcity: Why having too little means so much. Macmillan. [Google Scholar]
  43. Norman, L. R. (2013). Communication. In Loue S. (Ed.), Mental health practitioner’s guide to HIV/AIDS (pp. 147–149). Springer Science & Business Media. [Google Scholar]
  44. Pujols, Y., Seal, B., & Meston, C. (2010). The association between sexual satisfaction and body image in women. The Journal of Sexual Medicine, 7, 905–916. 10.1111/j.1743-6109.2009.01604.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Raidoo, S., Tschann, M., Elia, J., Kaneshiro, B., & Soon, R. (2020). Dual-method contraception among adolescents and young people: are long-acting reversible contraception users different? A qualitative study. Journal of Pediatric and Adolescent Gynecology, 33(1), 45–52. 10.1016/j.jpag.2019.09.008 [DOI] [PubMed] [Google Scholar]
  46. Ramseyer Winter, V. (2017). Toward a relational understanding of objectification, body image, and preventive sexual health. The Journal of Sex Research, 54(3), 341–350. 10.1080/00224499.2016.1190807 [DOI] [PubMed] [Google Scholar]
  47. Ramseyer Winter, V., & Ruhr, L. R. (2017). Body appreciation and contraceptive use among college women: A brief report. International Journal of Sexual Health, 29(2), 168–172. 10.1080/19317611.2016.1259707 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Schaefer, M., Sheeder, J., & Teal, S. (2012). Predictors of IUD initiation in adolescents. Contraception, 86(3), 319. 10.1016/j.contraception.2012.05.126 [DOI] [Google Scholar]
  49. Schick, V. R., Zucker, A. N., & Bay-Cheng, L. Y. (2008). Safer, better sex through feminism: The role of feminist ideology in women’s sexual well-being. Psychology of Women Quarterly, 32(3), 225–232. 10.1111/j.1471-6402.2008.00431.x [DOI] [Google Scholar]
  50. Schick, V. R., Calabrese, S. K., Rima, B. N., & Zucker, A. N. (2010). Genital appearance dissatisfaction: Implications for women's genital image self-consciousness, sexual esteem, sexual satisfaction, and sexual risk. Psychology of Women Quarterly, 34, 394–404. 10.1111/j.1471-6402.2010.01584.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Snell, W. E., & Papini, D. R. (1989). The sexuality scale: An instrument to measure sexual esteem, sexual depression, and sexual preoccupation. Journal of Sex Research, 26(2), 256–263. 10.1080/00224498909551510 [DOI] [Google Scholar]
  52. Sonfield, A. (2010). Guttmarcher Institute. Contraception: An integral component of preventive care for women. Guttmarcher Policy Review, 13, 1–6. [Google Scholar]
  53. Steiner, R. J., Pazol, K., Swartzendruber, A., Liddon, N., Kramer, M. R., Gaydos, L. M., & Sales, J. M. (2018). Use of long-acting reversible contraception among adolescent and young adult women and receipt of Sexually Transmitted Infection/Human Immunodeficiency Virus-Related Services. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 62 (4), 417–423. 10.1016/j.jadohealth.2017.10.017 [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Tolman, D. L. (2002). Dilemmas of desire: Teenage girls and sexuality. Harvard University Press. [Google Scholar]
  55. Vo, T. Q. (2018). Knowledge, perceptions, and attitudes toward contraceptive medicine among undergraduate students in southern Vietnam. Asian Journal of Pharmaceutics (AJP), 12(01), S90-S98. [Google Scholar]
  56. Wiederman, M. W., & Hurst, S. R. (1998). Body size, physical attractiveness, and body image among young adult women: Relationships to sexual experience and sexual esteem. Journal of Sex Research, 35(3), 272–281. 10.1080/00224499809551943 [DOI] [Google Scholar]
  57. Wigginton, B., Harris, M. L., Loxton, D., & Lucke, J. (2018). Who takes responsibility for contraception, according to young Australian women? Sexual & Reproductive Healthcare: Official Journal of the Swedish Association of Midwives, 15, 2–9. 10.1016/j.srhc.2017.11.001 [DOI] [PubMed] [Google Scholar]
  58. Wyatt, K. D., Anderson, R. T., Creedon, D., Montori, V. M., Bachman, J., Erwin, P., & LeBlanc, A. (2014). Women’s values in contraceptive choice: A systematic review of relevant attributes included in decision aids. BMC Women's Health, 14(1), 28. 10.1186/1472-6874-14-28 [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from International Journal of Sexual Health are provided here courtesy of Taylor & Francis

RESOURCES