Sex education and contraceptive use of adolescent and young adult females in the United States: an analysis of the National Survey of Family Growth 2011-2017

Abstract

Objectives: The effects of the comprehensiveness of sex education on sexual health measures have not been well-studied. We compared trends in comprehensive sex education and its relation to contraceptive use at first intercourse and current contraceptive use for women ages 15-24 in the United States between 2011 and 2017.

Study design: Analyses included females ages 15-24 from the 2011-2017 National Survey of Family Growth. We defined comprehensive sex education as including 6 topics queried in the NSFG (how to say no to sex, birth control methods, where to get birth control, how to use condoms, sexually transmitted infections, HIV/AIDS), and non-comprehensive sex education as including less than 6 topics. Multivariable regression models investigated associations with contraceptive indicators.

Results: Among 5445 respondents, percentages of women receiving comprehensive sex education in 2011-2013, 2013-2015, and 2015-2017 were 35%, 40%, and 34%. Across all periods, respondents reporting comprehensive sex education before first sex were less likely to report first sexual intercourse before age 15 (aOR 0.55; 95% CI: 0.40-0.74) and non-volitional first intercourse (aOR 0.42, 95% CI: 0.26-0.72) compared to those with non-comprehensive sex education. At first intercourse, those with comprehensive sex education were more likely to have used any (aOR = 1.63; 95% CI: 1.18-2.25) and very effective (aOR = 1.35; 95% CI: 1.04-1.75) contraception. Comprehensive sex education was unrelated to current contraceptive use (aOR = 0.87; 95% CI: 0.63-1.21).

Conclusions: Comprehensive sex education was associated with increased odds of contraceptive use at first intercourse, but not current contraceptive use.

Implications: Programs that promote comprehensive sex education may have a positive impact on preventive behaviors at sexual debut.

Keywords: Adolescent; Coitarche; Contraception; National Survey of Family Growth; Sexual education.

Fig. 1

Percentage of women ages 15–24 in the United States who had first sexual intercourse before age 15, who reported non volitional first intercourse, who reported contraceptive use at first sex and who reported current use of contraception according to number of key sexual education topics learned* *The six key topics include: How to say no to sex, methods of birth control, where to get birth control, how to use a condom, sexually transmitted infections, and HIV/AIDS. Age at sexual debut, non-volitional first sex, and contraceptive use at first sex measures are based on key topics learned prior to first sex. **Non-volitional first sex and contraceptive use at first sex assessed among women who reported ever having had vaginal intercourse. ***Current contraceptive use evaluated among women in need of contraception at the time of the survey (sexually active in last 3 months, not pregnant or trying to conceive, not sterile or in the 2 months postpartum period).