Sexual activity and contraceptive use: the components of the decisionmaking process

Abstract

In light of the social consequences of early childbearing, unplanned pregnancy, and the transmission of AIDS, a great need exists to understand how adolescents make sexual and reproductive decisions. Drawing primarily on literature from sub-Saharan Africa, this article focuses on three behavioral outcomes: nonmarital sexual activity, contraceptive use, and condom use. It explores adolescent's perceptions of the costs and benefits of engaging in these behaviors, their assessment of their susceptibility to the potential consequences of their actions, and the role of family, peer, and dyadic factors in shaping their reproductive decisions. The literature reveals that cultural values regarding sexuality and gender roles, the power dimensions of adolescents' lives, and economic disadvantage exert powerful influences on the decisionmaking process. Decisions to engage in unprotected sex may also be based on insufficient knowledge and distorted judgements of the risks of becoming pregnant and acquiring sexually transmitted infections. Nondecisionmaking is found to be fairly common in some contexts.

PIP: Adolescents appear to make decisions about sexual activity and contraceptive use in an idiosyncratic manner. This paper reviews the research literature on three aspects of this decision-making process: whether or not to engage in premarital intercourse, whether or not to use contraception, and whether or not to use a condom to protect against sexually transmitted diseases (STDs). The conceptual framework utilized in this analysis considers these decisions to be based on a consideration of the costs and benefits of engaging or not engaging in a particular behavior, an assessment of the risks of becoming pregnant or contracting an STD, norms perceived to be held by significant others, a willingness to conform to the wishes of these significant others, and self-efficacy in decision making. The literature indicates that cultural norms regarding sexuality and gender roles, the power dimensions of adolescents' lives, and economic disadvantage exert powerful influences on the decision-making process. In sub-Saharan Africa, where women's access to resources and social opportunity is limited, early marriage and childbearing are likely to be viewed as a means of obtaining necessary resources or as markers of social and personal achievement. In South Africa, the popular view that AIDS is a conspiracy aimed at reducing the African population may lead teenagers to underestimate their vulnerability to HIV infection. Socialization patterns often prepare young women to accept male domination in sexual encounters. Greater attention is needed in the research literature to the structural barriers to pregnancy and STD prevention, including providers' attitudes toward adolescent sexuality, service location, and lack of privacy.