Median body mass index was 26. Fifty-one percent were smokers, 19% were binge drinkers, 11% had hypertension, and 5% had diabetes. Ninety-four (62%) of the respondents had at least 1 previous pregnancy (average of 2 live births), and 39% of them had used a home pregnancy test kit to diagnose their last pregnancy.
Reasons for unprotected intercourse
Of the 84 women who reported having unprotected intercourse in the past year, 1 woman selected all 42 of the reasons on the survey, with a single exception (“I don’t know where to get birth control/contraception”). On average, the women selected 9 reasons each. The most common reasons for having unprotected intercourse appear in the TABLE.
Lack of concern. Seventy-three women (87%) cited at least 1 of the following reasons: “just not thinking about birth control,” “not planning to have sex,” getting caught up in the “heat of the moment,” or “just went with the flow.” We categorized these reasons as lack of thought/preparation.6
Beliefs about relationship. Fifty-nine women (70%) cited relationship-related reasons: their partner would “be there” for them if they did get pregnant, or they were “in a long-term relationship and it was too much of a hassle to keep using birth control/condoms.”
Unacceptable side effects. Sixty-seven women (80%) cited method-related side effects, including weight gain, discomfort with condoms, and reduced pleasure. Of note, the most commonly cited reason was that condoms gave the woman discomfort.
Categories not mutually exclusive. These 3 categories—lack of thought/preparation, relationship-related reasons, and side effects—overlapped significantly, with 72 women (86%) choosing more than 1 of these categories, and 44 (52%) choosing all 3. Eighty-three of the 84 women (99%) chose at least 1 of these categories.
As stated, 55 women (65%) believed their partner would “be there” for them, and 43 of these had a previous pregnancy. Of the 43, 58% said their partner actually “was there” for them during the last pregnancy. The remainder had not had partner support during the last pregnancy, but believed their current partner would support them in the event of a future pregnancy.
Additional volunteered reasons. Beyond the reasons given in the TABLE, 23% said they forgot to take their pill, and 20% said they would not really mind that much if they got pregnant.
Between 10% and 18% of women cited each of the following reasons: judgment clouded by alcohol or drugs, thinking they could always get an abortion if they conceived, not wanting to ask their partner to use a condom, being scared of needles, being worried about vaginal bleeding, having a medical condition (smoking, obesity, etc.) that limited their choice of contraception, having a partner who objected to her using contraception, or feeling that contraception was unnatural.
Less than 10% of women cited the following reasons: problems with transportation to get to clinic, insurance that did not cover contraception or a preferred method of contraception, not liking the clinic or clinic personnel, inability to understand explanations by clinic personnel, cost, forced sex, a preference for rhythm method, feeling that a method was messy, family/friends being against her using contraception, religious objections, being embarrassed to buy contraception, or being unsure how to use contraception.
Few age or race differences. There was little difference in response between races, with the exception of being uncomfortable asking a partner to use condoms, which was noted by 23% of blacks and 2% of whites (P=.006). There were no significant differences by age.
Among the women who had unprotected intercourse, 79 (94%) had used some form of birth control at least once during the past year. Of these, 90% had used condoms, 34% had taken the Pill, 22% had used medroxyprogesterone acetate injectable suspension (Depo Provera), and 20% had used the norelgestromin/ethinyl estradiol transdermal system (Ortho Evra/“the patch”). Eighteen percent had used emergency contraception in the past year.
TABLE
Reasons women most commonly cited for unprotected intercourse
| REASON | PERCENT (N=84) |
|---|---|
| “Heat of the moment”/“just went with the flow” | 70% |
| Partner would “be there” if pregnancy occurred | 65% |
| Not planning to have sex | 54% |
| Not thinking about using birth control at the time | 52% |
| Condoms are uncomfortable for woman | 49% |
| Weight gain with hormonal methods | 43% |
| Partner does not like condoms | 43% |
| Ran out of birth control method | 37% |
| In a long-term relationship and it was too much of a hassle to keep using contraception | 37% |
| Thought pregnancy was unlikely to occur | 36% |
| Contraception reduces pleasure | 36% |
| Forgot to use birth control method | 32% |
| Prefer to use withdrawal | 30% |
Discussion
The most common reasons for having unprotected intercourse reflected lack of thought/preparation, relationship issues, and concerns about side effects. Most women expressed reasons from more than 1 of these categories, suggesting they are interrelated.7