Male adolescents and contraception

Jorge Peláez Mendoza, M.D.^I , Orlando Rodríguez Pons, M.D.^II,
Raúl Bermúdez Sánchez, M.D.^III

ABSTRACT: Authors carried out this study to determine the level of knowledge and sexual responsibility in male adolescents in relation to the use of contraception. A survey was developed for this purpose, which was applied anonymously and voluntarily among 400 junior-high and high-school male adolescent students in April 1996. The youngest in the sample were 13 years old; and the oldest 18; and the mean was 16 years of age. A high percentage demonstrated some knowledge of contraceptive methods (82%), although only 8% used any form of contraception in their first sexual experience and 26% say they currently use contraception, indicating that knowledge does not correspond with use of contraceptive methods in male adolescents. The peer group was the main source of knowledge about contraceptive methods, and the method best known was the condom. The main reason given for not using condoms was reduced sensation perceived during intercourse. We also found "machista" or sexist attitudes influenced sexual responsibility among these young men, since 61% did not acknowledge their responsibility for contraception and furthermore believed themselves well within their rights in demanding  unsafe (unprotected) sexual relations from their partners. 

Subject headings: CONTRACEPTION/use; SEXUAL BEHAVIOR; SEX                 EDUCATION; EPIDEMIOLOGIC SURVEYS.

The need for love is felt by all human beings, part of the individual's quest to overcome isolation.  Transcending this need for existential union is a more specific biological necessity: the desire for union between males and females.

From birth, children need affection and physical contact, but it is at puberty and especially in adolescence, that their heterosexual feelings have a more profound impact on their emotional life. Adolescents are generally biologically capable of procreation, but they are not psychologically, socially, or emotionally mature enough to assume the reproductive process.  Thus, they frequently begin early sexual activity in casual relationships, not based on love, in which they habitually change partners. This in turn means that these young people develop risky sexual conduct--leading either to unwanted pregnancy and/or to sexually-transmitted diseases (STDs). These characteristics underscore the importance of contraception at this age.

Studies show that only 23% of pregnancies among teenage women are wanted pregnancies¹; over 50% of unwanted pregnancies take place during the six months after first intercourse^2,3; and only one couple out of five ever use contraceptive methods.⁴

Until recently, contraception at any age, and particularly in adolescence, has generally been viewed as the woman's problem, and there are few articles that discuss the issue from the viewpoint of men's responsibility.⁵ Studies reviewed indicate that some 45% of male adolescents consider contraception to be a woman's responsibility.⁶  This led us to undertake the research at hand, aimed at assessing male adolescents' degree of  knowledge and responsibility concerning contraception.

Methods

Sexual behavior, knowledge and use of contraceptives in male adolescents were studied, including an anonymous and self-administered questionnaire concerning sexuality, sexual behavior, contraception and sex education in young men.

The survey was applied to groups of students of both sexes in junior high school, senior high school and polytechnical institutes, in April 1996.  The groups were randomly selected, in each case with prior consent from teachers and students; and the questionnaire was given to all groups at the same time.  Three teams were involved in the administration of the questionnaire, each headed by a  specialist in pediatric-adolescent gynecology.

The total sample included 800 young people, half of whom were male.  Items were chosen related to sexual behavior, knowledge and the use of contraceptives, resulting in the statistical analysis reflected in the charts below. Students were included from 13 to 18 years of age, and the mean age was 16.

Results

Three hundred twenty seven male adolescents (82%) of the four hundred that were polled said they had some knowledge of contraceptive methods; the most common sources of information about these methods were the peer group or friends (283), parents (227) and partners (125).
 

Concerning the right to demand sexual relations from partners, 213 male adolescents (53%) consider they always have this right; 111 (28%) that they have the right only occasionally; and 76 (19%) consider they have no right to demand  sexual relations from their partners.

Discussion

Some opinions question contraception education among teenagers, alleging that numerous family planning centers have a negative impact on the level of sexual activity among adolescents.^7-11

The fact is that with or without these services, the tendency towards precocious sexual relations, pregnancy in adolescence and the alarming increase in the incidence of sexually-transmitted diseases (STDs) in this age group, are commonplace and universal realities.^{12, 13}

Furthermore, there is no evidence of a negative impact of the use and knowledge of contraception in adolescence¹⁴; on the contrary, most professionals agree on the advantages and importance of contraception education in adolescence.^12-14

As we have already commented in our Results, 82% of the male adolescents said they had some knowledge of CM.  However, analyzing their sources of information, we found that friends (peer group) played the fundamental role. Other authors have confirmed the primary influence of peer groups on sexual behavior and use of CM—specifically in adolescents—over and above the influence of parents¹⁴, although this  could change if  parents were duly educated in such matters.

Schools, medical institutions, the media and others were less influential than peer groups, an important aspect to consider when designing sex education programs.  Other researchers, arriving at similar conclusions, have expressed the same idea.^{12, 13}

In a study of sexual behavior and the use of contraceptives in male adolescents⁵, Finkel and Finkel⁵ reported that more than 90% knew of the contraceptive efficacy of condoms; and we noted, too, that condoms were the most well-known contraceptive method among our male adolescents.  Though this result would seem positive, as we will see later, there is a great gap between knowing about and using CM, especially condoms.  It is clear that, despite the high percentage of male adolescents who knew of the advantages of condoms, only 10% used them regularly.  Another study of male adolescents conducted in Thailand showed that less than 2% of the individuals polled used this contraceptive method regularly.^{13, 15}

The scant use of condoms is a conduct that has been modified since the appearance of Acquired Immune-Deficiency Syndrome (AIDS). However, the World Health Organization (WHO) calculates that the six billion condoms used in the world in 1990 were far less than the thirteen billion needed to protect sexual relations from the risk of STDs or unwanted pregnancies, mainly in adolescent couples.¹³  This world reality is very similar to our own:  234 (59%) of the Cuban adolescents polled engaged in regular sexual activity; but only eight of these (3%) had safe sex with CM in their first intercourse, and only 61 (26%) now use the condom regularly.

Analysis of our data revealed that despite practical knowledge of contraceptive methods and their advantages, most male adolescents do not use them because they perceive a loss of sensation, specifically in the case of condoms.  Many authors have reported this contradiction between knowledge of condoms and their benefits on the one hand, and the lack of use on the other.^{13, 16, 17}

Del Río concluded that "condom use is a method for preventing STDs and unwanted pregnancies,  not for increasing sexual sensitivity, so sensation could never be the same with the condom.  This makes it necessary to learn to feel with the condom on to discard the idea that its use interferes with or cools sexual relations."

Other reasons cited by the young men for not using CM are related to a lack of understanding on their part of male responsibility for contraception, and their opinion that this is mainly a woman's problem.  This view was expressed by 198 of the 234 young men who had initiated sexual relations, concurring with other reports on this issue⁶, which state that some 45% of young men maintain this view, and 64% consider abortion as an alternative solution if an unwanted pregnancy has occurred.

We polled male adolescents' opinions on their responsibility towards contraception,  whether or not they have already initiated sexual activity.  As a result, we found that 247 (61%) understand this to be the woman's responsibility, 99 (25%) think it is the responsibility of both partners, and 56 (14%) consider it the man's responsibility, reflecting the sexist and discriminatory views still prevalent among young men today.

As a third reason for not using CM, the adolescents polled complained of difficulties in their acquisition.  In the future, we can work on this aspect by developing efficient, sufficient and accessible services for adolescents.

Sexist thinking clearly prevails among young men, too, because 213 (53%) of the four hundred that were polled think they have the right to demand sexual relations from their partners, 111 (28%) say they have this right occasionally, and only 76 (19%) do not believe they have this right ever, considering sexual relations a joint decision by both partners, free of pressure and demands from one or the other.  If we link these opinions with those concerning responsibility for contraception, then it becomes clear that  male adolescents begin their sex life from a sexist and prejudiced point of departure.

As this study shows, contraception in adolescence and mainly among male adolescents is complex, and must be accompanied by well-oriented sex education programs.  The best among these help adolescents learn to manage their sexuality and relate to their partners.¹⁸

In conclusion, we can say that a high percentage of male adolescents (82%) say they know about contraceptive methods (CM). Their main source of information was the peer group (friends), followed in order of importance by their parents and partners.  The most familiar contraceptive methods were first the condom; second, intrauterine devices (IUDs); and third, oral contraceptives.  Fifty five percent of the young men had already initiated sexual relations when the survey was taken; only 8 of them (3%) used CM for protection during their first intercourse; and 61 (26%) currently use CM regularly.  This indicates that the degree of knowledge about CM does not correspond with their use.  The main reason male adolescents reject the use of CM is reduced sensation during  intercourse, mainly when using condoms.  Sexist and prejudiced viewpoints prevailed among these young men regarding male responsibility for contraception and sexuality, as demonstrated by the failure to recognize this responsibility and their assumption that they have the right to demand sexual relations from their partners.

References

1. Shah G, Zelnick M, Kantner J. Unprotected intercourse among unmarried teenagers. Fam Plann Perpect 1975: 7:39.

2. Alan Gutmacher Institute: Teenage Pregnancy: The problem that hasn't gone away. New York. The Alan Gutmacher Institute. 1981.

3. American College of Obstetricians and Gynecologists: The adolescent Obstetric-Gynecologist Patient. ACOG, Technical Bulletin No. 45 Sept, 1990.

4. Peláez MJ. Consideraciones del uso de anticonceptivos en la adolescencia. In: Ginecología Infanto/Juvenil: Su importancia, SOCUDEF, La Habana. 1996. p.30-4.

5. Finkel M, Finkel D. Sexual and Contraceptive Knowledge, Attitudes and Behavior of Male Adolescent. Fam Plann Perspect 1975; 7: 256.

6. Yankelovich M, et al. Family Health in an Era of Stress. Minneapolis General Mills Inc. 1979.

7. Hughes ME, Furstenberg FF, Teitler JO. The impact of an increase in family planning services on the teenage population of Philadelphia. Fam Plann Perspect 1995; 27: 60-5.

8. Reichelt PA. Changes in sexual behavior among unmarried teenage women utilizing oral contraception.  J Popul 1978; 1:57-68.

9. Kirby D, Waszak C. School based clinics, in: Miller B, Card JJ, Parkoff RL, Peterson JL, eds. Preventing adolescent pregnancy. Newbury Park, California: Sage, 1994: 185-219.

10. Brewster KL, et al. Social context and adolescent behavior. The impact of community on the transition to sexual activity. Social forces 1993; 71: 713-40.

11. Ruoti AM. Anticoncepción de la adolescencia, In: Planificación Familiar y Salud, EFACIM. Asunción, Paraguay. 1994: 255-62.

12. Blum RW, Resnick MD. Adolescent Sexual Decision Making: Contraception, Pregnancy, Abortion, Motherhood. Ped Ann 11: 10, Oct. 1992.

13. Del Río C, Uribe ZP. Prevención de enfermedades de transmisión sexual y SIDA mediante el uso del condón. Salud Pública México 1993; 35(5).

14. Jaccard J. Adolescent Contraceptive Behavior: The impact of the Provider and the Structure of Clinic-Based Programs. Obstet Gynec. 1996; 88(3).

15. Population Reports: Condones ahora más que nunca. Population Reports. September 1990; Serie H, Número 8.

16. Torres A, Singh S. Contraceptive practice among Hispanic Adolescents. Fam Plann Perspect 1986; 18: 193-4.

17. Moore PJ et al. Adolescents and the Contraceptive Pill: The impact of beliefs on intentions and use. Obstet Gynec 1996; 88(3)

18. Peláez JM. Anticoncepción en la adolescencia: Uso y criterios de selección: In: Adolescencia y Sexualidad. Capítulo 4. Salud Reproductiva. La Habana, Científico/Técnica, 1961.

This article originally appeared in Spanish in the Revista Cubana de Obstetricia y Ginecología , vol.24, no.1, (pp.5-12), January-April, 1998.     

1. Head of the Child and Adolescent Section of the Cuban Society of Obstetrics and Gynecology, Havana.  Assistant Professor, Higher Institute of Medical Sciences of Havana.  Second Degree Specialist in Obstetrics and Gynecology.
    
2.  Secretary for the Child and Adolescent Section of the Cuban Society of Obstetrics and Gynecology, Havana.  Vice-director of the 10 de Octubre Maternity Hospital. First Degree Specialist in Obstetrics and Gynecology.
    
3.  President of the Child and Adolescent Gynecology Provincial Section, Havana.  Assistant Professor of Obstetrics and Gynecology. 10 de Octubre Maternity Hospital. First Degree Specialist in Obstetrics and Gynecology.