Adolescents, Sex, and Contraception,

Adolescents, Sex, and Contraception,
Book by Donn Byrne, William A. Fisher; Lawrence Erlbaum Associates, 1983

Preface

According to numerous surveys, an American female who was born at the time of the first world war was very likely to reach her wedding night without previously experiencing sexual intercourse--slightly more than two out of three had sex for the first time after marriage. Most males of that period did not remain premaritally chaste, thanks in large part to the existence of formal and informal prostitution. For those individuals born just after the second world war, the sexual realm had indeed undergone a revolution. By that point, the odds very much favored premarital intercourse for both males and females. In the most recent research on college campuses, it has been found that the two genders are almost indistinguishable in their sexual histories, and only a small percentage are virginal at graduation. Not only are more adolescents engaging in sexual intercourse at some point prior to marriage, but the average age of puberty has been getting gradually lower each decade; the average age of first intercourse has shown a corresponding drop. Recent figures suggest that about one out of ten thirteen year olds in the U.S. are sexually experienced.

Whatever one's reactions to these changes in behavior and moral standards, there is one aspect of the new sexuality about which it is easy to become scandalized. Among teenagers, their first act of intercourse is most likely not to involve contraceptives. The impetus to seek such protection is very often either a pregnancy or the false alarm of a late menstrual period. As is documented in various places in this book, the result is about 1,000,000 unwanted teenage pregnancies each year in the United States. Though these data are based on the American experience, the combination of teenage sexuality, the avoidance of contraception, and the consequent unwanted pregnancies are by no means unique to this country. The U.S. birthrate among 15-19 year olds is matched or exceeded by Australia, Hungary, Romania, New Zealand, East Germany, and Bulgaria.For behavioral scientists, there is an interest in these phenomena that goes beyond the intriguing new sexual mores, the personal tragedies, and the societal costs. First, there is a very

I ADOLESCENT PREGNANCY: THE PROBLEM, AND SOME INITIAL CONCEPTUALIZATIONS REGARDING THE PROBLEM

As individuals who are concerned about teenage pregnancy, there are a number of important tasks before us. First--before any preventive measures may be proposed--it is necessary to describe in detail the social problem that we wish to solve. How many teenagers become pregnant each year? Is teen pregnancy a phenomenon that is limited to inner city minority youth, or is it common among white middle class teens as well? What are the consequences of early childbearing for teenage mothers and their children? To provide some indication of the dimensions of this problem, our volume begins with a description of the teenage pregnancy epidemic and the personal, societal, and global difficulties that are associated with it.

The second task before us is to formulate theory--however tentative--to help explain why teens so often risk pregnancy by having intercourse without contraceptive protection. Is it that teenagers are simply uninformed about sex and contraception? Do they neglect using birth control because it is so difficult to obtain? Or are there additional, psychological barriers to the use of contraception? In the chapters that follow, several conceptualizations are proposed to account for why sexually active adolescents may fail to use contraception. To the degree that these explanations prove to be accurate, they should help us in devising strategies for reducing the incidence of teenage pregnancy, and is with just such solutions that this book is ultimately concerned.

1 Sex without Contraception

Donn Byrne State University of New York at Albany

Editors' Note

During the past 20 years or so, there has been a much discussed sexual revolution in various advanced societies. For example, it is now the norm--at least statistically speaking--for American teenagers to have sexual intercourse before they get married. Unfortunately, however, it is also the norm for them to do so without using effective means of contraception. To the surprise of few (with the possible exception of some of the teenagers involved), this leads to an enormous number of unplanned and unwanted adolescent pregnancies in the U.S. each year. In Chapter 1, Donn Byrne describes the extent of the teenage pregnancy epidemic and discusses the constellation of social problems that result from it. Then, Byrne provides a social psychological analysis of the several behavioral steps that sexually active adolescents must undertake in order to acquire and use contraception. A theoretical model of sexual behavior is then proposed to explain systematically why teenagers may perform--or fail to perform--these necessary contraceptive behaviors.

In most of the world's industrialized nations, sexual attitudes and sexual practices have undergone truly astonishing changes. The attitudinal changes have been in the direction of greater tolerance and permissiveness with respect to a great many aspects of sexuality. The behavioral changes have been in the direction of earlier, more frequent, and more varied sexual experiences. An elemental, but often ignored, concomitant of the new sexual mores is conception. That sexual intercourse often results in the creation of a new being may not come as a great shock to many of us, but such expectations seem to play a negligible role in our earliest sexual interactions. The simple biological reality of the blind union of sperm and ovum can lead to the profound joy of deliberate parenthood, but italso can lead to the anguish of an unwanted pregnancy and the specter of a critically overpopulated earth. The antecedents of each of these negative consequences involve psychological processes that cause an individual to engage in sexual intercourse or not

Physiological Responses: Arousal and Sexual Behavior . The final internal process in the model is physiological sexual arousal--the bodily changes associated with various stages of the sexual act, as documented by Masters and Johnson ( 1966). Arousal is instigated by external physical stimulation such as touching various sensitive bodily areas, internal physical stimulation such as pressure on the seminal vesicles of the male, external psychological stimulation such as erotica, and internal psychological stimulation such as an erotic daydream ( Kelley & Byrne, in press). As sexual excitement increases, the probability of sexual behavior increases. The major reason for referring to such matters here in a discussion of contraception is to emphasize the fact that arousal propels the individual toward engaging in a sexual act without regard for emotions, attitudes, information, expectancies, or fantasies. In other words, the entire system can be at least partially "short-circuited" by intense arousal. Recognition of the powerful influence of excitement is reflected in booklets for teenagers cautioning against "crossing over the line" when petting. The warning is that too much stimulation leads to getting carried away, being unable to stop, losing one's head, etc. Dealing with the same general phenomenon is the saying that an erection "knows no conscience."

Whether such lack of control is genuine or simply the result of a widely shared belief, its effects are real. That is, even the most contraceptively aware and responsible individual can find himself or herself engaging in sexual intercourse without benefit of contraceptive protection. The association between sexual arousal and sexual pleasure on the one hand and the various contraceptive steps on the other is tenuous at best. It is proposed that to the extent that any of the processes described above are not directing the individual toward contraception, sexual arousal will act to make such behavior even less likely ( Schwartz, 1973). The only solution would seem to be to attempt to establish strong links between excitement and contraception (as in the male magazine ads that associate condom use with sexual pleasure and interpersonal popularity) or to attempt to decrease the amount of stimulation available for those who are not contraceptively prepared (as in a repressive society).

CONCLUSION

As has been implied from time to time in the foregoing discussion, three stages are involved in solving the problems of unwanted and unneeded pregnancies. One of these stages is completed, the second is well developed, and the crucial third stage is underway.

First, it was necessary to analyze in detail the steps involved in contraceptive behavior and to isolate the proposed psychological determinants of behavior at each of those steps. The analysis of the steps involved in contraceptive behavior and the hypothesized determinants of each were described in the present chapterSecond, research had to be undertaken to verify the hypothesized associations among the processes in the theoretical model and each contraceptive behavior. Some of that research has been noted in the present chapter, more will be discussed in the following

2 An Intrapersonal and Interactional Model of Contraceptive Behavior

John DeLamater Department of Sociology University of Wisconsin-Madison

Editors' Note

In Chapter 2, John DeLamater discusses adolescents' use or nonuse of contraception, as well as their choices of a particular method of birth control. To understand these behaviors adequately, DeLamater suggests that we must consider both an individual's sexual-interpersonal relationship and the person's views concerning sex and contraception. Thus, to explain why adolescents may fail to use contraception, we need to assess the intimacy of teens' sexual relationships, their premarital sexual standards, and frequency of intercourse, as well as adolescents' judgments about the likelihood of pregnancy and their desire to avoid it. With regard to teens' choice of a particular method of contraception--a heretofore neglected subject-DeLamater emphasizes the need to examine their attitudes towards different methods of birth control, their knowledge about each as well as its perceived availability, and finally, their own experiences with various methods of birth control. Throughout this chapter, DeLamater stresses the importance of understanding teens' own point of view and their perceptions with respect to contraception, as well as the basic need to study contraceptive behavior in the context of a sexualinterpersonal relationship.

Studies of sexually active single persons have consistently found substantial nonuse of contraception ( Morris, Conn, Stroh, & Gesche, 1976; Sorensen, 1972; Zelnik & Kantner, 1977). However, research has only begun to address the question of precisely what factors influence the use or nonuse of birth control. Is it the quality of the individual's heterosexual relationship(s), as proposed by Rains ( 1971)? Is it acceptance by the person of his/her own sexual activity, as hypothesized by Reiss, Banwart, & Foreman ( 1975)? Or is it primarily a matter

and MacCorquodale, 1979), but the utility of such data is limited because these studies were addressed to sexual attitudes and behavior, not the use of birth control.

Zelnik and Kantner ( 1973, 1977) have collected and published the most extensive data about the contraceptive activity of 15 through 19-year-old single women. Their research thus makes a major contribution; at the same time, their published work has been primarily descriptive. There have been four previous works which present conceptualizations ( Rains, 1971; Lindemann, 1974; Reiss et al., 1975; Luker, 1975), of varying degrees of specificity, of premarital contraception. All are based on empirical studies of limited, nonrandom populations. Only one (Reiss et al., 1975) reports quantitative data. All rely on samples of women attending birth control or counseling clinics; such samples do not provide data on those women in comparable situations who choose not to go to a clinic.

The model presented here is much more explicit in specifying basic variables than the previous conceptualizations. It includes more precise statements about the links between these variables. Also, as noted earlier, the present conceptualization assumes that contraceptive use involves a dynamic process rather than a unidimensional progression from nonuse to the use of the most effective, medically prescribed techniques. Finally, this model combines the emphasis of the Luker ( 1975) and Reiss et al. ( 1975) models on cognitive variables with the emphasis of Lindemann ( 1974) and Rains ( 1971) on heterosexual relationships and coital frequency as determinants of contraceptive behavior.

The paucity of research in this area perhaps reflects, in part, the lack of an explicit model on which to base hypotheses, the selection of instruments, subject samples, etc. To that extent, the present model will hopefully stimulate greater empirical activity. This lack of data is especially striking in view of the need for information about the antecedents of contraception in order to formulate public policy. In particular, given the continuing controversy over the availability of and funding for abortions, it is imperative that we identify the antecedents of contraceptive activity by single women (and men). Such information is basic to the designing of effective programs to reduce premarital conception.

REFERENCES

Center for Disease Control, Abortion Surveilance, 1973. Atlanta: 1975.

DeLamater, J., & MacCorquodale, P. "Premarital Contraceptive Use: A Test of Two Models". Journal of Marriage and the Family, 40, May 1978, 235-247.

DeLamater, J., & MacCorquodale, P. Premarital sexuality: Attitudes, relationships, behavior. Madison: The University of Wilconsin Press, 1979.

Goldsmith, S., Gabrielson, M., Gabrielson, I., Matthews, V., & Potts, L. "Teenagers, Sex and Contraception". Family Planning Perspectives, 4, January 1972, 32-38.

Lindemann, C. Birth control and unmarried young woman. New York: Springer, 1974.

3 Implications of the Sexual System

Paul R. Abramson University of California at Los Angeles

Editors' Note

According to Paul Abramson, adolescents' sexual behavior is governed by hypothetical "cognitive structures" or sets of principles concerning sexuality. Cognitive structures are, on the one hand, the products of past experience (i.e., parental standards, social norms, maturational processes, and one's own sexual experience), and on the other hand, they regulate our future sexual behavior. In Chapter 3. Abramson proposes that many adolescents develop cognitive structures which-reflecting society's own values--are fundamentally ambivalent about sexuality. For these teens, sex becomes a covert activity, and by extension, birth control is also viewed as illegitimate, resulting in teens' failure to use contraception effectively. Moving from the level of theory to the level of the individual teenager, Abramson illustrates this reasoning in the analysis of a case study of contraceptive neglect.

I am sure that every reader knows that there are eye boggling statistics for unwanted teenage pregnancies. In fact, many of those statistics are presented elsewhere in this book. There is also a growing debate as to whether teenage pregnancy is of "epidemic" proportions ( Culliton, 1978; Kierman & Jekel, 1978). However, I am going to sidestep all of these figures in order to talk about one person--a teenager with an unwanted pregnancy. I believe that this particular case will provide considerable insight into the process of contraceptive neglect.

The whole issue of contraceptive neglect is obviously independent of the availability of contraceptives. For instance, several authors ( Allen, 1968; Finch & Green, 1963; Hines, 1936; Tietze, 1965) have already described the chimeral devices of yesteryear even as far back as ancient China, which by the wayinclude having the woman lie completely still, using vaginal suppositories made of exotic and unmentionable substances, using a hollowed out lemon as a diaphragm to cover the cervix, and so on, suggesting that contraception has had a long, albiet unusual

It should be clear that most teenagers are not sabotaging themselves with pregnancy as a need to punish themselves for being sexual. Instead, the pregnancies are usually a consequence of inadequate sexual training. However, in the event that all children were to receive sufficient sexual educations, there would still be unwanted pregnancies. That is, to be an adolescent is to be impulsive, and to be impulsive is to take risks. Although impulsivity may contribute to growth and development, there are always going to be certain adolescents who will use the "risk" of avoiding contraceptives as excitement for their sexuality.

In concluding, I would like to offer several suggestions for minimizing the risk of unwanted adolescent pregnancies. First, parents must realize that their children have the right to be sexual. Although every reader of this book may not agree with my position, it is still the case that parents need to systematically train their children about sexuality and reproduction. This training should occur simultaneously with all other forms of education, using graduated levels of information for varying age groups. This particular type of training will yield teenagers who are conversant about sexual matters and experienced and comfortable with contraceptives. However, I am by no means implying that parents should avoid training children about love, intimacy, or ethical standards. Instead, I mean only to convey that sex education (whether at home or in school) must also be included since sexuality is an integral part of adolescence.

As far as the impulsivity issue is concerned, contraceptive neglect is less likely to occur if contraceptives are presented as a necessary aspect of hygiene. That is, rather than training children to conceive of contraceptives as "sexual devices", it is more effective to present contraceptives as a hygienic requirement. Given that mothers have little trouble convincing their daughters that precautions are necessary for menstruation, parents are also capable of conveying that contraceptives are required for sex.

REFERENCES

Abramson, P. R. The sexual system: A theory of human sexual behavior. New York: Academic Press, 1983, forthcoming. (a)

Abramson, P. R. Sexual lives. Under editorial review, 1983. (b)

Allen, C. The long history of birth control. Sexology, 1968, Dec., 276-278.

Byme, D. "Social psychology and the study of sexual behavior". Personality and Social Psychology Bulletin, 1977. 3, 3-30.

Culliton, B. "News and Comment". Science. 1978, 199, 508.

Finch, G. E., & Green, H. Contraception through the ages. London: Peter Owen, 1963.

Freud, S. The basic writings of Sigmund Freud. New York: The Modern Library, 1938.

Gagnon, J. H., & Simon. W. Sexual conduct: The social sources of human sexuality. Chicago: Aldine, 1973.

Hines, N. E. Medical history of contraception. Baltimore: Williams & Wklkins, 1936.

Klerman, L. V., & Jekel. J. F. "Teenage pregnancies". Science. 1979, 199. 1390.

Neisser. U. Cognitive psychology. New York: Appleton-Century-Crofts, 1967.

II EXAMINING THE DETERMINANTS OF ADOLESCENT CONTRACEPTIVE BEHAVIOR

In the first section of this book, three conceptual models were proposed to help explain why teens use--or fail to use--contraception. The present section follows up this theorizing with empirical research on some of the determinants of contraceptive behavior. We begin with an overview of the literature on factors that affect teens' use of contraception. A number of general hypotheses emerge from this review, and findings are reported from a largescale study that tested these hypotheses. Next, we turn to more narrowly focused research on particular antecedents of adolescent contraception. Two chapters adopt a developmental perspective on this issue, and discuss the effects of limited maturity and early socialization experiences on teens' use of birth control. The last three papers in this section consider the roles of sex-related knowledge, beliefs, and emotions in the process of adolescent contraception.

4 Personality and Attitudinal Barriers to Contraception

Stuart Oskamp Claremont Graduate School

Burton Mindick Cornell University

Editors' Note

A good deal of research has examined personality and attitudinal factors that may affect teens' use of contraception. Unfortunately, these studies are scattered throughout the disciplinary journals, their results are often enough in conflict, and methodological problems consistently bedevil this line of research. In Chapter 4, Stuart Oskamp and Burton Mindick provide a very useful critical review of the literature that clarifies the research on personality and attitudinal determinants of contraceptive behavior. A general conclusion that emerges from this analysis is that a longitudinal approach is most suitable for studying the relationship of personal dispositions to contraceptive behavior. In this approach, an individual's characteristics are measured first and are correlated with contraceptive behaviors that occur later; in this fashion, we can come closer to teasing out cause and effect relations with respect to personality, attitudes, and teens' contraceptive behavior.

Based on their review of the literature, Oskamp and Mindick propose several hypotheses concerning the role of personality factors and attitudes as determinants of teenage use of birth control. Two large-scale longitudinal studies were conducted to evaluate these hypotheses, and the results of this research are reported and discussed in detail. It is especially noteworthy that these investigations followed the contraceptive successes and failures of several hundred teenage women across a long span of time--one and a half to three years--and sampled women from a variety of ethnic groups (black, Hispanic) and socioeconomic levels.

The unintended results of adolescent pregnancy--including illegitimacy, abortion, and ill-advised hasty marriages--comprise major social problems in modern society ( Baldwin, 1976; Chilman, 1979). These problems could be drastically reduced if contraceptive programs for teenagers were more widespread and successful. Sexually active young women who never use contraception have about a 60% likelihood of getting pregnant, whereas those who use a method of contraception regularly run only about a 6% risk of pregnancy. Yet about 30% of sexually...

Conclusion

In summarizing the value of these studies, we would stress that they share both the strengths and weaknesses of naturalistic, longitudinal, multivariate research designs. They have investigated socially important questions, studied them in real-life situations, and tracked the research subjects for several years in order to develop stable measures of their behavior. On the other hand, in this kind of research there are many complex interrelationships among the variables, and there is no possibility of experimentally controlling the conditions and experiences of the subjects. Since the design is correlational in nature, it is more difficult to demonstrate causal connections between variables. However, despite these inevitable limitations, we have found support for a number of hypotheses based on past research studies, and we have had some success in predicting important contraceptive behaviors on a longitudinal basis.

Finally, from a practical point of view, these methods and findings may not only have predictive value, but they may also suggest new approaches to planning treatment strategies in family planning agencies, both public and private. A basic goal in such intervention programs must be to break the web of relationships between low socialization, poor personal efficacy and adjustment, insufficient information, poor planning, unfavorable attitudes and intentions, and responsiveness to external pressures toward deviancy--all of which can contribute to inadequate contraceptive behavior in which society and the unfortunate adolescent both lose. Future research should continue to be directed toward breaking this chain of relationships.

Conclusion

ACKNOWLEDGMENTS

We are grateful for the help of countless people in carrying out this research: particularly the 2000 or so young women whose contraceptive progress we have studied; the dozens of interviewers, coders, clinic staff members, research assistants, and secretaries who have contributed to the work; and the Center for Population Research of NICHD which provided six years of support under research grant HD-08074 and research contract HD-82842.

REFERENCES

Adler, N. E. Factors affecting contraceptive use. Paper presented at the American Psychological Association meeting. New Orleans. August 1974.

Ager. J. Comparison of participants and dropouts from a contraceptive teen program. Paper pre- sented at the American Psychological Association meeting, Washington, D.C., September 1976.

Ager, J. W.. Werley. H. H., & Shea, F. P. "Correlates of continuance in a family planning program". Journal of Obstetric, Gynecologic, and Neonatal Nursing. 1973, 2, 15-23.

5 Adolescent Development and Teenage Fertility

George Cvetkovich and Barbara Grote Western Washington University

Editors' Note

What is it like to be young and in love? According to George Cvetkovich and Barbara Grote, an adolescent's transition to sexual activity may cause such conflict and denial as to make it impossible for them to plan for contraception. It is pointed out that, during adolescence, teens must eventually come to accept their own sexuality and learn to think about it rationally. Many teenagers, however, begin to have sexual intercourse before they develop the psychosexual maturity that is required for contraceptive planning. This may result in contraceptive neglect for as long as teens are unable to see themselves as sexual beings with contraceptive needs. A longitudinal study of high school students was conducted to examine these assumptions, and the findings reported in this chapter confirm the hypothesized links among maturity, teens' acceptance of their own sexuality, and the responsible use of contraception.

In one sense it is paradoxical that there is a heightened concern about teenage fertility at this time. Statistics show that there has actually been a recent drop in the rate of fertility for women under the age of twenty ( Baldwin, 1976). A high point in teenage fertility was reached in 1957 when 97.3 births for every 1,000 women between the ages of 15 to 19 years occurred. In 1974 the rate was 58.7 per 1,000, a little more than half of the 1957 rate. There has even been a slight decline in the absolute number of children borne by teenage mothers. While the number of women between 15 and 19 years of age increased dramatically between 1960 and 1974, owing to the declining fertility rate, the annual number of births decreased from 609,000 to 608,000. We can expect that as the proportion

explore, through discussions, lectures and programmed instruction units, their own feelings and attitudes, and the thinking of others about human sexuality. They are courses in sexual decision making. Our findings are tentative, but indicate that this program has the results it should. The students are accurately informed concerning factual aspects of sex and contraception, and seem to have a high degree of sexual responsibility. More of these students plan to postpone their initial coital experience until they are older. Contraception use is high among those who are sexually active. The program is possible because of concerned administrators who are willing to take sensible steps in developing educational programs, and because of faculty who are qualified to conduct the courses and dedicated to the success of the program.

CONCLUSION

Our study began with the question of how adolescent development is related to teenage fertility. It leads to the question, "Are teenagers really different from older individuals?" Our findings indicate that in some respect they are. Detailed here are some of the ways in which sexual experiences are influenced by social and emotional maturity, and some of the problems which result from the need to coordinate development on the levels of biology, individual differences, and social interactions. Many of these problems will never again concern the individual to the great extent that they do during adolescence.

It is well to remember, however, that in a larger sense, teenage fertility regulation is not greatly different than at later ages. Human fertility decisions always demand a blend of emotion and logic. This is an overriding characteristic of human sexuality. The ability to combine both feelings and facts in making life's decisions develops during the adolescent years. If we are to understand the dynamics of psychosexual development, this characteristic must be central to our thinking.

REFERENCES

Alan Guttmacher Institute. 11 Million Teenagers. 1977.

Baldwin, W. "Adolescent pregnancy and childbearing-growing concerns for Americans". Population Reference Bureau. 1976, 31, 2, (Sept.).

Baldwin, W., & Cain, V. S. "The children of teenage parents". Family Planning Perspectives. 1980, 12, 1, 34-43.

Byrne, D., Jazwinski, C., DeNinno, J. A., & Fisher, W. A. "Negative attitudes and contraception". In D. Byrne & L. Byrne (eds.), Exploring human sexuality. N.Y.: Crowell, 1977.

Chilman, C. S. Adolescent sexuality in a changing American society: Social and psychological perspectives. Washington, D.C.: U.S. Government Printing Office (NIH publ. no. 80-1426), 1980.

6 Adolescent Sexuality: The First Lessons

Kathryn Kelley State University of New York at Albany

Editors' Note

In Chapter 6, Kathryn Kelley uses the concepts of learning theory to explain how early socialization experiences may affect the use of contraception in the teenage years. Specifically, it appears that individuals learn emotional responses to sexual cues while they are very young, and such emotional responses may remain influential as the person enters adolescence. According to Kelley, these learned emotional responses to sexuality will generalize to contraceptive behavior, since such behavior is essentially sexual in nature. Thus, an individual who has learned a negative emotional response to masturbation should generalize this negative response to contraceptive methods that require genital manipulation (i.e., inserting a diaphragm, putting on a condom, etc.); the person in question should dislike and hence avoid these methods of birth control. By the same token, a person who has acquired ambivalent feelings about heterosexual activity in general should also be ambivalent about contraception in general. In the chapter that follows, Kelley presents research findings that are consistent with these assumptions and discusses how the principles of learning theory may be applied to reduce the negative emotional responses that interfere with contraception.

Sexuality occupies a special place in the lives of most people living in Western society. Individuals are curious about the topic, and will at times exert unusual effort to find answers to their questions. Anyone familiar with the tattered, soiled edges of references to sex in the card catalogs of university libraries can gauge fairly accurately the popularity of such information. Sex sells--witness the relatively recent surge in the number of articles and reports on sexual behavior in periodicals and newspapers. If asked to supply reasons for such general interest,psychologists might offer as an explanation the absence of the ordinary mechanisms for communicating about an important matter when attention shifts from "acceptable" topics to sex. The processes of social comparison allow the individual to build personal standards for behavior,...

CONCLUSIONS ABOUT THE SEXUALITY LEARNING EXPERIENCE

Current data on the socialization of sexuality highlight the importance of learned emotional reactions to even early sexual behavior in differentiating the attitudes and behaviors of individuals. Tendencies to engage in activities like intercourse and contraception are strongly related to basic feelings about sexuality. But these dispositions can be changed by future learning experiences that present other rewards or punishments added to the affective base from which the responses emanate.

The use of learning principles to explain sexuality has some resemblance to a one-night stand. It has no moral guidance to provide and lacks concern about the past except as it influences the interesting present. Just as the potential partner in a singles' bar tries to size up the probability for success with one person and not another, learning principles attempt to assess the affective content of clues to behavior in order to predict and understand it. But it doesn't "love 'em and leave 'em" when it comes to dissecting phenomena. From past experience with its treatment of other areas of behavior, it will follow through with as thorough an examination as the facts permit. As the bar's closing time approaches, the theory may even begin to look more attractive due to its impressive explanatory power.

REFERENCES

Abramson, P. R., & D. L. Mosher Development of a measure of negative attitudes toward masturbation. Journal of Consulting and Clinical Psychology, 1975, 54, 485-490.

Arafat, I. S., & Cotton, W. L. Masturbation practices of males and females. Journal of Sex Research, 1974, 10, 293-307.

Bailey, K. G. Psychotherapy or massage parlor technology? Comments on the Zeiss, Rosen, and Zeiss treatment. Journal of Consulting and Clinical Psychology, 1978, 46, 1502-1506.

Bakwin. H. Masturbation in infants. Journal of Pediatrics, 1952, 40, 675-678.

Bardwick, J. Psychological factors in the acceptance and use of oral contraceptives. In J. Fawcett (Ed.), Psychological aspects of population. New York: Basic Books, 1973.

Bennett, S. M., & Dickinson, W. B. Student-parent rapport and parent involvement in sex, birth control, and venereal disease education. Journal of Sex Research, 1980, 16, 114-130.

Bullough, V. L. Sex education in Medieval Christianity. Journal of Sex Research, 1977, 13, 185-196.

Byrne. D., & Byrne, L. A. Exploring human sexuality. New York: Crowell, 1977.

Byrne, D., & Kelley, K. An introduction to personality. Englewood Cliffs, N. J.: Prentice-Hall, 1981. 3rd Edition.

Calderone. M. S. The acceptability of contraceptive methods to their users. In L. Rainwater (Ed.). And the poor get children. Chicago: Quadrangle Books, 1960.

Chilman. C. S. Why do unmarried women fail to use contraceptives'? Medical Aspects of Human Sexuality, 1973, 7(5), 166-168.

Chilman. C. S. Adolescent sexuality in a changing American society: Social and psychological perspectives. Report of United States Department of Health, Education, and Welfare, Public Health Service, National Institutes of Health. Publication Number (NIH) 79-1426, 1977.

7 Informational Barriers to Contraception

A. R. Allgeier Northwest Center for Human Resources, Inc.

Editors' Note

Experience teaches us that it is difficult to find anyone over the age of three who will admit to serious gaps in their sexual knowledge. Nevertheless, it is clear that many teenagers are uninformed about sex and contraception, and such ignorance may place a limit on the effectiveness of the adolescent's use of birth control. In Chapter 7, A. R. Allgeier describes factors which prevent teens from learning the essentials about sex and contraception, including legal prohibition of sex education, parents' reluctance to discuss sexuality with their children, and the failure of the schools to provide instruction on sexual or contraceptive topics. His discussion then turns to a review and critique of research on sex education and its impact (or lack of impact) on students' attitudes and behavior. This chapter concludes with some innovative suggestions for improving the sex education of the future.

LEGAL BARRIERS TO SEXUAL AND CONTRACEPTIVE INFORMATION

The effects of accurate information about sexuality and contraception on the recipient's behavior have been the subject of an ongoing debate in this country that has spanned the last two centuries. Proponents of sex education have generally put forth a rationale that is best reflected in the position taken by the World Health Organization that "ignorance, not knowledge, of sexual matters is the cause of 'sexual misadventure'" ( Calderone, 1965). The assumption is that people will make rational decisions about their sexual behavior if they are adequately informed about sexuality. At the other end of the spectrum are those individuals who believe that sexual information will lead to experimentation. If children are taught "how to do it" they will, in fact, "do It." The assumption here

ing with the issues and decisions facing them as they move into adolescence, most adults are equally inexperienced in dealing with their new role of providing guidance to their sexually maturing offspring. Many parents are lacking knowledge about sex and contraception and practice in discussing these issues. A few years ago, I offered a continuing education class called "Adolescent Sexuality for Parents." As it happened, the initial motivation for most of the parents who enrolled was to pick up tips on how to keep their teenagers "chaste" (or in some cases, how to stop them from being sexually active) until marriage. I used the first few sessions to review basic sex education--anatomy, physiology, processes involved in sexual response and reproduction, etc. We then reviewed normative information regarding the incidence of masturbation, premarital sex, and adolescent pregnancy. Toward the end of the class, I asked the parentstudents to think back to their own adolescence in terms of what information they wish their parents had given them and what information their parents had actually given them. The responses of these middle-aged parents were very similar to those given by adolescents in research on this issue ( Gagnon, 1965). Although their primary preference for the source of their sex education was their parents, most of their information came from other sources. During the remaining sessions of the course, the parents eagerly participated in a series of role-play exercises. Half the parents played the part of teenagers and the other half played the role of parents. In addition to producing some hilarious interactions, this process gave the parents practice in talking openly about sex and birth control.

Such courses could be set up for parents (with appropriate control groups of parents) to see if changes in the attitudes of important reference persons (parents) can be produced, and if, in turn, these changes are accurately perceived and reflected in the contraceptive behavior of their offspring. Presumably, adolescents who are raised by parents who discuss sexual and contraceptive responsibility are more likely to perceive their parents as approving the use of contraception than are those who are raised by parents who bend their energies toward trying to ignore or prevent any sexual expression by their offspring.

REFERENCES

Ager, J. W. "Multiple-regression and facet techniques in psychological research on population". In S. H. Newman & V. D. Thompson (Eds.), Population psychology: Research and educational issues. Washington: U.S. Government Printing Office, 1976.

Ajzen, I., & Fishbein, M. "The prediction of behavior from attitudinal and normative variables". Journal of Experimental Social Psychology, 1970, 6, 446-487.

Ajzen, I., & Fishbein, M. "Attitudes and normative beliefs as factors influencing behavioral intentions". Journal of Personality and Social Psychology, 1972, 21, 1-9.

Ajzen, I., & Fishbein, M. "Attitudinal and normative variables as predictors of specific behaviors". Journal of Personality and Social Psychology, 1973, 27, 41-57.

Alan Guttmacher Institute. 11 million teenagers. New York: Planned Parenthood Federation of America, 1976. (a)

8 Ideological Barriers to Contraception

Elizabeth Rice Allgeier Bowling Green State University

Editors' Note

If ignorance were the only obstacle to teens' use of contraception, it would be relatively easy to educate adolescents and to realize a swift reduction in the incidence of teenage pregnancy. Unfortunately, however, there appear to be other barriers to adolescent contraception as well. In Chapter 8, Elizabeth Allgeier points out that many teens are committed to beliefs or belief systems which are entirely incompatible with responsible contraception. Such an "anticontraception ideology" may hold that contraception is immoral; that it is dangerous to one's health. or one's fertility, or one's sex drive; or that the use of birth control contradicts one's religious beliefs. In the present chapter. Allgeier describes five clusters of beliefs that act as barriers to the use of birth control by teenagers; the validity of these beliefs is discussed as well, and the chapter closes with suggestions for changing beliefs that inhibit adolescent contraception.

If a girl truly doesn't want to have a baby, she won't get pregnant even though she may have sex without taking any birth control precautions. ( Sorensen, 1973, p. 323)

If a girl uses birth control pills or other methods of contraception, it makes it seem as if she were planning to have sex. ( Sorensen, 1973, p. 322)

Pregnancy, under any conditions, is one of the most significant and wonderful experiences a woman can have. You must not let your experience be marred by the problems that surround it. ( Cowart & Liston, cited in Ambrose, 1978)

These quotations are examples of some of the beliefs held by adolescents which inhibit their use of contraception. In this chapter, I will review five major

REFERENCES

Ajzen, I., & Fishbein, M. "The prediction of behavior from attitudinal and normative variables". Journal of Experimental Social Psychology, 1970, 6, 446-487.

Ajzen, I., & Fishbein, M. "Attitudes and normative beliefs as factors influencing behavioral intentions". Journal of Personality and Social Psychology, 1972, 21, 1-9.

Ajzen, I., & Fishbein, M. "Attitudinal and normative variables as predictors of specific behaviors". Journal of Personality and Social Psychology, 1973, 27, 41-57.

Alan Guttmacher Institute. 11 million teenagers. New York: Planned Parenthood Federation of America, 1976. (a)

9 Emotional Barriers to Contraception

William A. Fisher The University of Western Ontario

Donn Byrne State University of New York at Albany

Leonard A. White Survey Branch, Army Personnel Center Alexandria, Virginia

Editors' Note

Earlier in this book, it was pointed out that contraception is an active process which involves learning about birth control, anticipating intercourse, and acquiring, discussing, and using contraception. An adolescent may be motivated to undertake these behaviors, or he or she may be motivated to avoid such contraceptive preparations. In Chapter 9, William Fisher and his colleagues propose that an individual's emotional response to sexuality will generalize and, in part, determine whether the person approaches--or avoids--contraception. To the extent that individuals are comfortable (or uncomfortable) about sex, they should also be comfortable (or uncomfortable) about performing each behavioral step in the contraceptive process. In the present chapter, research which has examined this assumption is discussed, and findings are reported which confirm the proposed link between sex-related emotions and contraceptive behavior. The chapter concludes with a proposal for changing teens' emotional associations to contraception and, by way of such changes, improving adolescents' use of birth control.Those who are concerned about adolescent pregnancy have tried to understand why sexually active teens so often fail to use contraception. It has been noted, for example, that ignorance of basic contraceptive knowledge may limit teens' use of birth control....

tate adolescents' use of contraception. Such interventions, we feel, will complement efforts to change adolescents' general emotional response to sexuality. These specific changes cannot, however, replace the broader emotional changes suggested earlier. Unless adolescents are helped to feel good about sex in general, it will be hard to convince them that contraception is good.

Changing Beliefs and Expectancies

Research discussed in this chapter suggests that informational factors as well as emotions may govern contraceptive behavior. Therefore, we advocate interventions that focus on changing relevant beliefs and expectancies, in addition to the emotional changes discussed earlier. A promising framework for such intervention has been provided by Fishbein and his colleagues (see Chapter 8). Using this approach, it should be possible to identify particular beliefs and expectancies that govern contraceptive intentions and behavior in specific target populations. Educational interventions could then be developed in efforts to change such beliefs and expectancies and through such changes, improve adolescents' practice of contraception.

In Conclusion

Based on our research, we propose fairly wide-ranging interventions that are aimed at changing teens' emotions, beliefs, and ultimately their contraceptive behavior. These are obviously long term objectives that will require much work and will likely engender resistance. Nevertheless, it should be made clear that inaction is also a decision of sorts. That is, failure to attempt interventions promotes, by default, a status quo that has literally millions of U.S. teenagers at risk of unwanted pregnancy. Therefore, despite the costs involved, it seems clear to us that positive change is needed.

REFERENCES

Byrne, D. "Social psychology and the study of sexual behavior". Personality and Social Psychology Bulletin, 1977, 1, 3-30.

Byrne, D., Fisher, J. D., Lamberth, J., & Mitchell, H. E. "Evaluations of erotica: Facts or feelings?" Journal of Personality and Social Psychology, 1974, 29, 111-119.

Byrne, D., Jazwinski, C., DeNinno, J. A., & Fisher, W. A. "Negative sexual attitudes and contraception". In D. Byrne and L. A. Byrne (Eds.), Exploring human sexuality. New York: Harper and Row, 1977.

Byrne, D., & Sheffield, J. "Response to sexually arousing stimuli as a function of repressing and sensitizing defenses". Journal of Abnormal Psychology, 1965, 70, 114-118.

Crowne, D. P., & Marlowe, D. The approval motive; Studies in evaluative dependence. New York: Wiley, 1964.

III POSSIBLE SOLUTIONS

Perhaps the most important goal of this book is to explore potential solutions to the problem of teenage pregnancy. To provide a foundation for such solutions, we have discussed theory and research which help explain the mechanisms that govern teens' sexual behavior and their use--or neglect--of contraception. Now, it is time to consider strategies for controlling the epidemic of adolescent pregnancy. The present section begins with a description of what is in many ways a model contraception clinic and educational program for college students. The health educator who was based at this clinic discusses its history, its methods, and some of the successes and difficulties that have been encountered in delivering contraceptive care to thousands of young persons. Next, two social psychologists report on a series of in-depth interviews that were conducted with young men and women who have engaged in unprotected coitus. It is pointed out that certain social arrangements that are common in adolescence predispose teens to pregnancy risk, and specific suggestions are proposed for dealing with these "social traps." In the concluding chapter, one of the theories that was discussed earlier--the Sexual Behavior Sequence--is used as a conceptual framework for organizing and interpreting many of the findings that are reported in this volume. Based on this analysis, systematic recommendations are made for a new kind of sex and contraceptive education that is directed at reducing the incidence of teenage pregnancy. Let us now consider some of these possible solutions to the problem of adolescent pregnancy.

10 Providing Contraceptive Care on a College Campus

Marilyn Edmunds The Pathfinder Fund Boston, Massachusetts

Editors' Note

Part of the reason that adolescents neglect to use contraception is that birth control services are either unavailable to them or are perceived as being in some way unsatisfactory. In Chapter 10, Marilyn Edmunds outlines a two-component approach that is geared to providing attractive, accessible contraceptive care for college youth. The medical facet of this strategy utilizes the expertise of gynecological nurse clinicians as well as physicians to examine patients, answer questions, and prescribe contraception. The educational component of this approach includes peer health educators who conduct outreach programs on contraceptive education, as well as an obligatory contraceptive counseling session for each person who wishes to obtain birth control at the campus clinic. Limitations of this method with respect to involving males in the contraceptive process are discussed, and applications of this approach in settings other than universities are also considered. The chapter closes with the script of a contraceptive education movie-No Choice But to Choose--that was developed especially for use in the clinic's programs. As you read the script, it is worth noting how the similarity of the actors to the intended audience emphasizes the relevance of the contraceptive message to viewers' own lives. The film presents a more-or-less explicit behavioral script concerning how viewers may acquire and use contraception. and the movie's recommendations are phrased in such a way as to motivate the audience to avoid unwanted pregnancy by using contraception responsibly.

11 A Social Psychological Approach to Reducing Pregnancy Risk in Adolescence

Alan E. Gross University of Maryland

Martha Bellew-Smith St. Louis University

Editors' Note

In Chapter 11, Alan Gross and Martha Bellew-Smith propose that we must understand the social context of teenage sexuality if we are to develop ways to reduce pregnancy risk in adolescence. To begin with, the authors point out that the social conventions that govern teenagers' sexual behavior may predispose them to contraceptive neglect. For example, a traditional sexual goal for young men involves more-or-less subtle attempts to seduce a female, and such attempts could be irretrievably botched if contraceptive preparations became known to the female in question. Similarly, many teenage women do not wish to appear as if they have planned to have sex, and this desired image is also inconsistent with the discussion, acquisition, or use of contraception. In addition to such conventions, Gross and Bellew-Smith note that teenagers' sexual relationships have a social history which may affect the use of contraception. For instance, at the beginning--or the end--of a relationship, intercourse may be quite unpredictable, and this makes it difficult for teens to take contraceptive precautions. In the present chapter, the authors report on a series of interviews with young men and women who have engaged in unprotected coitus, and identify social factors that are associated with contraceptive neglect. Gross and Bellew-Smith then propose a detailed list of objectives for sex education to help teens deal with social arrangements of adolescence that may lead to pregnancy risk.

ACKNOWLEDGMENTS

We are grateful to Susan K. Green for helpful suggestions and comments.

REFERENCES

Baron, R. A., & Byrne, D. Social psychology: Understanding human interaction. Boston: Allyn & Bacon, 1977.

Carlson, J. E. "The sexual role". In F. I. Nye (Ed.), Role structure and analysis of the family. Beverly Hills, CA: Sage Publications, 1976.

Fisher, W. A., Byrne, D., Edmunds, M., Miller, C. T., Kelley, K., & White, L. A. "Psychological and situation-specific correlates of contraceptive behavior among university women". Journal of Sex Research, 1979, 15, 38-55.

Foreit, K. G., & Foreit. J. R. "Correlates of contraceptive behavior among unmarried U.S. college students". Studies in Family Planning, 1978, 9, 169-174.

Gagnon, J., & Simon, W. Sexual conduct: The social sources of sexuality. Chicago: Aldine, 1973.

Gross, A. E. "The male role and heterosexual behavior". Journal of Social Issues, 1978, 34, 87-107.

Masters, W. H., & Johnson, V. E. Human sexual response. Boston: Little, Brown, 1966.

Peplau, L. A., Rubin, Z., & Hill, C. T. "Sexual intimacy in dating relationships". Journal of Social Issues, 1977, 33, 86-109.

12 Adolescent Contraception: Summary and Recommendations

William A. Fisher The University of Western Ontario

Editors' Note

A great deal of theory and research on adolescent contraception has been discussed in this volume. In our concluding chapter, William Fisher summarizes a number of the major findings that have been reported, and provides research-based recommendations for a new kind of sex and contraceptive education that is directed at controlling teen pregnancy. Throughout this paper, however, it is stressed that the problem of adolescent pregnancy will require political as well as pedagogical solutions. In fact, while many believe that all that is needed is a breakthrough in sex education technology (on the order of a "silver bullet"), Fisher suggests that what is needed just as much are political breakthroughs to permit and encourage sex education programs to combat teenage pregnancy. The chapter ends with a note on the desirability of researchers and practitioners joining their efforts to understand and improve adolescent contraception.

Thus far in our discussion, it has been established that American adolescents now engage in premarital intercourse in greater numbers and at an earlier age than ever before. Although few wish to conceive, the majority of these sexually active teens do not always use effective means of contraception. Predictably enough, this results in large numbers of unplanned teenage pregnancies each year-pregnancies that lead to hundreds of thousands of abortions, out-of-wedlock births, and hasty marriages annually, as well as elevated levels of child abuse by teenage parents, maternal suicide, and the like. What is more, the problem of adolescent pregnancy is part of a global population explosion that may threaten our planet with Malthusian disaster.

In an effort to understand and ultimately reduce the problem of adolescent

pragmatic reasons we still need to establish, where possible, cause-and-effect relations between dispositional factors and contraceptive behavior. Too, as noted earlier, interpersonal aspects of couples' contraceptive behavior remain largely unexplored. Thus, while it is a cliche, it is also true that more research is needed to help understand adolescent contraception.

At the same time that researchers call for further investigation, educators and health care workers have an immediate need to provide the best contraceptive services possible to the maximum number of teens. How can these diverse interests be reconciled? We propose that interventions be undertaken to improve adolescent contraception, and we advocate studying these interventions for further clues as to determinants of contraceptive behavior. By doing research within ongoing interventions, we can answer important theoretical questions at the same time that we bring much needed services to our teenage constituency. Thus, researchers and practitioners can work together to understand and improve adolescent contraception.

REFERENCES

Alan Guttmacher Institute. 11 million teenagers. What can be done about the epidemic of adolescent pregnancies in the United States. New York: Alan Guttmacher Institute, 1976.

Fishbein, M., & Ajzen, I. Belief, attitude, intention and behavior: An introduction to theory and research. Reading. Massachusetts: Addison Wesley, 1975.

Guttmacher, A. F. Pregnancy, birth and family planning. New York: Signet. 1973.

Hyde, J. S. Understanding human sexuality. New York: McGraw-Hill, 1979.

Watts, P. R. "Comparison of three human sexuality teaching methods used in university health classes". Research Quarterly, 1977, 48, 187-190.

West, N. W. The effect of instruction in family planning on knowledge, attitudes and behavior of London (Ontario) senior secondary school students. Unpublished doctoral dissertation, The Ohio State University, 1976.

Wolpe, J. Psychotherapy by reciprocal inhibition. Stanford: Stanford University Press, 1958.

Zuckerman, M., Tushup, R., & Finner, S. "Sexual attitudes and experience: Attitude and personality correlates and changes produced by a course in sexuality". Journal of Consulting and Clinical Psychology, 1976, 44, 7-19.