The Relationship Between Forced Sexual Intercourse and Contraceptive Use Among Sexually Active High School Students in the United States.

PURPOSE: Contraceptive use among US adolescents remains relatively low, and sexual violence is linked to adverse reproductive health outcomes, including unplanned pregnancies and increased HIV/sexually transmitted infection risk. This study examines differences in contraceptive use among sexually active high school students in the United States based on their history of forced sexual intercourse (FSI).

METHODS

Data were obtained from the 2021 Youth Risk Behavior Survey involving 5,466 sexually active high school students. We conducted multinomial logistic regression to compare contraceptive use, with no contraceptive use as the referent, against (1) hormonal methods, (2) condoms, and (3) withdrawal. Analyses were stratified by sex, controlling for race/ethnicity, and age.

RESULTS

Students who reported experiencing FSI were significantly less likely to use any form of contraception (relative risk ratio [RRR]: 0.53; 95% confidence interval [CI]: 0.40-0.71) at subsequent sex compared to those without a history of FSI. Specifically, adolescents with FSI history were significantly less likely to use hormonal contraceptives (RRR: 0.59; 95% CI: 0.44-0.79) or condoms (RRR: 0.44; 95% CI: 0.31-0.64) compared to their peers without FSI history. However, no significant difference was observed for the use of withdrawal methods. Among females, a history of FSI was associated with decreased use of hormonal contraceptives and condoms, but no significant difference was noted for withdrawal. Males with FSI history were significantly less likely to use any form of contraception.

DISCUSSION: These findings underscore the need for public health policies and educational interventions that encourage contraceptive use and primary prevention efforts centered on healthy relationships, boundaries, and consent to prevent FSI and associated reproductive health risks.