Acta Obstet Gynecol Scand 2016 Dec 28. doi: 10.1111/aogs.13088. [Epub ahead of print]

Contraceptive non-use and emergency contraceptive use at first sexual intercourse among nearly 12 000 Scandinavian women

Guleria S, Juul KE, Munk C, Hansen BT, Arnheim-Dahlström L, Liaw KL, Nygård M and Kjaer SK


Introduction: To describe recent patterns of contraceptive use at first sexual intercourse (FSI) and to examine whether selected factors are associated with non-use and emergency contraceptive pill (ECP) use at FSI, among 18-26-year-old women from Denmark, Norway and Sweden.

Material and methods: This was a population-based, questionnaire study of randomly chosen 18-26-year-old Scandinavian women. The prevalence of contraception methods used at FSI was calculated. Factors associated with contraceptive non-use and ECP use at FSI were determined using log binomial models.

Results: The prevalence of contraceptive non-use and ECP use was lowest in Denmark (9.6% and 2.1%, respectively) compared with Norway (14.1% and 4.4%) and Sweden (16.6% and 4.5%). The risk of contraceptive non-use increased in women who had FSI at or before 14 years of age (13-14 years: PR 1.40; 95% CI 1.24-1.58). The risk of both non-use and ECP use increased when the partner at FSI was 20 years or older and with increasing age difference between the partner and the woman at her FSI. Smoking initiation prior to FSI increased risk of contraceptive non-use (PR 1.70; 95% CI 1.50-1.92), while alcohol initiation prior to FSI increased risk of ECP use at FSI (PR 1.95; 95% CI 1.49-2.54).

Conclusion: Contraceptive non-use at FSI was strongly associated with early age at FSI. ECP and contraceptive non-use at FSI were both strongly associated with increasing partner age and an increasing difference in age between the woman and her partner. Hence, young women should be educated to negotiate contraceptive use with their partners.

Comment: Even in Scandinavia, where women are very well educated and where sexual education is very prevalent, this study finds that young women do not know when and how to use emergency contraception, although they do know what it is. This means that everywhere parents, teachers and health care providers must explain early and in detail the correct use of emergency contraception. (HMV)