Contraception and Unintended Pregnancy among Unmarried Female University Students: A Cross-sectional Study from China

This study aims to understand the level of contraceptive knowledge and attitudes towards contraception, and then to explore the association between the contraceptive behavior and unintended pregnancy in unmarried female university students in China. A cross-sectional study was conducted of university students in 49 universities across 7 cities in China from September 2007 to January 2008. We distributed 74,800 questionnaires, of which 69,842 were returned. In this paper, the data from 35,383 unmarried female university students were analyzed. The prevalence of sexual intercourse in unmarried female university students was 10.2%. The prevalence of unintended pregnancy in those sexually active female university students, was 31.8%. Among students with pregnancy, 53.5% experienced two or more pregnancies. 28.3% of the students with sexual intercourse reported that they always adopted contraceptive methods, and of those 82.9% chose to use male condoms. The majority (83.9%) of students with unintended pregnancy chose to terminate the latest pregnancy by surgical abortion or medical abortion. The contraceptive knowledge level of students who experienced unintended pregnancy was lower than those who did not. In China, about one third of unmarried female students with sexual intercourse experience unintended pregnancy. A variety of contraceptive methods are adopted, but the frequency of contraceptive use is low. Most of unmarried female students who experienced unintended pregnancy would choose to terminate the pregnancy with surgical or medical abortion. University students, especially the ones who have experienced unintended pregnancy, lack contraceptive and reproductive health knowledge.     

Knowledge,Practices, and Attitudes of Emergency Contraception among Female University Students in KwaZulu-Natal,South Africa

Objective

The purpose of this study is to investigate the knowledge, practices, and attitudes among female university students in South Africa regarding emergency contraceptives (EC).

Methods

A cross-sectional study was conducted among 582 female university students who were selected using multi-stage sampling techniques. Multivariate logistic regression analysis was used to find significant predictors for EC awareness.

Results

The average age of the female students was 20.9 years (SD = 3.0) and 57.2% were presently sexually active. Overall, 49.8% of the participants reported having heard about EC prior to the study. Regarding sexual activities among the female students, 53.2% reported to have sex, and 21.2% of the sexually experienced students used EC prior to the study. Regarding the effectiveness of EC, 29.5% students said it could be used up to 72 hours after unprotected sexual intercourse, and 8% said it could be used just before sex. About two-thirds (61.8%) would recommend the use of EC and 63.2% would use it if they needed. The multivariate analysis indicated that students who were older (>20 years), presently sexually active, and living with their parents were more likely to be aware of EC (p<0.05).

Conclusion

The students’ knowledge and utilization of EC were low. Health education and promotion should be targeted towards these students, and the EC services should be offered on campus.     

Condom use and its consistency among metropolitan high school students in Croatia, 1997-2001: has anything changed?

Sexually active adolescents face serious health risks associated with unprotected sexual intercourse, such as HIV infection and other sexually transmitted diseases (STDs), as well as unwanted pregnancy. To assess protective behavior among urban adolescents in Croatia we surveyed over 4000 high-school students, 15-19 years of age, in two waves: 2070 in 1997 and 1972 in 2001. The survey was carried out in various types of secondary schools in the capital city. The analyses suggest statistically significant increase in HIVIAIDS related knowledge in the observed period. A slight but significant increase was also observed in the acceptance of condom use. Both changes were more substantial among female students. In regards to protective behavior, we found significant increase in condom use, as well as in its consistency. Still, a large proportion of students did not use condom at last sexual intercourse (40% in 2001). In addition to generational effect, number of sexual partners, sexual victimization and mother's education (only in the case of young women) were identified as correlates of condom use consistency. While mother's education had positive effect, having 4 or more partners and having survived sexual violence decreased the likelihood of consistent condom use. In conclusion, the authors discuss the relevance of systematic school-based prevention of sexual risk taking among Croatian adolescents.     

Sexuality,Contraception and Pregnancy in a High-School Population

Students in a middle-class and in an economically lower-class high school were surveyed regarding their attitudes and behavior with respect to sexuality, contraception, and pregnancy. A large majority of students approved of premarital intercourse for both sexes within the context of a loving relationship. The most important deterrent to sexual intercourse was fear of pregnancy. A majority of both sexes had had sexual intercourse. Forty percent of the sexually active had used no contraception on some occasions, and many of the remainder had used poor methods such as withdrawal or rhythm. The pregnancy rate was high—at least 20 percent in several of the sexually active subgroups.Parents were an infrequent source of information about sex. On the other hand, there was some evidence that students exposed to a sex education program retained useful information if it was relevant to their situation, and if they were appropriately motivated.A model for integrating the various aspects of this subject area is offered.     

Effectiveness of School-based Education on HIV/AIDS Knowledge, Attitude, and Behavior among Secondary School Students in Wuhan, China

Background

Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) are among the most complex health problems in the world. Young people are at high risk of HIV and AIDS infections and are, therefore, in need of targeted prevention. School-based HIV/AIDS health education may be an effective way to prevent the spread of AIDS among adolescents.

Methods

The study was a school-based intervention conducted in three middle schools and two high schools in Wuhan, China, which included 702 boys and 766 girls, with ages from 11 to 18 years old. The intervention was a one-class education program about HIV/AIDS for participants. HIV/AIDS knowledge, attitude, and high-risk behaviors were investigated using an anonymous self-administered questionnaire before and after the education intervention. Chi-square test was used to compare differences before and after the intervention. Non-conditional logistic regression analysis was used to identify the factors that affect HIV/AIDS knowledge.

Results

Misconceptions about basic medical knowledge and non-transmission modes of HIV/AIDS among all the students prevail. Approximately 10% to 40% of students had negative attitudes about HIV/AIDS before the intervention. After the intervention, all of the students had significant improvements in knowledge and attitude about HIV/AIDS (P<.05), indicating that educational intervention increased the students’ knowledge significantly and changed their attitudes positively. Logistic regression analyses indicated that before the intervention the students’ level of knowledge about HIV/AIDS was significantly associated with grade, economic status of the family, and attitudes toward participation in HIV/AIDS health information campaigns.

Conclusions

HIV/AIDS education programs were welcomed by secondary students and positively influenced HIV/AIDS-related knowledge and attitudes. A systematic and long-term intervention among secondary school students must be conducted for the prevention of HIV.     

Knowledge of possible pregnancy at first coitus: a study of in-school adolescents in Ibadan, Nigeria

This paper discusses the reproductive health knowledge of Nigerian in-school adolescents, with special reference to pregnancy occurrence at first coitus. The data were derived from an Association for Reproductive and Family Health (ARFH) survey carried out in four secondary schools in Ibadan, Nigeria, between August and October 1995. A total of 828 students were interviewed. The results revealed that the majority of sexually active adolescents were not aware of the consequences of their actions. Religious affiliation and number of wives in a male adolescent's family, and religion and marital status of a female adolescent's parents, were found to influence adolescents' knowledge of pregnancy probability at first coitus. This paper confirms earlier findings that the majority of Nigerian adolescents do not know the consequences of sex. Therefore, a clear-cut plan of action is needed to inform sexually active adolescents through an effective sex education programme.     

University students' knowledge of, and attitudes towards, hiv and AIDS, homosexuality and sexual risk behaviour: a questionnaire survey in two finnish universities

Summary This study describes Finnish university students' knowledge and attitudes towards HIV and AIDS, homosexuality and sexual risk behaviour. Finnish-speaking students were randomly selected from all registered students at two universities in Finland (N=9715, n=950). The data were collected by using a modified version of the State University of New York at Buffalo School of Nursing AIDS Study Questionnaire on sexual risk behaviour developed by Held and Chng. The total response rate was 35% (n=333). The data were analysed using quantitative statistical methods. Normally distributed data were analysed by t-test and one-way ANOVA, with Bonferroni corrections. Non-normally distributed data were analysed using the Mann-Whitney U-test and Kruskal-Wallis test, followed by a post-hoc test. The majority of students were familiar with HIV and AIDS, including its mode of transmission. However, there were still some misconceptions concerning HIV and AIDS. The oldest students and women had a more positive attitude towards people living with HIV and AIDS (PLWHA). Of patients with HIV or AIDS, intravenous drug users were perceived most negatively. Male students had more homophobic attitudes. Students who reported that religion had an important role in their lives had significantly stricter attitudes towards sexual risk behaviour. Students' knowledge correlated positively with general attitudes towards HIV and AIDS. Knowledge about HIV and AIDS will lead to more positive attitudes towards HIV and AIDS as a disease, towards those infected as well as homosexual people. There is a need to focus on preventive health care and sexual health promotion by educating young people and changing their attitudes towards sexual risk behaviour.     

Sexual behaviour, contraceptive practice and knowledge of AIDS of Oxford University students

In 1987, a questionnaire was sent to 584 undergraduate students at Oxford University requesting information about their sexual behavior and contraceptive practices as well as the impact of acquired immunodeficiency syndrome (AIDS) on both these factors. Of the 374 responders, 65% of the women and 62% of the men had experienced sexual intercourse; 1st intercourse had occurred at ages 16-20 years for 89% of the experienced women and 83% of the men. For 36% of women and 37% of men intercourse had been with 1 partner only, for 28% of women and 27% of men with 2-3 partners, and for 36% of both men and women with more than 3 partners. 27% of the women reported no contraceptive was used at the time of 1st intercourse. During the 4 weeks preceding completion of the questionnaire, 15% of sexually active female undergraduates reported not using adequate contraception. Users during this period selected the pill (64%), condom (19%), IUD or diaphragm (9%), or withdrawal/rhythm (8%). General knowledge about AIDS was highly accurate among these students. Most students considered themselves to be at lower risk of contracting AIDS than others of their age and sex. Of the 78% of students describing themselves as at lower than average risk, 14% had had intercourse with more than 3 partners, while 50% of the 20% of students who ranked themselves as at average risk had this number of partners. Only 2% placed themselves as at above average risk, and 65% of these students had had more than 3 sexual partners. Of students who were sexually active, 35% of the females and 44% of the males indicated they are now more likely to use a condom because of fear of AIDS. 49% of the females and 30% of the males indicated they had, or would have, fewer sexual partners because of the AIDS risk. However, there was no association between increased likelihood of condom use and the total number of sexual partners and having had intercourse with someone in a high-risk group for AIDS (prostitutes). Overall, however, these findings suggest that the AIDS threat is producing reductions in high-risk behaviors.     

Contemporary patterns of adolescent sexuality in urban Botswana

In Botswana, as in other areas in southern Africa, there is a growing concern about the risks associated with adolescent sexuality. To facilitate the design of policies that can address these problems, it is necessary to gain a thorough understanding of contemporary patterns of adolescent sexual behaviour, and the factors that affect them. This paper examines these issues using data from the 1995 Botswana Adolescent Reproductive Health Survey in conjunction with data from focus group discussions. The results suggest that adolescents become sexually active at an early age, and that many of them, males and females alike, have multiple sex partners. This early sexual initiation implies that adolescent reproductive health programmes should target youths aged 13 or younger. For school-based programmes this implies starting no later than Grade 6 or Standard 1, and preferably earlier. Young males appear to be a particularly vulnerable group that needs further attention. Adolescents perceive that teachers, peers and parents have the largest influence on their reproductive health attitudes. Schools appear to have the most potential for providing reproductive health information, because they reach youths both directly and indirectly by educating their peers. The results also show that male and female sexual behaviour is affected by different factors. Among males, having secondary education strongly increases the odds of being sexually active, presumably because such males make attractive partners. Among females, on the other hand, being in school significantly reduces the odds of being sexually active. This finding is consistent with the policy imposing a one-year school expulsion for pregnant schoolgirls, which was implemented as a deterrent to schoolgirl pregnancy.     

Higher Risk Perception of HIV than of Chlamydia and HPV among Secondary School Students in Two German Cities

Background

Chlamydia and genital human papillomavirus (HPV) are the two most common sexually transmitted infections (STIs) among teens and young adults in industrialised countries. The majority of adolescents, however, have limited or no knowledge of these infections. Within the context of a cross-sectional survey on awareness and knowledge of sexually transmitted infections, secondary school students attending the 8th grade and above in Bremen and Bremerhaven, two cities in northern Germany, were asked to rate the risk of peers to get infected with HIV, HPV or chlamydia.

Methods

Between October and December 2011, students aged 12–20 years completed an anonymous, self-administered questionnaire at their school. In addition to answering questions on awareness and knowledge of sexually transmitted infections, all students were also asked to rate the risk of peers to get infected with HIV, HPV or chlamydia. Furthermore, those reporting ever having sexual intercourse were asked to rate their own risk of getting infected with each of the three infections.

Results

1,148 students, 55% female, completed the questionnaire. 27% of the students reported having had sexual intercourse. 68% of all students rated the risk of same-aged students to get infected with HIV/AIDS as high/medium. The corresponding proportions for HPV and chlamydia were 19 and 25% respectively. Those reporting ever having sexual intercourse generally perceived their own risk of getting infected with HIV, chlamydia or HPV as lower than that of their peers.

Conclusion

Generally, the risk of getting infected with HIV was perceived as being higher than that of getting infected with HPV or chlamydia, most likely due to the fact that the students were more aware of HIV than of the other two infections. Efforts should be made to improve awareness and knowledge of HPV and chlamydia among school going adolescents, and to make them realize that these are common infections that are preventable.     

Cross-sectional study on attitudes toward sex and sexual behavior among Japanese college students

A total of 978 Japanese students, who visited the health services center of a college in Japan for medical check-ups, were asked to anonymously complete a 55-item questionnaire which assessed their attitudes toward sex and sexual behavior. Seven hundred eighty-five Japanese students (80.3%) responded to the questionnaire. In this survey, 90% of male students and 83% of female students indicated that they expected to have sexual intercourse before marriage, while 8% of male students and 3% of female students indicated that it was not wrong to have extramarital sexual intercourse after marriage. In addition, 75% of sexually experienced students reported that they used a condom during their first sexual intercourse, while 73% reported using a condom during their most recent sexual intercourse. The more sexual partners students had had up to the time of the study, the less condom use they reported for both their first and most recent sexual intercourse. The proportion of Japanese students who used a condom is high in comparison to that of students in other countries. However, as students are prone to have sexual intercourse with non-steady, casual partners, more efforts are needed to promote safe sex practices among college students in Japan.     

The evolutionary origins of patriarchy

This article argues that feminist analyses of patriarchy should be expanded to address the evolutionary basis of male motivation to control female sexuality. Evidence from other primates of male sexual coercion and female resistance to it indicates that the sexual conflicts of interest that underlie patriarchy predate the emergence of the human species. Humans, however, exhibit more extensive male dominance and male control of female sexuality than is shown by most other primates. Six hypotheses are proposed to explain how, over the course of human evolution, this unusual degree of gender inequality came about. This approach emphasizes behavioral flexibility, cross-cultural variability in the degree of partriarchy, and possibilities for future change. This work was supported in part by NSF grant BNS-8857969. Barbara Smuts is a professor of psychology and anthropology at the University of Michigan. She received her B.A. in social anthropology at Harvard and her Ph.D. in bio-behavioral sciences at Stanford Medical School. She has studied the behavior of wild chimpanzees, baboons, and bottlenose dolphins and is particularly interested in evolutionary, comparative analyses of female-male relationships.     

Sexuality, color, and stigma among Northeast Brazilian women

Despite its international image as a sexually free-spirited country, local attitudes toward morality of sexual behavior remain complex throughout Brazil, especially in rural areas and the conservative Northeast region. In addition, notwithstanding its official ideology of nonracism, African ancestry as judged through personal appearance (color) constitutes a significant social and economic disadvantage. Using Goffman's idea of "spoiled identity" as a starting point, I show how locals use sexual behavior as a multivocal symbol of moral status in women, and how spoiled sexual reputation interacts with other stigmatized statuses, especially color. I also consider how the acquisition of sexually stigmatized status jeopardizes women's well-being and that of their children. [Brazil, color, gender, sexuality, stigma, women]     

Teenagers' knowledge of emergency contraception: questionnaire survey in south east Scotland.

OBJECTIVE--To determine the level of knowledge of emergency contraception among 14 and 15 year olds. DESIGN--Confidential questionnaire survey. SETTING--10 secondary schools in Lothian, south east Scotland. SUBJECTS--1206 pupils predominantly (98.7%) aged 14 and 15 in the fourth year of secondary school. MAIN OUTCOME MEASURES--Knowledge of the existence of emergency contraception; of its safety, efficacy, and time limits; and of where to obtain it. RESULTS--1121 (93.0%) fourth year pupils aged 14-16 had heard of emergency contraception. 194 girls (32.7%) and 168 boys (27.5%) had experienced sexual intercourse. Of girls who had experienced sexual intercourse, 61 (31.4%) had used emergency contraception. Knowledge of correct time limits was poor, sexually active girls being the most knowledgeable. Pupils attending schools ranked lower than the national average for academic attainment were less likely to have heard of emergency contraception and more likely to have been sexually active. 861 (76.8%) pupils knew they could obtain emergency contraception from their doctor. 925 (82.5%) pupils believed emergency contraception to be effective but 398 (35.5%) thought it more dangerous than the oral contraceptive pill. CONCLUSIONS--One third of sexually active girls aged under 16 in Lothian have used emergency contraception. This may help explain the fairly constant teenage pregnancy rates despite increasing sexual activity. Scottish teenagers are well informed about the existence of emergency contraception. However, many do not know when and how to access it properly. Health education initiatives should target teenagers from less academic schools as they are more likely to be sexually active at a young age and are less well informed about emergency contraception.     

Adolescents’ Experience and Knowledge of,and Attitudes toward,Bees: Implications and Recommendations for Conservation

Invertebrates are generally regarded with apathy, distaste, and fear in Western society. These negative sentiments likely contribute to the disparity in wildlife conservation efforts, which largely favor vertebrate organisms. Bees represent one of the most ecologically and economically important invertebrate groups, yet bee diversity and abundance is declining worldwide, mirroring the general decline of invertebrate biodiversity. Developing and implementing successful conservation efforts requires interdisciplinary research that considers the ecological and social realities of today’s world. To better inform conservation efforts related to bees, we examined adolescents’ experiences and knowledge of, and attitudes toward, bees and investigated how these dimensions related to one another. A total of 794 eighth-grade science students from the suburbs of Chicago, USA completed a 48-item, paper questionnaire. The results indicated that adolescents were only somewhat knowledgeable about bee biology and services, and they confused bees with other flying insects, especially those with black-and-yellow coloration. Adolescents regarded bees with a generally neutral attitude; their knowledge and attitudes were correlated in a positive manner. Various bee-related experiences were linked to adolescents’ knowledge and attitudes and may have influenced bee-related behavior. In particular, students who engaged in gardening and lawn-care activities demonstrated higher levels of knowledge and more positive attitudes. This study provides insight into the relationships between experiences and knowledge of, and attitudes toward, invertebrates and suggests that engaging in certain outdoor activities may promote positive attitudes toward bees among adolescents.     

Physical fitness, aging, and sexuality

Sexuality is a major quality-of-life issue, even into advanced age. Although relatively few studies have addressed sexuality, most studies have emphasized the decline in both sexual performance and satisfaction with aging. In an effort to assess possible positive modifiers of the decline, we included questions concerning sexuality in a multipurpose 90-item questionnaire submitted to members of the Fifty Plus Fitness Association based in Stanford, California. This group is unique in its commitment to a very active lifestyle and has served as a cohort for many prior studies related to fitness and medical outcomes. Sixty-seven percent of the membership returned the mail questionnaire, and 59% of these respondents replied to the sexually relevant items. The results indicated a high level of sexual activity and satisfaction in both older men and women of the Fifty Plus Fitness Association members. Further, sexual satisfaction seemed to correlate with the degree of fitness. We conclude that physical fitness and high levels of sexual activity are mutually supportive elements of successful aging.     

HIV/AIDS and Croatian migrant workers

Due to their geographical mobility and long periods of separation from intimate partners, migrant workers are at increased risk for a variety of sexually transmitted infections (STIs) including HIV/AIDS. This study sought to investigate patterns in HIV/AIDS related knowledge, attitudes and sexual behaviour in migrant workers in Croatia. In 2003, 566 male migrant workers were recruited during regular required medical examinations and surveyed at seven locations throughout the country. Each participant was asked to complete a self-administered KABP (sexual knowledge, attitudes, beliefs and practices) questionnaire. The average age of respondents was 38.2 years and the majority worked as seafarers (77.3%) and construction workers (20.5%). Only 18.5% of respondents were able to correctly answer all 13 questions assessing knowledge of HIV/AIDS. Seafarers reported higher levels of knowledge than did construction workers. The average respondent reported having had two sexual partners in the last 12 months, with slightly over half of the respondents (55.3%) reporting condom use at their last intercourse with a casual partner. One fifth of the respondents (20.3%) who reported having had intercourse with a sex worker during the last year reported not using condoms at last intercourse. The number of sexual partners was correlated with age, marital status, faith in God, and personal HIV risk assessment. Attitudes toward condom use, co-workers' HIV/AIDS concerns and the duration of migrant status (within the last two years) were shown to be significant correlates of condom use at last intercourse with a casual partner. The effect of HIV/AIDS related knowledge on analyzed behaviors did not reach statistical significance. Inadequate patterns of migrant workers' condom use, gaps in knowledge about HIV transmission and modes of protection, as well as widespread ignorance regarding available anonymous HIV testing found by this study suggest a critical need for expert intervention to avert the potential for an increase in new HIV/AIDS cases. A coordinated, systematic campaign for HIV/AIDS prevention among Croatian migrant workers should focus on increasing peer communication about HIV/AIDS, especially among younger migrant workers, and on reducing the frequency of sexual risk taking.     

Sexual behaviours and contraception among university students in Turkey

The aim of this study was to evaluate the sexual attitudes and behaviours of university students. An anonymous questionnaire was administered to 550 final-year university students aged 20-25 years in Izmir, Turkey. Male students opposed premarital sexual intercourse for both genders more than female students did. The frequency of sexual intercourse among male students (61.2%) was higher than that among female students (18.3%). The mean age of first sexual intercourse was lower among male than among female respondents. The rate of condom use at first sexual intercourse was 47.4%. The frequency of having two or more past sexual partners and masturbation was higher among males than females. It was found that there were culture-specific and gender-dependent differences in sexual attitudes and behaviours of the university students. These results may help in the planning of education and health policies in Turkey.     

Low-investment copulation: Sex differences in motivations and emotional reactions

Samples of male (n = 113) and female (n = 175) college students were surveyed. Majorities of both sexes agreed with statements indicating that males' sexual attractiveness varied more than females' sexual attractiveness as a function of their status. Subjects who reported more sex partners and a greater aversion to sexual monogamy were slightly more likely to agree that they tested their partners to see how far they could push them. Interviews with highly sexually active females (n = 32) and males (n = 24) indicated that low-investment copulation and lack of control over the sexual access-investment ratio caused even women with very permissive attitudes and multiple sex partners to develop an aversion to low-investment copulation. Three levels were identified in this process. The techniques that women with multiple partners used to deal with their feelings are described. Females tested their partners for ability and willingness to invest. Males tested for opportunities to reduce investment and pursue other women. High status, for example athletic stardom, transformed males' sexual attractiveness to women and numbers of sex partners. Results were consistent with the view that the emotional-motivational mechanisms that moderate sexual arousal and attraction are sexually dimorphic.