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American women are putting the "safe sex" message into practice, as evidenced by the growing use of condoms, according to the latest figures from the National Survey of Family Growth. Condom use more than tripled among never-married women between 1982 and 1995, from 4% to 14%. Condom use at first intercourse increased from 18% in the 1970s, to 36% in the late 1980s, to a 54% level in the 1990s.1
The newly released report is the fifth cycle of the national survey, conducted by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics in Hyattsville, MD. It is based on personal interviews with a sample of women ages 15 to 44, with previous surveys conducted in 1973, 1976, 1982, 1988, and 1990. The latest survey polled 10,847 women between January and October 1995, says Linda Piccinino, MPS, a CDC statistician/demographer who analyzed the data for the new report.
Interviewers picked up more reports of condom use partly because of a change in the 1995 survey that allowed them to ask about the use of contraceptive methods for any reason, she says.
The survey team then standardized the figures to match what had been done in previous cycles. If women in the 1995 survey reported use of more than one method, then interviewers listed the most effective method.
"The only difference this would make is if they were just using condoms for STD prevention, and then we would count that as currently using the condom," Piccinino says. "Whereas in previous cycles, we would not have counted it because they would not have mentioned it as a birth control method."
Interviewers were able to get the first information on use of injectables, implants, and female condoms in the 1995 survey, she says. "This is the first time we’ve had an opportunity to ask about ever-use of those methods and current use of them and to include them in all of our method use questions."
While the proportion of women in 1995 using these new methods was small hormonal injectables were noted by 2%, implants by 1%, and female condoms by less than 1% the figures will give the survey team a baseline to measure growth when the next cycle of the survey is done around the year 2000.
When it comes to contraceptive choices, sterilization remains the leading choice, followed closely by birth control pills. A total of 17.8% of women reported sterilization in the 1995 survey, with 17.3% relying on oral contraceptives. Condom use was ranked third at 13.1%, with male sterilization at 7%. Methods such as injectables and the diaphragm were used by 2% or less of women, as were withdrawal and periodic abstinence. Implants, IUDs, and female condoms were even further down the list, used by less than 1% of women surveyed.
Results from the 1995 survey bring encouraging news in the form of lower rates of unwanted pregnancies. Ten percent of births between 1990 and 1995 were unwanted by the mother at the time of conception, compared with 12% between 1984 and 1988. For black women, the drop was significant, with a 29% to 21% decrease in unwanted births during the same time period.
Efforts to screen for sexual infections that lead to pelvic inflammatory disease (PID) may be paying off, as the number of women who reported treatment for the disease fell from 14% in 1982, to 11% in 1988, to 8% in 1995.
The CDC’s division of STD prevention has taken several steps since 1990 to help providers lower the PID rate, says Sevgi Arol, PhD, the division’s associate director for science. The CDC, along with the National Institutes of Health, collaborated in publishing comprehensive information on PID in 1991 and has continued to extend its chlamydia screening projects to reach more men and women at risk for the disease.
The survey also records a drop in vaginal douching, a finding that is good news to the CDC and other health organizations that have been cautioning women about its negative effects, says Arol. "It seems as if many health care providers are now telling their patients that douching is not helpful, it’s not necessary, and in fact, it may be dangerous," she says. "So that seems to be having an effect too. All of these are quite pleasing changes."
1. Abma JC, Chandra A, Mosher WD, et al. Fertility, family planning, and women’s health: new data from the 1995 National Survey of Family Growth. National Center for Health Statistics. Vital Health Stat 1997; 23(19).