This month, researchers from the Section of Family Planning & Contraceptive Research presented results of several ongoing studies at the North American Forum on Family Planning. Dr. Elisabeth Woodhams, now a physician at Thomas Jefferson University Hospital, discussed her findings from a focus group study that sought to understand African American adolescent males’ perceived responsibility for pregnancy prevention. Dr. Woodhams also received the award for the top presentation from an investigator in training.
Dr. Elisabeth Woodhams
Men, particularly young men, are often left out of conversations about how to improve contraception use, but male partners can have significant influence over the contraceptive and pregnancy decisions of their female partners. Several studies indicate that women are more likely to stick to a chosen method if their partners know they’re using it, or if the partner is involved in the decision to use that method. The reality of this influence drove Dr. Woodhams to wonder how the partners regard this responsibility. Her study included teenaged African American males enrolled in charter schools on Chicago’s South Side. Several compelling themes emerged in Dr. Woodhams’ findings. One theme throughout was that even though the young men reported feeling responsible for the outcome of an unplanned pregnancy, it did not mean they acted to prevent pregnancy.
Focus on condoms, lacking knowledge of non-barrier methods
When asked about ways to prevent pregnancy, the most common answers were condoms, pull out, or don’t have sex. All had heard of pills, some had heard of IUDs or vaginal rings, and none knew about the contraceptive implant. Some had heard of Plan B, but often thought of it as a shot. Several quotes below reflect some of the misunderstandings about methods:
“…I heard about one where you put it under a layer of skin in your arm. It’s called….Nuvaring.”
“She get the morning after shot and they’ll just kill all the sperm…”
“I also heard of that thing…they take the top off and put it in their vagina or whatever. Like it knock out, it blocks it. It works for years. It’s called… starts with ovulation.”
“All I heard is it goes inside them, but if you hitting it, if you playing bump around, you can knock it out of place.”
Primary role in sex was condom use and provision
Participants did know a lot about condoms, felt responsibility to provide and use a condom, and really only considered condom use when they talked about “protection.”
“…she like grabbin’ me…and just automatically stop and be like ‘you got the rubber?’ and I’m like ‘what?!’ … and most of the time I do because I always carry condoms like in my back pocket or something…”
“I take at least a third of the condoms… and I take ‘em to my girl crib. Cause I might come over there and then, you know, something might happen, I know that if I didn’t bring a condom I got somethin’ over there with her.”
STI prevention greatest motivator in condom use
STI prevention was the greatest motivator for condom use and reflected attitudes about partners.
“I’mma need some condoms ’cause. Like, it wasn’t the fear of me havin’ a baby as the fear of me catchin’ something.”
“You still use a condom. I don’t know what she got. No matter what. Like, a girl could be on birth control all her life. She could be on the best birth control. I’m still not gon’ go in raw.”
“Even before you get down to the having sex part you should always ask a girl when the last time she got checked up.”
Partner type, access, and family indirectly impacts condom use
Motivation to use condoms in a specific sexual encounter was indirectly mediated by several things, the most notable being the “type” of girl they’re having sex with, access to condoms, and family influence. The vast majority of the conversations were actually about the various names and terms the teens had for the girls they have sex with. For instance, “thots” were considered “dirty girls” who sleep with anyone, are likely to have an STI, and are not worthy of respect. “Mains” are a more regular partner, although not necessarily a monogamous partner. Young men behaved differently when they were with casual partners than when they were with more regular partners, who in general they spoke about with more modesty and respect. With regular partners they often would forgo condoms, but several guys mentioned going to get STI testing with their partners before they made that leap. They did not universally mention discussing pregnancy prevention, although some did.
“Mod: If the thot’s like ‘man, come on get down, but you can’t use nuttin’.” Resp: “If we don’t use it then we ain’t doin’ it. Point blank.” Mod: “Okay. But wit’ yo main you not that way.” Resp: “mmm-mmm [MEANING NO]“.
“But, when it comes to like fuckin’ thots …you don’t know who they be fuckin’, you don’t know what they got, so you always wanna be protected.”
Access was also an issue, both in terms of immediate access and terms of cost and availability. As one participant observed, “We in the basement, I know I ain’t got no condoms, they’re upstairs. I’m not about to go to the 3rd floor, leaving a thot downstairs.”
Finally, participants referred to the women in their family as motivators to protect themselves, more from STIs than from pregnancy. They generally felt comfortable telling their family they were having sex, and depended on their mothers/grandmothers/aunts to provide condoms.
“Like when you first talk to yo’ moms about it, you don’t wanna tell her cause feel like somethin’ bad gon’ happen. But after you tell her it turns out different…she gonna force condoms on you because she don’t want her child to catch no disease…”
Responsible for pregnancy, but not prevention
While the participants did not prioritize pregnancy prevention, when asked directly whose job it is to prevent pregnancy they reported it was a shared responsibility. However, if pregnancy happened, it was mostly the young man’s fault, especially if they weren’t using a condom. They feared unplanned pregnancies and felt a very strong sense of responsibility if pregnancy happened – this often came out within the context of manhood. When they talked about unplanned pregnancy there was a sense of helplessness; they weren’t interested in fathering but there was little they could do about it aside from use condoms.
“And I shoulda used a condom. And basically, I’mma have to like get two jobs and like I can’t like, I’mma have to finish school so I could get a better job and I’m not even ready yet. And you thinkin’ all of this, and how your parents is gon’ react. And you havin’ a child. Like how that’s gon’ make you growin’ up so much faster and your life is basically through.”
“With the guy he has to know that he has two options that he can take. Face it like a man or basically run away. Run away and then he has that title saying ‘you a coward, you’re not a man that gon’ step up to the challenge of taking care of a child.’ But if he stays there he knows that he has to be dedicated, committed, make a sacrifice in his life.”
Dr. Woodhams found the young men in the study were much more focused on STI prevention rather than pregnancy prevention, even though they would feel responsibility if a pregnancy occurred. The concern for STIs prompts condom use, but if they believe their partner is low-risk, they will also stop using condoms. Dr. Woodhams suggested that one approach would be to leverage awareness and comfort with condom use among these young men to emphasize that condoms can also be part of pregnancy prevention. While other contraceptive methods may be more effective, young men may respond more positively to education about a method they already use. In addition, Dr. Woodhams observed that the young men perceived their sexual relationships completely based on risk, rather than on the relationship they were in with their partner. In fact, they rarely referred to a relationship at all, but easily categorized the young women they were having sex with into “good” or “bad,” “clean” or “dirty.” She suggested that sex education programs work to emphasize healthy and fulfilling relationship-building and respect as a response to these attitudes and their influence on condom use.