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02-05-2017

Non-Heterosexuality, Relationships, and Young Women’s Contraceptive Behavior

Authors: Elizabeth J. Ela, Jamie Budnick

Published in: Demography | Issue 3/2017

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Abstract

Non-heterosexual young women have a higher rate of unintended pregnancy than their heterosexual peers, but their fertility behaviors are understudied. We use longitudinal data from the Relationship Dynamics and Social Life study to investigate mechanisms contributing to non-heterosexual women’s higher pregnancy risk. These data include weekly reports of relationships, sex, and contraceptive use over 30 months. We compare the relationships and fertility behaviors of three groups: exclusively heterosexual (consistent heterosexual behavior, identity, and attraction); mostly heterosexual (heterosexual identity with same-sex behavior and/or same-sex attraction); and LGBTQ (any non-heterosexual identity). We find that mostly heterosexual and LGBTQ women behave differently from exclusively heterosexual women in ways likely to elevate their risk of unintended pregnancy: more distinct partners during the study period, more sexual intercourse with men, less frequent contraceptive use, less use of a dual method (condom plus hormonal method), and more gaps in contraceptive coverage. Mostly heterosexual women resemble LGBTQ women in their contraceptive behavior but have significantly more intercourse with men, which may increase their pregnancy risk relative to both LGBTQ and exclusively heterosexual women. We conclude by considering implications for LGBTQ health and the measurement of sexual minority populations.

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By “non-heterosexual,” we mean people who are attracted to or have had experience with same-sex partners, or people who identify as lesbian, gay, bisexual, or not straight.

Barber et al. (2011) estimated 96 % agreement between the Michigan Department of State database and the projected number of 18- and 19-year-old women in the county based on the 2000 census. Please see Barber et al. (2011) for additional technical details about the design and implementation of RDSL.

See Table 5 in the appendix for a comparison of our analytic sample, the full RDSL sample, and women aged 18/19 in the nationally representative National Survey of Family Growth sample. We discuss differences between these samples and the potential effect of selection bias on our results in greater detail in the Discussion section.

Some notable differences between NSFG and RDSL question wording produce different prevalences of non-heterosexuality. (NSFG prevalences describe women ages 18–24; see Copen et al. 2016). The NSFG behavior measure specifies sex (19.4 % report a lifetime history of any sex with a female partner), and the RDSL measure captures a broader range of romantic and sexual behavior. The NSFG identity question limits response options to heterosexual/straight, homosexual/gay, or bisexual (10.5 % report anything other than straight). The NSFG attraction question includes response options for “only” men/women, “mostly” men/women, and “equally” men/women (24.1 % report anything other than “only the opposite sex”), while the RDSL measure includes a more open-ended response option. RDSL measurement choices are informed by sexualities research (Diamond 2008a, b) and community-specific recommendations for language choice (Badgett 2009) and are designed to capture a broad range of non-heterosexual people and practices.

As a sensitivity check, we conduct a version of analyses excluding respondents who answered, “I don’t label myself in this way.” These results are comparable with those presented here.

The diversity of terms used in research on sexual minorities reflects the inherent complexity of sexuality as well as the foci and priorities of different research traditions. We have used terms that clearly and consistently identify our three analytic groups, reflect meaningful distinctions among our respondents, and are common in research on sexuality and popular discourse (Coleman-Fountain 2014; Diamond 2008a, b; Savin-Williams and Vrangalova 2013).

The prevalence of non-heterosexual identity in the RDSL sample is comparable with the prevalence of non-heterosexual identity in the Add Health sample (15 %) (Savin-Williams and Ream 2007).

These associations could result from sociodemographic differences in behavior, identity, and attraction but could also result from differences in young women’s willingness to disclose non-heterosexuality to a researcher.

Hispanic ethnicity is assessed in a separate question. Our sample includes 19 Hispanic black women and 28 Hispanic white women whom we categorize as black and nonblack, respectively. The “Other” groups are combined with white respondents as part of the nonblack category because they more closely resemble white women.

Results do not change appreciably when these three variables are included as separate predictors.

A respondent in a long-term relationship at baseline who stayed with that partner for much or all of the journal study could have a very high value on average relationship duration. Results do not change when long relationship outliers (n = 6) are excluded.

This is consistent with an analysis of sexual behavior among college women that found that some lesbian and bisexual women reported having “penetrative sex” with women (Ford and England 2015). The authors hypothesized that this could be sex with fingers or toys, and called for researchers to include unambiguous definitions of sex in survey language.

Women were already pregnant in 1,923 journal weeks (4.1 % of weeks in the analytic sample). Women reported strong pregnancy desire in 738 journal weeks (1.5 % of weeks in the analytic sample). When these weeks are excluded, the analytic sample decreases from 579 to 578 women because one woman reported strong pregnancy desire in all journals. These 578 women contributed 47,068 eligible weeks.

We categorize each use week as LARC (long-acting reversible contraception: includes IUD, implant, and Depo-Provera), pill/patch/ring, condoms, or withdrawal. Categories are mutually exclusive and give priority to the most effective method used in a given week.

OLS regression may yield illogical estimates when the outcome is a proportion. Thus, we conducted a version of analyses using generalized linear models (GLM) with a binomial error distribution, which is appropriate when the outcome is bounded from [0,1] and both endpoints are valid values (Papke and Wooldridge 1996). This method produced nearly identical results and the same substantive conclusions, so we present the OLS models for ease of interpretation. (GLM results are not shown; available upon request.)

We ran all models with and without controls. We present only the version with controls because the sexuality coefficients do not change appreciably when controls are added.

Weighted proportions among women aged 18/19 in the 2006–2010 NSFG (authors’ tabulations).

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Title: Non-Heterosexuality, Relationships, and Young Women’s Contraceptive Behavior
Authors: Elizabeth J. Ela
Jamie Budnick
Publication date: 02-05-2017
Publisher: Springer US
Published in: Demography / Issue 3/2017
Print ISSN: 0070-3370
Electronic ISSN: 1533-7790
DOI: https://doi.org/10.1007/s13524-017-0578-y

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