Recent National Survey of Family Growth data indicates that approximately 70% of men and 61.9% of women of reproductive age in the United States use some form of contraception [6
] (). The rate of contraception use in our medical student population was approximately 70% for men and 76% for women. It is suggested from these results that male medical students have contraceptive utilization in line with age-adjusted normative data, but female medical students are more likely to use contraception than their age-matched peers. Medical students older than 35 years of both genders were less likely to use any form of contraception compared to their peers aged 20–35 years. This differs from the general population, in which increasing age predicts lower utilization of contraception in men and higher utilization in women ().
Rate of any contraception use in North American populations
More common use of contraception among female medical students when compared to their age-matched peers is not particularly surprising given the time commitment pregnancy entails; female physicians have long been known to face challenges in family planning, and the average physician has her first child in residency [12
]. In North America, most women enter residency after the age of 25, the mean age of US women completing their first pregnancy [13
]. Women with higher levels of education generally seek more contraceptive services and have lower rates of fertility compared to women of lesser education achievement [11
]. Our data certainly supports this assertion as our subjects are among the most educated men and women in North America.
Race was predictive of differences in contraceptive usage in our medical student population. The association of race is very important and could be influenced by a number of factors, including cultural, economic and social differences relating to beliefs on contraception. Interestingly, our data differs from national data on contraception usage, in which Hispanic men have lower utilization of contraception than both white and black men [9
]. National data also suggests that white women are more likely than blacks or Hispanics to use some form of contraception. In our cohort, the rate of contraception usage was very similar between black and Hispanic women (57.6% and 59%, respectively). While a recent study determined that access to contraception in the United States was relatively equal between ethnic groups, significant differences in counseling about options exist and may influence utilization rates [15
]. While education may play a role in the national data, our study represents women and men of equal educational level, demonstrating the need for further outreach and studies to elucidate the factors behind differing contraception levels in these communities.
Our data indicate that students are more likely to use contraception if they are in a relationship than if they are single. However, students who were married were less likely to use contraception than those in nonmarital or partnered relationships. Although it was not assessed in our study, it is likely that a desire to initiate a pregnancy was driving some married subjects to avoid contraceptives.
Additionally, it is also likely that many of the married subjects were in monogamous relationships in which STD prophylaxis was not a particular concern. Unmarried individuals who were in a relationship were more likely to utilize some form of contraception relative to their married and single peers. This effect is likely related to increased sexual activity (relative to single students) with a concomitant desire to prevent unintended pregnancy.
In this study, students who were comfortable discussing sexual matters with patients were more likely to use effective contraception. This was consistent among all groups and likely represents a major factor influencing contraception practices among students. These findings are congruent with previous research [3
] and provide evidence for the relationship between personal knowledge regarding sexuality and ability to communicate with patients about sexual issues. Given the importance of sexuality in personal health, it is imperative that medical professionals feel comfortable discussing sexuality with patients. Our findings demonstrate that, in addition to improved patient communication, comfort in discussing sexuality is associated with better informed contraceptive choices among providers.
Interestingly, students who felt that they had been well trained in sexuality during medical school were no more likely to utilize effective contraception. It cannot be denied that education during medical school is an important tool in acquiring contraception knowledge, and we believe that this finding is related to the way the question was phrased (i.e., with a greater emphasis on sexuality than on contraception). Furthermore, an individual’s own contraception practice is likely set before medical school and may not be affected by training.
Despite a relatively high rate of contraception usage, a substantial minority of students in this study utilized contraceptive options with poor efficacy in the prevention of unintended pregnancies. The majority of male students in our sample were aged 25–29; this age group has been shown to be at high risk for failure to use contraception and/or use of ineffective modalities such as withdrawal [16
]. Furthermore, there is a very clear difference in contraception utilization rates based on race and age. It cannot be gleaned from this data whether this effect is derived from a false sense of security or invulnerability regarding risk of pregnancy in this population or a lack of accurate information or personal beliefs regarding contraception. This interesting and concerning finding is worthy of further research and may have implications for medical educators when designing medical school curricula about contraceptive options.
These findings are of importance to health care providers who provide services to medical students, as well as to the larger population of college and post-graduate students. It is clear that there are medical students in need of more counseling and education around contraception and safer sex practices; student health centers should collaborate with medical educators to ensure that students receive proper education and counseling regarding contraception and safer sex as well as access to effective contraception for personal use. The need for medical students to be well informed on matters pertaining to safer sex is particularly great, as these individuals may have profound influences on the public at large in the line of professional duties.
Several important limitations of this study must be addressed. This study represents a small proportion of North American medical students. Individuals with liberal views on sexuality and sex practice may be more likely to take and finish a sexuality survey and therefore our results may not be representative of the general medical student population. The regularity of contraceptive use was not quantified in this study. Furthermore, we did not directly explore the rationale for failure to use contraceptives. Some students may lack knowledge about effective contraception. Others may avoid contraception for religious or cultural reasons, or because they are attempting to initiate pregnancy. Individuals who participate in sexual activities other than coitus may have different needs for contraception, although the risk of STDs remains significant with noncoital sexual activity and safer sex practices should still be emphasized with these activities. It is for this reason that all students were included in the contraceptive analysis, which, as noted above, allows more comparison to known national demographic data which does not control for sexual minority groups.
Additionally, the National Survey of Family Growth data do not include any information on the contraceptive practices of Asian-Americans, which limits our capacity to compare our Asian medical student population to national norms for this major demographic group. Asian-Americans often have been neglected in large-scale analyses of contraception utilization [15
]. Further investigations on racial predictors of contraceptive usage will be required to more clearly ascertain how representative our data are of the larger Asian-American population.
Despite these limitations, our findings suggest some important predictors of effective and ineffective contraception use; these data may be of value to medical school administrators and educators as well as to student health providers.