As research shows: among never-married women, infrequent sex ranks as one of the most common reasons for not using contraception. Ready When She Is, a CIFF-funded project creating a case for investing in on-demand contraception, sat with Gilda Sedgh, a Sexual and Reproductive Health Research Scientist, to explore the evidence – and where we go from here.
Ready When She Is (RWSI): What does the research say about the segments of women who cited infrequent or no sex as a reason for not using contraception?
Gilda Sedgh: We started our research simply examining why women across low- and- middle-income countries who want to avoid getting pregnant choose to not use contraception. We have information on sexually active, never-married women in 31 low- and middle-income countries. We found that, on average, 49 percent of women in this group who wanted to avoid pregnancy and weren’t using a contraceptive method said that they were not using a method because they had sex infrequently. Infrequent or no sex was the most common reason for not using a method cited by never-married women in 17 out of 31 countries for which we have data.
We have data on married women from 52 countries and, maybe surprisingly, many married women also said they weren’t using contraception because they have sex infrequently. About one in three married women who wanted to avoid getting pregnant and weren’t using a method in Asia, Latin America and the Caribbean, and one in five in Africa, cited infrequent or no sex as a reason for not using contraception. In 12 out of these 52 countries, infrequent or no sex is the most commonly cited reason for nonuse among married women.
We also found that the prevalence of this reason has been increasing: compared with studies on women’s reasons for not using contraception from the 1980s, more women cite infrequent sex as their reason for non-use in the most recent evidence, which is from the past decade.
RWSI: How do you define infrequent sex?
GS: Women define it for themselves. But we did do some analyses to see how many of the women who cited infrequent or no sex as their reason for non-use had sex recently. Among the married women who cited infrequent or no sex as a reason for non-use, about half (47 percent) reported being sexually active in the prior three months. In some countries, closer to 80 percent had sex in the three months before the survey. These women are probably at risk of having an unplanned pregnancy. All of the unmarried women in these analyses had had sex in the three months before the survey. The question is, how can we support them to make the choices best for their bodies and their lives?
RWSI: Women and girls who have infrequent sex – or no sex – say they would consider using contraception in the future. What’s stopping them from using contraception now?
GS: Of course, every woman is different. Some women might believe they have little or no risk of conceiving if they have sex infrequently, and some might be having infrequent sex in order to avoid an unplanned pregnancy. Others might feel that contraceptive methods available to them are too burdensome for the number of times they have sex. No matter their situation, all women can benefit from access to contraceptive options and sexual health education from trust sources that align with their needs and preferences.
Unmarried women face additional challenges related to contraceptive use. Strong taboos against sexual activity outside of marriage make it harder for them to ask for contraceptive services. They are also more likely to require methods that they can use discreetly such as pericoital contraceptive methods, including condoms, which can be used at the time of sex in non-emergency situations.
RWSI: What adaptations are needed to support women and girls who have infrequent sex to choose contraception, when they are ready?
GS: Counseling supports women who have infrequent sex to understand their risk of getting pregnant and plan for the families they desire. This education should be incorporated into their primary care services to more easily reach women who are not visiting family planning clinics.
Counseling should emphasize choice. Based on a woman’s preferences, we can support women to choose tools, like contraception, so they can take their health into their hands. For example, for some who rarely have sex, the contraceptive pills that we typically refer to as emergency contraception (contraception used in the first few days after unprotected intercourse) would help them prevent an unintended pregnancy if they do have sex. But many women who have infrequent sex do still have sex – that is, sex is not a rare event nor an “emergency.” A wide range of contraceptive choices – including on-demand options – are key.
RWSI: What opportunities do woman-controlled, on-demand contraceptive methods offer?
GS: Woman-controlled, on-demand methods of contraception can be of value for women who have sex infrequently and want to prevent a pregnancy. But these methods might help other groups of women, too. Some women do not use contraception because they do not like the side effects of the methods available to them, and others do not use a method because their partners don’t want them to. If these women had access to a method free from undesirable the side effects typical of hormonal methods, and can be used discreetly, we could better support women to make the best choices for them.
RWSI: How can on-demand contraceptives support us – donors, partners, health systems and consumers together – to be #ReadyWhenSheIs? What will it take to get there?
GS: When it comes to contraceptive options today, our research shows that we’re missing the needs of a large segment of women and girls who have infrequent sex. When we invest in bringing woman-controlled, on-demand options closer to consumers, we’re support consumers to make the choices best for their lives. That’s what it means to be #ReadyWhenSheIs: to go where she needs us to go so she has the tools and support to be the driver of her own life.