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Sexual Risk Taking: – Perceptions of Contraceptive Use, Abortion, and Sexually Transmitted Infections Among Adolescents in Sweden
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Sexuellt risktagande : – svenska ungdomars inställning till, och erfarenhet av preventivmedel, abort och sexuellt överförbara infektioner (Swedish)
Abstract [en]

The overall aim of this thesis was to inestigate Swedish adolescents' perceptions and behaviours regarding sexual risk taking. Specific objectives were to explore teenagers' perceptions of contraceptive use, unintended pregnancy, and abortion; teenage girls' experiences of decision making process and support connected to abortion; and male adolescents' perceptions of sexual risk taking and barriers to practicing safe sex. Another objective was to evaluate the effect of advance provision of emergency contraceptive pills to teenage girls. The methodologies included focus group discussions, in-depth interviews, and a randomized controlled trial.

Among the adolescents in our studies, teenage parenthood was generally viewed as a "catastrophe", and the majority expressed supportive attitudes towards abortion (studies I-IV). Occasions of failure to use contraceptives were common, especially when sex was unplanned (studies I-V). Pregnancy prevention was perceived as the woman's responsibility. However, many girls were reluctant about using homonal contraceptives due to worries about negative side effects (I, III). Initiating condom use was difficult for girls, as well as for boys, for a number of reasons (I-IV): fear of ruining an intimate situation, associations with disease, distrust, pleasure reduction, and (for the boys) the fear of loosing one's erection. Males generally perceived personal and partner-related risks connected to unprotected intercourse as low. Few males were worried that an unintended pregnancy would be carried to term, and the majority would urge the girl towards abortion if she seemed ambivalent (II, IV). Girls viewed the abortion decision as a natural, yet difficult choice, strongly influenced by attitudes of partners, parents, peers and societal norms (III). Teenage girls provided with emergency contraceptive pills in advance used it more frequently and sooner after unprotected intercourse compared with controls, without jeopardising regular contraceptive use (V).

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2008. , 81 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 325
Keyword [en]
Obstetrics and gynaecology, Adolescents, attitudes, sexual risk taking, contraceptive use, unintended pregnancy, teenage abortion, communication, gender, decision making, STI, Chlamydia, condom use, Health Belief Model, emergency contraception, RCT
Keyword [sv]
Obstetrik och kvinnosjukdomar
Identifiers
URN: urn:nbn:se:uu:diva-8598ISBN: 978-91-554-7144-6 (print)OAI: oai:DiVA.org:uu-8598DiVA: diva2:171713
Public defence
2008-04-25, X, Universitetshuset, Biskopsgatan 3, Uppsala, 09:15
Opponent
Supervisors
Available from: 2008-04-03 Created: 2008-04-03Bibliographically approved
List of papers
1.
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2. Preventing pregnancy: A girls' issue. Seventeen-year-old Swedish boys' perceptions on abortion, reproduction and use of contraception
Open this publication in new window or tab >>Preventing pregnancy: A girls' issue. Seventeen-year-old Swedish boys' perceptions on abortion, reproduction and use of contraception
2007 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 12, no 2, 111-118 p.Article in journal (Refereed) Published
Abstract [en]

Objective To gain deeper understanding of how teenage males view abortion, adolescent   fatherhood, sexual behavior, and use of contraception.  Method We conducted six focus-group interviews with 17-year-old boys (n 1⁄4 40). The interviews were tape-recorded, transcribed verbatim, and analyzed using manifest content analysis.  Results Adolescent fatherhood was considered to be a catastrophe and abortion a moral   dilemma. Most participants agreed that the unrestricted right to decide on abortion rests upon the girl, but some were frustrated by not having any legal right to influence the decision. Contraceptive failure was viewed as common and mainly due to the influence of alcohol or in relation to unplanned sex. Boys perceived girls as having a greater responsibility in avoiding pregnancy, and they often put a blind trust in the girls’ use of hormonal contraceptives or initiation of emergency contraception. Several groups had insufficient knowledge about fetal development and other aspects of reproduction. Many were unsatisfied with the sex education they had received at school, but still considered it to be an important counterweight to other sources of information concerning sex, such as  pornography.  Conclusion Equal responsibility among boys and girls regarding reproductive issues is still a challenge, but nevertheless an important key to the prevention of unwanted pregnancies.

Keyword
Attitudes, Abortion, Adolescent fatherhood, Sexual risk-taking, contraception
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-96960 (URN)10.1080/13625180701201145 (DOI)000248249000004 ()17559008 (PubMedID)
Available from: 2008-04-03 Created: 2008-04-03 Last updated: 2011-01-27Bibliographically approved
3. An illusion of power: Qualitative Perspectives On Abortion Decision-Making Among Teenage Women In Sweden
Open this publication in new window or tab >>An illusion of power: Qualitative Perspectives On Abortion Decision-Making Among Teenage Women In Sweden
2009 (English)In: Perspectives on sexual and reproductive health, ISSN 1538-6341, E-ISSN 1931-2393, Vol. 41, no 3, 173-180 p.Article in journal (Refereed) Published
Abstract [en]

CONTEXT:Swedish law permits abortion at the request of a pregnant woman untilthe 18th week of gestation. However, the extent to which the decision istruly the woman's own is subject to debate; women are often influenced,directly or indirectly, by the attitudes of their partners, family andfriends or by social norms. METHODS: Individual in-depth interviewsabout the pregnancy and the abortion decision were conducted 3-4 weekspostabortion with 25 women aged 16-20 at different periods in 2003, 2005and 2007. Interviews were audio-taped, transcribed verbatim andanalyzed using latent content analysis. RESULTS: The main reasons forunplanned pregnancy were underestimation of pregnancy risk andinconsistent contraceptive use. Pregnancy prevention was perceived asthe woman's responsibility. The abortion decision was accompanied bymixed emotions, and was seen as a natural yet difficult choice. Socialnorms and the negative attitudes of family and friends stronglyinfluenced the decision. Partners and parents were regarded as the mostimportant sources of support. After the abortion, the women feltpressured by contraceptive counselors to use highly effectivecontraceptives despite their previous negative experiences or worriesabout side effects. CONCLUSIONS: Swedish teenagers' basic right todecide whether to have an abortion may be limited by societal norms anddisapproval of teenage childbearing. Given the perception that women areresponsible for contraception, programs need to emphasize thatpregnancy prevention is a shared responsibility; greater efforts toinclude males in prevention practices are needed.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-96961 (URN)10.1363/4117309 (DOI)000269543000005 ()19740236 (PubMedID)
Available from: 2008-04-03 Created: 2008-04-03 Last updated: 2014-12-08Bibliographically approved
4. Sexual risk taking for self and partner as perceived by young men in Sweden: - a suggestion for a modified Health Belief Model
Open this publication in new window or tab >>Sexual risk taking for self and partner as perceived by young men in Sweden: - a suggestion for a modified Health Belief Model
(English)Manuscript (Other academic)
Identifiers
urn:nbn:se:uu:diva-96962 (URN)
Available from: 2008-04-03 Created: 2008-04-03 Last updated: 2011-01-11
5. Advance provision of emergency contraceptive pills reduces treatment delay: a randomized controlled trial among Swedish teenage girls
Open this publication in new window or tab >>Advance provision of emergency contraceptive pills reduces treatment delay: a randomized controlled trial among Swedish teenage girls
2008 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 3, 354-359 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate an intervention involving advance provision of emergency contraceptive pills (ECP) to Swedish teenage girls. MATERIAL AND METHODS: Some 420 girls aged 15-19, requesting ECP at a local youth clinic were randomly assigned to intervention group (IG) (n=214) or control group (CG) (n=206). Both groups received ECP on request. The IG received one extra dose of ECP, condoms and an information leaflet regarding ECP and condom use. Main outcome measures were differences between IG and CG regarding ECP use, time span between unprotected intercourse and ECP intake, contraceptive use, and sexual risk taking. Questionnaires were completed at the initial visit, and the girls were followed up by structured telephone interviews 3 and 6 months later. RESULTS: At the 3-month follow-up, girls in the IG were almost twice as likely to have used ECP compared to girls in the CG (IG: 24.0%, CG: 13%, p=0.02), and they used it sooner after unprotected intercourse (mean time IG: 13.61 h, CG: 25.47 h, p=0.007). Significant differences persisted 6 months after the intervention (ECP use IG: 31%, CG: 19%, p=0.01; and mean time IG: 15.59 h, CG: 26.38 h, p=0.006). No significant differences were found in the use of regular hormonal contraceptives or condoms at either follow-up. About 40% of the girls in both groups had risked pregnancy during the follow-up period, but only half of these had used ECP. CONCLUSIONS: This intervention shortened the time interval from unprotected intercourse to pill intake without jeopardising contraceptive use and without increasing sexual risk taking.

Keyword
Emergency contraception, teenage girls, RCT, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-96963 (URN)10.1080/00016340801936024 (DOI)000253644400015 ()18307077 (PubMedID)
Available from: 2008-04-03 Created: 2008-04-03 Last updated: 2011-01-24Bibliographically approved

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