New research has found that women are on average no more likely to have multiple sexual partners in a single month after they are provided no-cost access to birth control methods than they were before. And while women reported a slight uptick in their reported monthly sexual encounters a year after getting free contraceptives, the new study says the resulting frequency of sexual activity fell within expected boundaries for women of childbearing age.
In a prospective cohort study called the Contraceptive Choice Project, 9,256 women and teenage girls in and around St. Louis were provided reversible birth control methods free of charge for a year. The subjects, ages 14 to 45, were asked to complete a survey upon recruitment, before they were prescribed and dispensed the birth control method of their choice, and at six and 12 months after their first visit.
The survey primarily aimed to measure two factors most closely tied to unintended pregnancies and sexually transmitted diseases: having multiple sexual partners and frequency of sex. Among the 7,751 participants who completed the surveys, researchers from Washington University in fact observed a statistically significant decrease in the number of sexual partners participants reported having had in the 30 days preceding. While 5.2% of the women reported having more than one male sexual partner in the past 30 days upon recruitment, 3.5% did so at month six and 3.3% did so at month 12.
While 70% to 71% of the participants reported no change in the number of sexual partners they had had in the past 30 days and 13% to 14% reported fewer, 16% reported they increased their number of partners. Among those who reported such an increase, 80% had reported no sexual partners initially and one in a subsequent survey.
The research, published Thursday in the journal Obstetrics and Gynecology, offers a belated response to a 2-year-old war of words between those advocating universal coverage of contraception under the Affordable Care Act and conservative critics of such a plan.
That debate erupted after the Obama administration proposed to require virtually all employer-provided health insurance policies to include coverage of contraceptives, even in cases in which the employer had a religious objection to contraceptive use. The proposal inflamed conservatives, many of whom argued that such a policy would promote increased sexual activity, and with it increased pregnancies, abortions, and sexually transmitted diseases.
In March 2012, conservative talk show host Rush Limbaugh denounced Georgetown University law student Sandra Fluke as a "slut" who "wants to be paid to have sex," after Fluke told lawmakers that the Jesuit university's unwillingness to cover contraception had a harmful impact on its women students.
Participants in the Contraceptive Choice Project study did report a slight increase in sexual activity after they received contraceptive protection. At the outset of the study, the median number of sexual encounters subjects reported having had in the past 30 days was four. At six and 12 months, that median rose to six. And researchers found no increases in sexually transmitted disease among participants -- reliable supporting evidence that sexually risky behavior among those on no-cost contraceptive had not increased.
The Washington University investigators behind Contraceptive Choice Project already had reported that providing no-cost access to birth control reduced rates of unintended pregnancy, abortions, repeat abortions and teenage pregnancies.
"Giving women access to contraception prevents unintended pregnancy," said public health specialist Gina Secura, the paper's lead author. "I get that folks are concerned about how much sex people are having," she added. But if the objective of policies is to reduce unwanted pregnancies, abortions and sexually transmitted diseases, Secura said, identifying the risky behaviors most likely to result in those -- such as having multiple sexual partners -- is the most valuable finding emerging from the latest study.
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