Sex, pregnancy and birth control: Stanford sociologists seek more info on trends in contraception use

Nearly half of all pregnancies in the United States are unintended, and lower-educated women and women in their 20s account for more than half of all abortions. So why aren't more of those women consistently using birth control?

L.A. Cicero Paula England and Krystale Littlejohn

Professor Paula England and graduate student Krystale Littlejohn are trying to figure out why some women are not consistently using birth control.

The woman talking to Krystale Littlejohn is insistent: There's no way she's ready to have a baby right now.

She'd consider adoption if she became pregnant, but would most likely get an abortion. After all, she says, she's only 21 years old – a community college student living at home and grateful to have her parents paying for her education. The way she sees it, raising a kid is not in the cards.

When Littlejohn, a doctoral student in Stanford's Department of Sociology, asks the woman if she thinks there is a right time to have a first child, the answer is quick.

"You have to be emotionally ready for that," she says. "You have to be able to deal with any situation at any time, and I'm definitely not there yet. There's no way I'm ready to have kids."

So why hasn't she used some form of reliable birth control every time she's had sex since losing her virginity at 17?

Littlejohn doesn't ask the question outright for fear of making the woman defensive or less likely to talk about her sex life. But it's at the heart of a study she's doing with sociology Professor Paula England and postdoctoral researcher Joanna Reed.

Federal statistics show that 49 percent of all pregnancies in the United States are unintended. With studies indicating that lower-educated women and women in their 20s account for more than half of all abortions, the Stanford researchers want to know why more women in those groups are not consistently using birth control, especially when they don't want to get pregnant.

"We're trying to figure out where the system is breaking down," England said. "You need to get to the point where contraception is so convenient and user-friendly that people who don't want to get pregnant use it all the time."

The researchers want to know if the inconsistencies in birth control use are because of a lack of information, services or self-control. They want to know if the cost of contraception is a factor. They want to know if partners are uncooperative when it comes to wearing a condom.

And they're asking how women learn about birth control.

"It seems that there needs to be more ways of getting women information about contraception and how to properly use it, rather than just in an advertisement or in a sex education class that comes a few years before their first sexual experience," Littlejohn says.

The data they're collecting will likely be used to inform policymakers, education planners, doctors and advocates who are trying to curb unintended pregnancies by better understanding the women who are most at risk of having them.

"This kind of research is extremely important," said Jennifer Frost, a senior research associate at the Guttmacher Institute, a New York-based organization that promotes sexual and reproductive health. "Getting the real scoop about why women aren't using contraception is needed to address the problems and create better education, better counseling and better services."

The Stanford researchers have spent the past several months interviewing women at Bay Area community colleges, where students are most likely to fit the age and education criteria they're interested in studying. By the time they finish the interviews in the next few weeks, the researchers will have interviewed about 70 women.

Their questions are blunt but never judgmental. Throughout interviews that can last up to three hours, Littlejohn – a 25-year-old with a knack for maintaining eye contact and a steady smile – encourages her subjects to "put it all out there."

With a simple prod like "Can you tell me more about that?" she's able to coax a complicated tale of lust, love, disappointment or frustration from what first fell flat as a yes or no answer to a question about whether a subject and her partner used birth control.

"Can I be vulgar about it?" an unmarried 24-year-old asks as Littlejohn is probing for reasons why she and her first sexual partner – the father of her daughter – didn't use birth control nine years ago.

"Yeah, totally," Littlejohn assures her. "You can say whatever you want. No worries!"

The woman graphically explains that her boyfriend's sex drive ruled their relationship. Birth control didn't factor into their conversations at all.

She's used different forms of contraception on-and-off in the years since, and Littlejohn discovers several reasons for the inconsistency: She was using drugs. She'd forget to take her birth control pills. She stopped getting hormone injections because they made her fat. Partners promised to withdraw, but didn't.  Condoms sometimes weren't around.

"Are there times that you wished you used something that you didn't use?" Littlejohn asks her.

The woman nods her head up and down.

"There's plenty of people that I slept with that I wished that I used condoms," she says. "I mean, you don't know someone very good after two weeks."

Her hindsight is shared by many of the women Littlejohn has interviewed.

"A lot of them think that if they use contraception some of the time or most of the time, they'll be fine," Littlejohn says. "There's a lack of understanding that that's not the case – you have to use it all the time."

The 21-year-old who told Littlejohn she's not ready to have a baby has never been pregnant. But despite a pregnancy scare that came after not using birth control, her contraceptive use has been spotty.

"I think she's feeling lucky," Littlejohn said.

But for the 24-year-old mother, luck ran out. Pregnant for a second time, she decided to have an abortion.


Adam Gorlick, Stanford News Service: (650) 725-0224,