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Change in Sexual Behavior With Provision of No-Cost Contraception

Secura, Gina M. PhD, MPH; Adams, Tiffany BA; Buckel, Christina M. MSW; Zhao, Qiuhong MS; Peipert, Jeffrey F. MD, PhD

doi: 10.1097/AOG.0000000000000184
Contents: Original Research

OBJECTIVE: To estimate whether providing no-cost contraception is associated with the number of sexual partners and frequency of intercourse over time.

METHODS: This was an analysis of the Contraceptive CHOICE Project, a prospective cohort study of 9,256 adolescents and women at risk for unintended pregnancy. Participants were provided reversible contraception of their choice at no cost and were followed-up with telephone interviews at 6 and 12 months. We examined the number of male sexual partners and coital frequency reported during the previous 30 days at baseline compared with 6-month and 12-month time points.

RESULTS: From our total cohort, 7,751 (84%) women and adolescents completed both 6-month and 12-month surveys and were included in this analysis. We observed a statistically significant decrease in the fraction of women and adolescents who reported more than one sexual partner during the past 30 days from baseline to 12 months (5.2% to 3.3%; P<.01). Most participants (70–71%) reported no change in their number of sexual partners at 6 and 12 months, whereas 13% reported a decrease and 16% reported an increase (P<.01). More than 80% of participants who reported an increase in the number of partners experienced an increase from zero to one partner. Frequency of intercourse increased during the past 30 days from baseline (median, 4) to 6 and 12 months (median, 6; P<.01). However, greater coital frequency did not result in greater sexually transmitted infection incidence at 12 months.

CONCLUSION: We found little evidence to support concerns of increased sexual risk-taking behavior subsequent to greater access to no-cost contraception.


Providing at-risk women and adolescents with no-cost contraception has little effect on sexual risk behavior over time.

Department of Obstetrics and Gynecology, Division of Clinical Research, Washington University in St. Louis School of Medicine, St. Louis, Missouri.

Corresponding author: Gina M. Secura, PhD, MPH, Washington University in St. Louis School of Medicine, 4533 Clayton Avenue, Campus Box 8219, St. Louis, MO 63110; e-mail:

Supported in part by the Susan Thompson Buffett Foundation and the Clinical and Translational Science Award (CTSA) program of the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) award numbers UL1 TR000448 and TL1 TR000449.

Financial Disclosure Dr. Peipert receives funding from Bayer Healthcare Pharmaceuticals and Merck & Company, Inc., and honorarium for serving on an advisory board for TEVA Pharmaceuticals and Watson/Activis. The other authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.