VB

Sex Roles, Vol. 42, Nos.
7/8, 2000
Factors Affecting HIV Contraceptive Decision-

Making Among Women
Gail E. Wyatt,1 Jennifer Vargas Carmona, Tamra Burns Loeb, Donald
Guthrie, Dorothy Chin, and Gwen Gordon
University of California, Los Angeles
We examined contraceptive decision-making among African American, Lat-

ina, and European American women ages 18–50 years. Logistic regressions
examined relationships between demographic and religious factors, unin-
tended pregnancies, sexually transmitted diseases (STDs), reasons for sex,
and contraceptive decision-making. Women who were older, single, African
American, used pregnancy prevention, and had histories of STDs and unin-
tended pregnancies made contraceptive decisions alone. Older and African
American women were more likely to choose no contraception. Among
contraceptive users, African Americans used effective methods of pregnancy,
but not disease, prevention. Women with STD histories, and younger, more
educated women were more likely to use methods that prevent against both
pregnancy and disease. Theoretical implications about contraceptive choices
among ethnically diverse women are discussed.
Women’s contraceptive patterns impact their sexual health and can

increase risks for HIV infection (Committee on Unintended Pregnancy,
1995; Golub, 1995). These contraceptive patterns, most likely influenced
by social, cultural, and structural factors, are not often studied. Conse-
quently, we need to better understand women’s ability to implement
contraceptive practices that best protect them from HIV. Further, socio-
cultural factors may differentially influence ethnically diverse women
and the decisions they make about protecting their sexual health (Cohen &
Alfonso, 1997).
There is no better time to understand women’s contraceptive deci-
1
To whom correspondence should be addressed at Department of Psychiatry and Biobehavioral
Sciences, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, California
90024-1759; e-mail: GWYATT@NPIH.MEDSCH.UCLA.EDU.
495
0360-0025/00/0400-0495$18.00/0  2000 Plenum Publishing Corporation

496 Wyatt, Carmona, Loeb, Guthrie, Chin and Gordon
sion-making. High rates of unwanted sexual outcomes, including unin-

tended pregnancies, sexually transmitted diseases (STDs), and HIV infec-
tion, have been recently documented among women of childbearing age
(Centers for Disease Control [CDC], 1997; Committee on Unintended
Pregnancy, 1995). This investigation examines contraceptive decision-
making and different contraceptive patterns that can either protect or
jeopardize the sexual health of a community sample of ethnically diverse
women. In so doing, we can gain a comprehensive understanding of the
factors that influence the contraceptive decision-making process in women
who range in their risks for unintended pregnancies, STDs, and HIV in-
fection.
CONTRACEPTIVE DECISION-MAKING
Although women may encounter risks depending on their contracep-

tive patterns, they do not always make these decisions. Some women
in relationships may exert sole control over contraceptive use, but others
may share this decision-making process with their partners or allow their
partners to choose for them. Further, even when women may view
condom use and other forms of contraception as acceptable, these views
may be overridden by their partners’ decisions to not use contraceptives
(Poma, 1987) or the consequences of contraceptive use may outweigh
decisions to use them. Indeed, there are many factors that contribute
to a woman’s inability to decide. For example, they may be socialized
to assume passive roles in sexual relationships (Holland, Ramazanoglu,
Scott, Sharpe, & Thomson, 1992), or they may lack the skills to be
assertive about condom use (Wyatt, 1994). Further, due to economic
dependence or the prevalence of physical and sexual abuse in relation-
ships, women may be unable to insist on condoms and consequently be
less able to implement HIV prevention efforts (Amaro, 1995; Bing et
al., 1990; Cohen & Alfonso, 1997; Novey & Novey, 1983; UN Chronicle,
1994; Worth, 1990; Wyatt, 1994). Research which examines factors that
influence decisions about contraceptive use is needed to understand
women’s decision-making ability within a relationship context. In order
to develop an appropriate conceptual framework to address the risks
that women face, we need to identify factors that influence a range of
contraceptive methods to best prevent both unintended pregnancy and
STD and HIV transmission. What we know about critical factors that
affect women’s sexual and contraceptive decision-making among sexually
active women thus far is reviewed below.
Contraceptive Decision-Making Among Women 497
Factors Influencing Contraceptive Decision-Making
Background Factors
Demographics. Sexual health risks are increasing even for women once
thought to be at minimal risk for disease transmission. For example, while
women in monogamous relationships of 4 or more years duration were
thought to be at minimal to no risk for HIV infection (CDC, 1992), we
now know that past sexual and drug-related practices of either partner can
increase women’s current risks (Committee on Unintended Pregnancy,
1995; Espin, 1997; Michael, Gagnon, Laumann, & Kolodny, 1994). New-
comb et al. (1998) found that married women tend to take greater sexual
risks in their relationships. Although single women are more likely to
engage in safer sexual practices, including using condoms (Wyatt, Forge, &
Guthrie, 1998; Wyatt et. al., 1997), we know less about the influence of
other background factors such as educational level, occupational status,
financial resources, and religiosity on contraceptive patterns (Cohen &
Alfonso, 1997). These variables are often overlooked in research using
clinical or at-risk samples, but are important to address, nonetheless, espe-
cially with multiethnic samples.
Factors that have received more attention—age, ethnicity, and eco-
nomic status—can also provide a context for understanding sexual health
(Belgrave & Randolph, 1993; Mays & Cochran, 1988; Vargas, 1988; For-
rest & Singh, 1990). It is well documented that certain groups of women—
specifically, those who are young, poor, and of minority status—are at
higher risk for unintended pregnancies, STDs, and HIV infection (CDC,
1997). For example, European American women were found to have higher
self-efficacy in condom use than Latina women (Gomez & VanOss Marin,
1996), and Latinas reported less condom use and poorer attitudes toward
condoms than White women (VanOss Marin, Tschann, Gomez, & Kegeles,
1993). However, it is not always clear if ethnicity is confounded by economic
status. For example, we know that African American and Latina women
have cultural values that endorse relationships in which personal needs are
sacrificed, potentially increasing their risk for unwanted sexual outcomes
(Wyatt, 1992). While financial dependence may exacerbate the likelihood
that women remain in personally risky relationships (Land, 1994), we know
less about whether poor women are at more risk than more economically
independent women within ethnic groups that endorse cultural values that
can also increase risks.
Some risk factors are culture specific. For African American women,
structural factors in relationships result in the lack of available mates,
increasing their chances of remaining single and being unable to fulfill
cultural expectations of marriage and children within a family context

(Tucker & Mitchell-Kernan, 1995; Wilson, 1987). As a consequence, they
may be less likely to challenge cultural and relationship norms endorsing
unprotected sex in order to avoid jeopardizing relationships through which
they can satisfy these goals. Similarly, Latinas have been described as being
socialized to be submissive and subservient to partners (Amaro, 1988; Espin,
1997), often fearing their partners’ negative reactions to requests for con-
dom use (Gomez & VanOss Marin, 1996). However, few studies have
examined the outcome of relationships where partners decide about contra-
ceptive use. As a consequence of limited information that focuses on wom-
en’s issues, these factors are often not included in theories used to under-
stand women’s decisions about condoms or other contraceptives (Wyatt et
al., 1999).
Other factors serving as social and economic resources for women may
influence contraceptive decision-making ability and increase their personal
power. For example, VanOss Marin and colleagues reported that less edu-
cated Latinos had lower self-efficacy for condom use, discussing condom
use, and managing partner resistance (VanOss Marin, Tschann, Gomez, &
Gregorich, 1998) than those who were more educated. Also, women em-
ployed full-time demonstrated greater power in marital decision-making
(Blumstein & Schwartz, 1983). Factors contributing to a woman’s sense of
independence and personal control may be important in sexual negotiation
and decision-making.
Religiosity. The degree to which religious beliefs influence sexual behav-
iors has been largely overlooked in research on women’s sexual decision-
making (Inazu & Fox, 1980; Zelnik & Kantner, 1980). Religious beliefs
appear to play a major role in how women view sex and sexuality and it is
important to assess the influence of religiosity on sexual risk behaviors. For
example, in some populations, highly religious women are less likely to en-
gage in sexual practices traditionally identified as risky (Poulson, Eppler, Sat-
terwhite, Wuensch, & Bass, 1998; Nicholas & Durrheim, 1995). However,
they are less likely to use contraceptives (Krishnan, 1990) and have adequate
knowledge about them (Studer & Thornton, 1987). Further, because ethnic
minority women have been characterized as highly religious, it is especially
important to assess the influence of religiosity on their sexual risk behaviors.
Wyatt (1997) noted that African American women who self-identified as
highly religious engaged in fewer risky sexual behaviors, but were more likely
to use no contraceptives. Similarly, women who reported greater religiosity
were also less likely to engage in drug use before sexual activity and more
likely to fear sex due to the possibility of contracting an STD (Wyatt et al.,
1997). The role of religiosity in contraceptive decision-making among other
ethnic groups of women has been understudied.
Sexual-Related Factors
Histories of Unwanted Sexual Outcomes. In order to identify factors

that influence women’s contraceptive decision-making, sexual histories
need to be examined to determine whether women’s choice of contracep-
tives is associated with past experiences of unwanted outcomes. Wyatt et
al. (1997) found that African American women with an STD history were
likely to take more risks in relationships, including engaging in unprotected
vaginal intercourse. Along with understanding the association of STD his-
tories and contraceptive decision-making, it is also important to identify
whether a woman’s history of unintended pregnancies would influence her
choice of contraceptive method as well.
Reasons for Engaging in Sex. Understanding women’s reasons for
protecting against pregnancy or disease is complicated by the fact that
both procreation and sex only for enjoyment (recreation) can result from
decisions about sex (Wyatt, 1994). Although both procreational and recre-
ational attitudes can influence women’s contraceptive choices and sexual
risk taking, the reasons why women engage in sex are not usually assessed
in research. Thus, women’s selection of a contraceptive method and its
efficacy to prevent unwanted outcomes often represents or misrepresents
what they expect as an outcome. For example, women may endorse cultural
traditions that emphasize procreation as the purpose for sex (Sobo, 1993)
and subsequently use no contraception. They may also, however, perceive
sex to be a natural act, and not wish to become pregnant, but use no
contraceptives (Wyatt, 1997). Others may engage in sex for recreational
purposes and wish to enjoy sex without unwanted consequences, but use
ineffective methods that do not protect against pregnancy or disease trans-
mission. It is essential that we identify reasons for engaging in sex and how
they influence contraceptive decision-making.
Purpose of the Study
This investigation is an exploratory study aimed at answering specific

questions about women’s contraceptive patterns and decision-making. Spe-
cifically, what characteristics enable a woman to make contraceptive deci-
sions alone or with others? Further, given the spectrum of contraceptive
choices that women can make—ranging from using no contraception, to
effective methods that can prevent either pregnancy and /or disease—this
study is aimed at identifying factors that may determine the type of contra-
ceptive patterns that women choose. Because sociocultural factors influence
women’s decision-making, we will assess if specific personal characteristics,
religiosity, reasons for sex, and histories of STDs and unintended pregnan-
cies are associated with the contraceptive decision-maker. Four phases of
analyses will examine contraceptive decision-making: Phase 1 identifies
the predictors of who decides about contraception, Phase 2 identifies the
predictors of contraceptive nonuse, Phase 3 identifies the predictors of
ineffective methods of contraception versus effective pregnancy or disease
prevention, and Phase 4 identifies the predictors of effective pregnancy/
disease prevention. The identification of predictors in a random, multiethnic
community sample of African American, Latina, and European American
women that range in demographic characteristics, attitudes about the rea-
sons for sex, and contraceptive use will help to advance the development
of theory in the area of women’s contraceptive decision-making and sexual
health. This study is a step toward developing models consisting of demo-
graphic, cultural, and sexual-related factors in predicting who makes contra-
ceptive decisions and contraceptive patterns among ethnic groups of women
most at risk for HIV and other unwanted sexual outcomes.
METHOD
Sample Selection
We used stratified probability sampling and random digit telephone

dialing procedures designed by the Institute of Social Science Research
(ISSR) at the University of California, Los Angeles. We recruited compara-
ble samples of European American, African American, and Latina women
l8–50 years of age in Los Angeles County for a larger study of women’s
sexual decision-making in 1992–1994. To achieve stratification of the sample
by ethnicity, the ISSR initially focused on the proportion of households in
census tracts that were African American and eventually included all tracts
in Los Angeles County. Over 10,200 calls were made to locate the desired
sample. Of those, 3334 were households where a woman resided, 1172
women in the target age range were recruited for the interview, and 905
were interviewed (305 African American, 300 Latina, and 300 European
American women). The acceptance rate was 71%. To be eligible to partici-
pate in the interview, respondents had to be female, between the ages of
18 and 50 years, and identify themselves ethnically as non-Latino European
American, African-American/Black, or of Mexican origin. European
American and African American women had to reside in the United States
for a minimum of the first 6 years of their lives to ensure that their sexual
socialization occurred in America. No residency criteria were applied to
the Latina sample. Latinas included both U.S.-born (N ⫽ 65) and Mexican-
born (N ⫽ 174). Three women did not provide information regarding their
place of birth.
Multiple regression analyses for each item were compared on demo-
graphic characteristics of the sample and census data for L.A. County
women who matched these characteristics. Both samples were found to be
similar on age, ethnicity, education, and marital status. We wanted to
examine contraceptive and sexual decision-making among women who
made decisions to use contraceptives themselves. Thus, women who had
not been sexually active within the year prior to the interview, who were
pregnant, or whose primary method of birth control was their partner’s
vasectomy were excluded from these analyses (N ⫽ 58 of the 300 inter-
viewed Latinas). Seven hundred twenty-four women (242 African American
women, 240 European American women, and 242 Latinas) who were sexu-
ally active with males and reportedly HIV-negative were included in this
study. Table I presents the demographic characteristics of the total sample
of women.
Procedure
Each participant was interviewed face-to-face by a trained female inter-

viewer of the same ethnicity at the participant’s location of choice (her
Table I. Demographic Characteristics of Random Sample (N ⫽ 724)

Number Percentage
Age range (years)
18–25 120 17
26–40 439 61
41–50 165 23
Ethnicity
African American 242 33
Latina 242 33
European American 240 33
Income ($)
0–6,000 186 26
6,001–14,000 177 24
14,001–30,000 188 26
$30,000–150,000 172 24
Employment status
Full-time 347 48
Less than full-time 109 15
Not employed 268 37
Relationship status
Married 379 52
Not married 345 47
Religiosity M ⫽ 11.13 (SD ⫽ 3.13)
Education M ⫽ 12.66 (SD ⫽ 3.44)
Note. Percentages may not total 100% due to rounding.
home, UCLA, or another location). Of the 242 Latinas, 99 were interviewed

in Spanish. The interviews ranged in length from 3 to 8 hr and were tape-
recorded to ensure accuracy. Respondents were paid $32 for their time
and given referral information for mental health services upon request (for
fewer than 5% of the sample).
Instrumentation
The Los Angeles Structured Interview (LASI) consists of open- and

closed-ended items designed to obtain both retrospective and current data
about women’s sexual socialization, sexual and physical abuse, sexual atti-
tudes, practices, and risk-taking, as well as contraception and reproduction.
Reliability was established for these portions of the LASI. Interrater relia-
bility (using the kappa coefficient), established on a weekly basis among
30 interviewers, averaged .95 (Wyatt, 1985).
Measures
Demographic Background
Demographic background was defined as personal characteristics and

resources—age, ethnicity, income, current employment status, education,
and relationship status. Respondents’ age was grouped into three categories:
18–25, 26–40, and 41–50 years. Women self-identified as non-Latino Euro-
pean American, African American/Black, or of Mexican origin and were
asked to provide their annual household income from all sources. For
analysis, income was divided into four categories: no income to $6,000,
$6,001–$14,000, $14,001–$30,000, and over $30,000. Women also indicated
whether they were currently working full-time, part-time, unemployed,
retired, keeping house, or in school. Their responses were collapsed into
three categories: full-time, less than full-time, and not employed. Education
consisted of the number of years that the participant attended school.
Finally, women were asked if they were currently married, divorced, sepa-
rated, widowed, or had never been married. Their responses were collapsed
into married (scored ‘‘1’’) and not married (separated, divorced, widowed,
never married) (scored ‘‘2’’).
Religiosity
Women’s self-reported perceptions of their religiosity was assessed by

five items, all measured on a 5-point scale, which comprised a single compos-
ite index. Women were asked how ‘‘religious’’ they felt they were (from
very religious to atheist or nonbeliever) and how closely they followed
their religion on issues of birth control, premarital sex, extramarital sex,
and abortion (from very closely to not at all). Higher scores indicated
greater religiosity. Coefficient alpha was .71.
Personal Histories of Sexually Transmitted Diseases
Women indicated whether they had ever had any of nine different
STDs (herpes, gonorrhea, syphilis, chlamydia, venereal warts, trichomonia-
sis, cervicitis, monilla/candida/thrush/yeast, and pelvic inflammatory dis-
ease), yielding a possible score from 0 (none) to 9 (all).
Personal Histories of Unintended Pregnancies
Respondents indicated the number of unintended pregnancies during

the 5 years prior to the interview.
Reasons for Sex
It is important to understand the reasons why women engage in sexual

intercourse in order to determine if there is a relationship between their
reasons and subsequent contraceptive decision-making. Women were asked
nine questions related to their reasons for engaging in sexual intercourse.
They indicated on a 4-point scale (from not important at all to very impor-
tant) how important each of the following were as reasons for having sex:
(‘‘for enjoyment,’’ ‘‘procreation,’’ ‘‘to show love and be close,’’ ‘‘to control
my partner and show my strength,’’ ‘‘to confirm my desirability,’’ ‘‘for my
health and happiness,’’ and ‘‘to keep my partner/to satisfy my partner’s
needs’’). They also indicated on a 5-point scale (from strongly agree to
strongly disagree) how much they agreed or disagreed with the following
statement: ‘‘Sex is an important, meaningful experience in my life.’’ Women
who had ever had sexual intercourse without a condom, or whose partners
had ever had sex without a condom, were also asked their main reason for
nonuse. Responses were collapsed into three categories including ‘‘my
partner refused to use a condom,’’ ‘‘I made the decision’’ (i.e., ‘‘careless,’’
‘‘embarrassed,’’ ‘‘monogamous,’’ ‘‘didn’t want to,’’ ‘‘dislike condoms,’’
‘‘sterile,’’ ‘‘condoms are uncomfortable’’), and for reasons that could result
in procreation (‘‘I wanted sex to be natural,’’ ‘‘I wanted a baby’’).
Who Decides About Contraception
Women who were currently using contraception indicated how they

had decided which contraceptive to use. Responses were grouped into two
categories: (1) women who indicated ‘‘I decide’’ were categorized as women
who made contraceptive decisions without their partner’s influence; and
(2) women whose response was ‘‘partner decided,’’ ‘‘[my partner] influenced
my decision,’’ or ‘‘I decided with my partner’’ were categorized as those who
made contraceptive decisions with their partner’s influence or participation.
Although it would have been interesting to examine three categories for
decision-making (‘‘I decide,’’ ‘‘I decided with my partner,’’ and ‘‘my partner
decided/my partner influenced my decision’’), the frequencies for these
responses would not permit this type of grouping: only 24 of approximately
600 women reported that their partner made the decision (N ⫽ 12) or
influenced their decision (N ⫽ 12). As a result, data were divided into two
categories: ‘‘I decide’’ and ‘‘We decide.’’
Contraceptive Method
Women reported their current contraceptive method. Responses were

classified into no contraception, ineffective methods of pregnancy preven-
tion (e.g., rhythm, withdrawal, washing out methods), effective pregnancy
prevention (e.g., birth control pill, IUD, sterilization, Norplant, sponge,
foam), and effective pregnancy/disease prevention (e.g., condom use, dia-
phragm use). Diaphragm use is a method controlled by women and also
effective in preventing tubal infertility and cervical dysplasia (Golub, 1995;
Kelaghan, Rubin, Ory, & Layde, 1982; Park et al., 1995).
RESULTS
Data Analyses
The first step in data analysis involved data reduction. A principal

components factor analysis with varimax rotation which included nine vari-
ables representing women’s reasons for sexual intercourse was conducted.
Three factors emerged, cumulatively accounting for 56% of the variance
(see Table II). These factors represented engaging in sex for the following
reasons: sex for self-enhancement, sex for personal satisfaction and inti-
macy, and sex for procreation.
The second step in the data analyses involved conducting a correlation
Table II. Factor Analysis of the Reasons for Sex

Loading Variable
Factor 1. Sex for self-enhancement
.79 To confirm my desirability
.78 To control my partner and show my strength
.66 For my health and happiness
⫺.54 To keep my partner/to satisfy my partner’s needs
Factor 2. Sex for personal satisfaction and intimacy

.72 Sex is an important, meaningful experience in my life
.72 Enjoyment
.62 To show my love, to be close
Factor 3. Sex for procreation

.80 Main reason for not using a condom—procreation
.59 Reason for engaging in sexual intercourse—procreation
analysis among all of the variables (Table III). Third, differences among
the three ethnic groups on the predictor variables using analysis of variance
and post hoc Bonferroni tests were examined.
Following the examination of ethnic differences, data were analyzed
in four separate phases as follows. Phase 1: Who Decides About Contracep-
tion; Phase II: Contraceptive Nonuse; Phase III: Ineffective Methods of
Contraception; and Phase IV: Pregnancy/Disease Prevention. In each
phase, both univariate analyses and multiple logistic regressions were con-
ducted.
First, the marginal relationships among variables were examined, using
chi-square tests and t tests. STD history and unintended pregnancies were
square root-transformed to stabilize variance in the statistical analyses.
Second, multiple logistic regressions were conducted to determine
unique predictors of contraceptive type and decision-making. These logistic
regressions examined relationships between who decides about contracep-
tion and women’s current contraceptive method, and demographic back-
ground, religiosity, personal histories of sexually transmitted diseases and
unintended pregnancies, and women’s reasons for sexual intercourse. In
order to limit the number of variables in the logistic regressions, we blocked
predictor variables from two domains, demographic and sexual-related,
and conducted the regressions in these two subgroups. The first regression
in each phase included the background variables (age, ethnicity, income,
marital status, education, employment status, and religiosity). The second
block in each phase included sexual-related variables. Phase 1 included six
sexual-related variables (STD history, unintended pregnancies, contracep-
tive method, and the three reasons for sex—sex for self-enhancement, sex
for personal satisfaction and intimacy, and sex for procreation). Phases 2–4
Table III. Correlation Matrix
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 Contraceptive methoda 1.00

2 Age ⫺.25*** 1.00
3 Who decides about .32*** ⫺.003 1.00
contraception
4 Income .01 .25*** .08* 1.00
5 Employment statusb ⫺.01 .18*** .06 .58*** 1.00
6 Marital status ⫺.05 .26*** ⫺.04 ⫺.07* ⫺.06 1.00
7 STD historyc .12*** .12*** .11** .29*** .14*** ⫺.05 1.00
8 Unintended .03 .16*** .09* ⫺.08 ⫺.13*** ⫺.06 .00*** 1.00
pregnanciesc
9 Sex for self- ⫺.03 ⫺.06 .04 ⫺.12** ⫺.10** ⫺.06 ⫺.15*** .01 1.00
enhancementc
10 Sex for personal .02 .12*** .05 .19*** .15*** .07 .23*** ⫺.02 .02 1.00
satisfaction
and intimacyc
11 Sex for procreationc ⫺.04 .03 ⫺.11** ⫺.10** ⫺.11*** .16*** ⫺.11** ⫺.07 ⫺.002 .001 1.00
12 Religiosityd ⫺.02 .08 ⫺.04 ⫺.14*** ⫺.09* .15*** ⫺.15*** ⫺.03 .12** ⫺.06 .11** 1.00
13 Education .05 .10** .04 .44*** .26*** ⫺.04 .40*** ⫺.10** ⫺.31*** .29*** ⫺.10* .13*** 1.00
14 Ethnicitye .006 .03**** .05**** .11**** .03**** .07**** .28**** .03**** .09**** .11**** .02** .08**** .31**** 1.00
a
Possible range: 0–2 (ineffective, pregnancy prevention, pregnancy/disease prevention).
b
Possible range: 0–2 (not employed, part-time, full-time).
c
Standardized score.
d
Based on a 5-point Likert scale.
e
Multiple correlations.
*p ⬍ .05; **p ⬍ .01; ***p ⬍ .001.
included five sexual-related variables (STD history, unintended pregnan-

cies, and the three reasons for sex—sex for self-enhancement, sex for
personal satisfaction and intimacy, and sex for procreation).
Because the sample was randomly selected, i.e., without stratification
of demographic measures, the univariate analyses represent associations
that could be found in these populations. The multiple regression analyses
were used to determine the degree of redundancy (or uniqueness) among
predictors of contraceptive decision-making, who decides about contracep-
tion, and contraceptive patterns.
Ethnic Group Differences
Analysis of variance and subsequent post-hoc Bonferroni tests revealed

the following significant (p ⬍ .05) between-group differences (see Table
IV for results). African American and European American women were
older, more educated, more likely to be employed, and had higher incomes
than Latina women. European American women were more educated than
African American and Latina women, while African American and Latina
women reported greater religiosity than European American women. Fur-
ther, African and European American women reported more STDs than
Latinas, whereas African American women reported greater unintended
pregnancies than European American and Latina women. Finally, in terms
of the reasons for engaging in sex, European American women were less
Table IV. Mean Differences Between African American (AA), European American (EA),
and Latina (L) Women
F Significant Pairwise Comparisonsa
Age 11.97*** AA, EA ⬎ L
Income 43.97*** AA, EA ⬎ L
Employment statusb 11.41*** AA, EA ⬎ L
Religiosityc 29.74*** AA, L ⬎ EA
Education 163.30*** EA ⬎ AA, L; AA ⬎ L
STD historyd 140.95*** AA, EA ⬎ L
Unintended pregnanciesd 12.06*** AA ⬎ EA, L
Sex for self-enhancementd 35.56*** L ⬎ AA, EA; AA ⬎ EA
Sex for personal 42.33*** EA ⬎ AA, L; AA ⬎ L
satisfaction and intimacyd
Sex for procreationd .86** L ⬎ AA, EA
Marital status ␹2 ⫽ 51.99*** AA ⬍ EA, L
a
Bonferroni corrected (p ⫽ .05).
b
Possible range: 0–2 (not employed, less than full-time, full-time).
c
Based on a 5-point Likert Scale.
d
Standardized Score.
*p ⬍ .05; **p ⬍ .01; ***p ⬍ .001.
likely to report engaging in sex for self-enhancement and more likely to

report engaging in sex for personal satisfaction and intimacy compared to
African American and Latina women. However, Latina women were more
likely to report engaging in sex for self-enhancement and for procreation
compared to African and European American women. All ethnic differ-
ences are adjusted for demographic disparity by the regression analyses.
Phase 1 Predictors of Who Decides About Contraception
Phase 1 was conducted to identify what characteristics enable women

to make their own decisions regarding contraceptive use. Of the 724 women
in our sample, 150 reported that they did not currently use any form of
contraception. To determine factors contributing to contraceptive decision-
making, we examined data from the 574 women who were currently using
contraceptives. Who decides about contraception was significantly associ-
ated with age of the participant, ethnicity, income, employment status,
relationship status, method of contraception, STD history, unintended preg-
nancy, and engaging in sex for procreation (see Table V for the percentages
and p values for significant univariate associations).
A logistic regression was conducted to determine the unique predictors
of who decides about contraception. The following predictors were signifi-
cant: age, marital status, ethnicity, contraceptive method, and histories of
STDs and unintended pregnancies. Older, unmarried, African American
women, women who used only pregnancy prevention, and women with
histories of STDs and unintended pregnancies were more likely to decide
alone about contraceptive use (see Table V for odds ratios and p values
of the logistic regressions).
Phase 2 Predictors of Contraceptive Nonuse
Phase 2 investigated factors associated with contraceptive nonuse in

order to understand the characteristics of women who are more likely to
use no contraception and were at risk for both pregnancy and disease
transmission. Univariate analyses were conducted to compare women hav-
ing unprotected vaginal intercourse (no contraception, N ⫽ 150) with
women using some form of contraception (N ⫽ 574). Nonuse of contracep-
tion differed only by age of the participant and ethnicity (see Table VI for
the percentages and p values for significant univariate associations).
A logistic regression to determine the unique predictors of contracep-
tive nonuse revealed that age and ethnicity were the only unique predictors
Table V. Phase 1: Predictors of Who Decides About Contraception

Significant Univariate Comparisons
‘‘I Decide’’ ‘‘He/We Decide’’ df ␹2
Age (years) 2 8.71**
18–25 42% 58%
26–40 55% 45%
41–50 61% 39%
Ethnicity 2 30.10***
African American 70% 30%
European American 51% 49%
Latina 42% 58%
Income ($) 3 13.76**
ⱕ6,000 45% 55%
6,001–14,000 47% 53%
14,001–30,000 61% 39%
⬎30,000 62% 38%
Employment status 2 6.41*
Full-time 59% 41%
⬍Full-time 48% 52%
Not employed 49% 51%
Marital status 1 15.75***
Unmarried 62% 38%
Married 46% 54%
Method of 2 44.48***
contraception
Ineffective 26% 74%
Pregnancy prevention 63% 37%
Pregnancy/disease 36% 64%
Prevention
STD history t
Prior STD history M ⫽ .95 (SD ⫽ .62) M ⫽ .75 (SD ⫽ .61) ⫺3.87****
Unintended pregnancy
history
Prior pregnancy M ⫽ 1.05 (SD ⫽ .82) M ⫽ .80 (SD ⫽ .80) ⫺3.76****
history
Reasons for sex
Sex for procreation M ⫽ ⫺.10 (SD ⫽ .94) M ⫽ .06 (SD ⫽ 1.03) 1.92*
Logistic Regressions Odds Ratio
Background predictors
Age .95***
Employment status .89
Marital status 1.96***
Ethnicity (African American vs. Latina) .34****
Ethnicity (European American vs. Latina) .76
Income 1.0
Religiosity 1.04
Education 1.05
Sexual-related predictors
STD history .54****
Unintended pregnancy .75**
Sex for self-enhancement .94
Sex for personal satisfaction and intimacy 1.17
Sex for procreation 1.11
Current birth control method 1.70**
*p ⬍ .05; **p ⬍ .01; ***p ⬍ .001; ****p ⬍ .0001.
Table VI. Phase 2: Predictors of Contraceptive Nonuse

No Contraception Contraception df ␹2
Age (years) 2 23.40***
18–25 14% 86%
26–40 18% 82%
41–50 34% 66%
Ethnicity 2 6.61*
Latina 17% 83%
Age .93****
Employment status 1.01
Marital status 1.40
Ethnicity (African American vs. Latina) .57*
Income 1.0
Religiosity 1.02
Education 1.03
Sexual–related predictors
STD history 1.23
Unintended pregnancy 1.12
Sex for self-enhancement 1.09
Sex for personal satisfaction and intimacy 1.01
Sex for procreation .93
*p ⬍ .05; **p ⬍ .01; ***p ⬍ .001; ****p ⬍ .0001.
of nonuse. Older women and African American were more likely to report
no current use of contraception (see Table VI for odds ratios and p values
of the logistic regressions).
Phase 3 Predictors of Ineffective Methods of Contraception Versus

Effective Prevention
Phase 3 was conducted to identify women who are more likely to use
ineffective methods of contraception versus women who prevented against
either pregnancy and/or disease transmission. These analyses helped to
identify women who may desire to prevent either pregnancy and/or disease,
but used methods that placed them at risk for an unwanted sexual outcome,
compared to women who use more effective methods of pregnancy and/
or disease prevention. Among women using some form of contraception
(N ⫽ 574), univariate analyses were conducted to determine the correlates

of the use of ineffective contraception. Ineffective contraceptive use was
associated with ethnicity, income, and STD history (see Table VII for the
percentages and p values for significant univariate associations).
A logistic regression of the predictors of ineffective methods of contra-
ception was conducted. Both ethnicity and STD history predicted the use
of ineffective contraceptive methods. African American women and Latina
women, and women with a history of STDs, were less likely to use ineffective
methods of contraception to prevent pregnancy and disease (see Table VII
for odds ratios and p values of the logistic regressions).
Table VII. Phase 3: Predictors of Ineffective Methods of Contraception

Pregnancy
and
Ineffective Pregnancy/Disease
Contraception Prevention df ␹2
Ethnicity 2 8.93**
Latina 10% 90%
Income ($) 3 9.21*
ⱕ6,000 11% 89%
6,001–14,000 5% 95%
14,001–30,000 3% 97%
⬎30,000 6% 94%
STD history t
Prior STD history M ⫽ .62 (SD ⫽ .65) M ⫽ .87 (SD ⫽ .62) 2.31*
Age .98
Marital status .84
Ethnicity (African American vs. Latina) 4.29**
Ethnicity (European American vs. Latina) 2.51
Income 1.0
Religiosity .99
Education .93
STD history 1.97*
Sex for personal satisfaction and intimacy .82
*p ⬍ .05; **p ⬍ .01; ***p ⬍ .001; ****p ⬍ .0001.
Phase 4 Predictors of Pregnancy/Disease Prevention
Phase 4 was conducted to identify characteristics of women who use

methods of contraception that effectively prevent against both pregnancy
and disease transmission. Among women using some form of contraception
(N ⫽ 574), univariate analyses were conducted to determine the correlates
of pregnancy/disease prevention methods of contraception versus the use
of ineffective contraception or methods that prevent only against pregnancy,
but not disease. The use of pregnancy/disease prevention significantly dif-
fered by women’s age, relationship status, education, STD history, and
engaging in sex for self-enhancement reasons (see Table VIII for the per-
centages and p values for significant univariate associations).
Table VIII. Phase 4: Predictors of Pregnancy/Disease Prevention

Ineffective Contraception
and Pregnancy/Disease
Pregnancy Prevention Prevention df ␹2
Age (years) 2 13.96***
18–25 64% 36%
26–40 73% 27%
41–50 86% 14%
Marital status 1 7.31**
Unmarried 68% 32%
Married 78% 22%
Education (years) t
M ⫽ 12.44 (SD ⫽ 3.42) M ⫽ 13.20 (SD ⫽ 3.05) ⫺2.39*
Prior STD history M ⫽ .82 (SD ⫽ .62) M ⫽ .96 (SD ⫽ .61) ⫺2.34*
Reasons for sex
Sex for M ⫽ ⫺.06 (SD ⫽ .99) M ⫽ ⫺.14 (SD ⫽ 1.01) 1.96*
self-enhancement
Age 1.06****
Marital status 1.39
Ethnicity (African American vs. Latina) 1.23
Income 1.0
Religiosity .97
Education .92*
STD history .68*
Sex for personal satisfaction and intimacy .96
*p ⬍ .05; **p ⬍ .01; ***p ⬍ .001; ****p ⬍ .0001.
A logistic regression of the predictors of the use of pregnancy/disease

prevention methods of contraception was conducted. Age, education, and
STD history emerged as unique predictors of pregnancy/disease prevention
methods. Younger, more educated women and women with a history of
STDs were more likely to use methods to prevent against both pregnancy
and disease (see Table VIII for odds ratios and p values of the logistic regres-
sions).
DISCUSSION
This study attempted to broaden our understanding of women’s contra-

ceptive decision-making and factors associated with several contraceptive
patterns by assessing relationships between demographic and religious
backgrounds, histories of STDs and unintended pregnancies, and reasons
for engaging in sexual intercourse among African American, Latina, and
European American women ages 18–50 years. These cross-sectional data
allowed us to examine variables predicting contraceptive patterns and who
decides about their use. From these findings, it is our hope that new concep-
tual frameworks regarding women’s sexual health will better inform efforts
to increase women’s control over their sexual health. In this discussion, it
is important to note that all ethnic differences reported were adjusted for
demographic disparity among ethnic groups in the regression analyses.
Women who reported histories of STDs and unintended pregnancies
were more likely to make contraceptive decisions on their own. These
findings suggest that women who have experienced unwanted sexual out-
comes may be assuming contraceptive decision-making responsibility. Their
reluctance to allow their partners to influence them may be an attempt to
avoid another negative sexual outcome. For these women, choosing a
method of contraception without a partner’s influence, however, may pre-
clude the possibility of sharing effective and responsible contraceptive deci-
sion-making with them. Alternatively, some women may be unable or
unwilling to communicate about contraceptive decision-making with part-
ners, particularly African American women, who were most likely un-
married.
Women who decide alone were also more likely to choose a contracep-
tive method that prevented against pregnancy only. Although it is encourag-
ing to note that these women are exerting control over a specific unwanted
outcome (procreation), their selection of a method to prevent only preg-
nancy renders them vulnerable to other significant negative outcomes, in-
cluding HIV infection and other STDs. Thus, it is possible that messages
about the role of condom use in protecting one’s sexual health are not
reaching older, single, African American women who demonstrate that

they can control contraceptive decisions, or that sociocultural factors (i.e.,
mate availability, implications of infidelity) make it difficult to choose a
contraceptive that may be undesirable to one’s partner. Further, some
women, particularly those who believe they are in monogamous relation-
ships, may not think that they are at risk for unwanted sexual outcomes
(Exner, Seal, & Ehrhardt, 1997). For instance, married Latinas engaged in
more risks in relationships (including unprotected vaginal intercourse) than
single women (Newcomb et al., 1998). Thus, while women who decided
alone may have been assuming a protective stance, their decisions appeared
to be influenced by long-established social and structural factors that have
affected women’s sexual health for decades.
Women who chose contraception by themselves may have been making
the decision to protect only against pregnancy because it was a method
that they could easily control, without requiring the support or consent of
partners. Although these women may perceive that they were in charge of
the contraceptive decision-making process, they may have had a false sense
of security as far as disease prevention is concerned. They may still have
lacked the sexual negotiation skills that would enable them to enlist their
partner’s participation in protecting their sexual health or feared for their
safety or that of their children—issues that need to receive more attention
in HIV prevention programs.
African American women differed from European American and Lat-
ina women in another important respect. When examining the total sample
of sexually active women who use no contraception and those who do, we
found that African American women were significantly more likely than
European American women to use no contraception. However, when exam-
ining contraceptive users (women who wish to prevent either a pregnancy
or disease), African American women were more likely to use effective
methods of pregnancy prevention. The methods African American women
used to protect themselves against pregnancy, however, were largely inef-
fective against disease transmission. Unfortunately, the strengths of women
who are engaging in some form of health protection appear to be overlooked
in HIV research. These women may be more amenable to HIV prevention
than women who are using no contraceptive at all.
Latinas, on the other hand, were less independent in their decision-
making about contraception. They were more likely than African American
women to select contraception with their partners, less likely to use contra-
ception, and more likely to use ineffective methods. These findings are
cause for concern as Latinas constitute a group at disproportionate risk for
HIV, particularly through heterosexual transmission (CDC, 1998). The
findings indicate that shared decision-making did not result in lower risk
for this group, and suggest that other methods of decision-making be investi-
gated and promoted.
Engaging in sex for procreation was not a significant predictor of
contraceptive nonuse. Accordingly, women who reported no current
method of contraception did not denote conceiving a child as their primary
reason for engaging in sex. This pattern suggests that more specific reasons
for nonuse of contraceptives may involve relationship issues regarding
partner refusal or the preference for sexual pleasure among partners (Exner
et al., 1997) rather than a focus on the future outcome of unprotected
sex. More research on reasons for not using contraceptives is needed (St.
Lawrence et al., 1998).
These findings highlight the importance of giving women adequate
pregnancy, STD, and HIV prevention information, and teaching sexual and
contraceptive negotiation skills as well as the importance of protection
beyond pregnancy prevention, while recognizing that not all partners are
amenable to pregnancy and disease prevention. These messages must be
tailored for various ethnic and cultural groups, specifically for African
American women, who are at high risk for disease transmission, but because
of cultural prohibitions around contraceptive use and perceptions of mate
unavailability, may be less likely to use methods that offer a full spectrum
of pregnancy and disease prevention (Wyatt et al., 1997). However, it is
also important to educate women that using methods to prevent pregnancy
and disease does not necessarily imply their interest in recreational sex.
Given stereotypes about African American women’s sexual promiscuity,
women may attempt to counter this myth by avoiding sexual decision-
making that implies that sexual pleasure was the reason for a pregnancy,
a reason that their cultural and religious values may not condone as the
reason for sexual activity (Wyatt, 1997). A more effective strategy might
be to involve African American women’s partners in contraceptive decision-
making to encourage discussions about what it means to prevent pregnancy
and disease transmission. Sexual health may be better achieved when
women and their partners can support each other in redefining reasons for
sex to include contraceptive methods that prevent unwanted outcomes until
both are aware of and ready for the consequences of unprotected sex.
Findings regarding older women being less likely to use contraception
were consistent with other studies (e.g., Newcomb et al., 1998; Wyatt et
al., 1997), but also suggest that more prevention information needs to be
directed to women in their 40s and 50s, some of whom may continue to
hold traditional notions about sexual health risks. Further, because this age
group may have been perimenopausal, their understanding of this phase
of life needs to include how STD and HIV infection can occur regardless
of age or women’s childbearing abilities. Although unmarried women in
their 40s and 50s may also be assumed to be wise, they may be naive about
the expectations of partners regarding sex today and lack the skills to
minimize their sexual risks. Those who are married still must assess their
partners’ past and current sexual health and their personal risks even while
in a committed relationship (Wyatt et al., 1997).
Not surprisingly, educated and young women are protecting themselves
from both pregnancy and disease transmission. It appears that HIV mes-
sages are reaching this population and as a result, they may be more
knowledgeable and better able to obtain resources to protect their sex-
ual health.
However, given that women with histories of STDs were also more
likely to protect against pregnancy and disease, these data do not indicate
whether women using the full spectrum of protection did so as a result of
having experienced a previous unwanted outcome, specifically an unin-
tended pregnancy or an STD, or if their efforts have begun too late to
prevent future sexual health problems. If women are going to engage in
sex and use condoms with partners, they need to be consistent users of
barrier methods beginning with first sexual activity or until they have as-
sessed past and current risks of unprotected sex.
Finally, when women made decisions about contraception, their rea-
sons for engaging in sexual intercourse and religiosity did not appear to
influence their contraceptive decisions. This finding suggests that women’s
reasons for sex may not factor into decisions about contraceptives, especially
if partners are involved in decision-making. While protecting one’s sexual
health must be a priority for all women, these findings suggest that their
sexual beliefs and attitudes may not totally influence contraceptive use. It
appears that women’s need for a partner or their partners’ perceptions may
be more influential than their informed decisions alone.
Implications
We have more work to do to minimize women’s risks for HIV and

other unwanted outcomes. Education needs to be tailored to women’s
current understanding of how contraceptive decisions affect their sexual
health. It is important to build on women’s strengths and current practices.
Given that among contraceptive users, some African American women are
already using effective pregnancy prevention methods, HIV prevention
efforts directed toward the African American community should build on
pregnancy prevention to include disease prevention as well. Further, as
African American women were more likely to make contraceptive decisions
without the influence of partners and were less likely to be married, it is
necessary for HIV prevention messages at the very least to include methods
that women can control. Because African American women were, in gen-
eral, less likely to use contraception at all, prevention efforts should con-
tinue to target this population, particularly those in their teens and in
their 40s and 50s, who have yet to incorporate realistic limitations and
consequences of preventing pregnancy and disease transmission.
European American and Latina women were more likely to be influ-
enced by their partners in making contraceptive decisions. These decisions
seem to confer risks. HIV prevention for these women should include
partners and/or focusing on communication between them. Additionally,
intervention strategies should promote greater independent decision-mak-
ing when joint decisions lead to greater risk for women.
An STD history appeared to be a powerful predictor of various aspects
of sexual decision-making, raising the possibility that personal experience
motivates behavior change. Broader based programs covering pregnancy,
STD, and HIV prevention are needed so that women do not have to
experience a negative sexual outcome to learn how to effectively protect
themselves.
Our findings highlight the need for further theory development in
women’s sexual decision-making. In order to fully understand the power
that women exert in protecting themselves from unwanted outcomes by
their use of contraceptives to prevent both pregnancy and disease transmis-
sion, we need to understand the relational and sociocultural context that
serves to facilitate or impede women’s use of contraception that protects
their health. These findings suggest that there are sociocultural, interper-
sonal, and environmental factors that influence women’s decision-making
regarding contraceptive use, and theoretical models need to address these
complex issues in STD and HIV prevention. Women’s decision-making
appeared to fall into two wide categories—those who decided alone about
contraceptive use versus those whose decision-making occurred within the
context of their relationships with partners. Some women used no contra-
ception, while some used methods to prevent disease and pregnancy. Inter-
estingly, both categories of responses were not only influenced by women’s
demographic characteristics, but also by attitudes and beliefs about the
context of sex, the importance of relationships, who should decide about
contraception, and past sexual experiences, including histories of trauma.
It appears that contraceptive use, including condoms, is only part of a series
of decisions made that reflects upon the relationship and the purpose of
sex. Another way to better understand the control that women assume in
STD and HIV prevention is to develop a model that examines both their
sexual health and risk taking, given that all women are not at the same
risk and the reasons for risk taking also vary. For example, the Sexual
Health Model (SHM) developed by Wyatt et al. (1999) attempts to explain

women’s sexual health behaviors by assessing seven dimensions: sexual
socialization, sexual ownership, past sexual health experiences including
childhood sexual abuse, interconnectedness, body touching, sexual risk
behaviors, and sexual judgment. The model has demonstrated utility in
preliminary studies on groups of African American, Latina, and European
American women (Wyatt, Myers, & Ashing-Giwa, 1998). The SH dimen-
sions were associated with STD and HIV risk practices, which established
the utility of the model for women with diverse reasons for risk taking.
Further studies, including comparisons with other models, need to be con-
ducted to assess its explanatory, predictive, and discriminative power with
respect to diverse groups of women. This iterative process will lead to
further development and refinement of useful theories or models.
It is imperative that notions about women’s sexual health and decision-
making ability be modified to fit the ways in which women actually use
power. For many women, the power to exert control is often best expressed
in a trusting relationship. However, learning whom to trust and when risks
may be encountered is also an expression of a woman’s power. Regardless
of relationships, sexual health is basic for women’s survival and is not
contingent on the presence of a partner. Friends and family can supplant
the role of partners in endorsing women’s needs to be in supportive and
healthy relationships. These notions challenge traditional assumptions by
helping to clarify that it is sexual health for which women need to assume
responsibility. Controlling sexual health can save women’s lives.
ACKNOWLEDGMENTS
This research was funded by the National Institute of Mental Health,

Grant No. RO1MH48269 and by a Research Scientist Award to the first
author, RO1MH00269-10.
REFERENCES
Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior.
Englewood Cliffs, NJ: Prentice-Hall.
Akbar, N. (1981). Mental disorder among African Americans. Black Books Bulletin, 7, 18–25.
Amaro, H. (1988). Considerations for prevention of HIV infection among Hispanic women.
Psychology of Women Quarterly, 12, 429–443.
Amaro, H. (1995). Love, sex, and power—Considering women’s realities in HIV prevention.
American Psychologist, 50, 437–447.
Bandura, A. (1986). Social foundation of thought and action. Englewood Cliffs, NJ: Pren-
tice Hall.
Belgrave, F., & Randolph, S. (1993). Psychological aspects of AIDS prevention among African
Americans. Journal of Black Psychology, 19, 103–107.
Bing, E. G., Nichols, S. E., Golfinger, F. M., Fernandez, F., Cabaj, R., Dudley, G., Krener,
P., Prager, M., & Ruiz, P. (1990). The many faces of AIDS: Opportunities for intervention.
New Directions in Mental Health Services, 48, 69.
Blumstein, P., & Schwartz, P. (1983). American couples: Money, work, sex. New York: Wil-
liam Morrow.
Centers for Disease Control. (1992). HIV/AIDS surveillance. Centers for Disease Control:
Atlanta, GA.
Centers for Disease Control. (1997). HIV/AIDS surveillance. Centers for Disease Control:
Atlanta, GA.
Cohen, M. A., & Alfonso, C. A. (1997).A comprehensive approach to sexual history-taking
using the biopsychosocial model. Journal of Mental Health, 26(1), 3–14.
Committee on Unintended Pregnancy. (1995). In S. S. Brown & L. Eisenberg (Eds.), The
best intentions: Unintended pregnancy and the well-being of children and families. Washing-
ton, DC: National Academy Press.
Espin, O. M. (1997). In R. T. Hare-Mustin & J. Marecek (Eds.), Latina realities—Essays on
healing, migration, and sexuality. Boulder, CO: Westview Press.
Exner, T. M., Seal, D. W., & Ehrhardt, A. A. (1997). A review of HIV interventions for at-
risk women. AIDS and Behavior, 1, 93–124.
Forrest, J. D., & Singh, S. (1990). The sexual and reproductive behavior of American women,
1982–1988. Family Planning Perspectives, 22, 206–214.
Gasch, H., Poulson, D., Fullilove, R., & Fullilove, M. (1993). Shaping AIDS education and
prevention programs for African Americans amidst community decline. Journal of Negro
Education, 60, 85–96.
Golub, E. L. (1995). Women centered prevention techniques and technologies. In A. O’Leary
and L. Sweet Jemmott (Eds.), Women at risk: Issues in the primary prevention of AIDS
(pp. 43–82). New York: Plenum Press.
Gomez, C., & VanOss Marin, B. (1996). Gender, culture, and power: Barriers to HIV-
prevention strategies for women. Journal of Sex Research, 33, 355–362.
Gutierrez, L. M. (1990). Working with women of color: An empowerment perspective. Social
Work, 35, 149–154.
Holland, J., Ramanzonoglu, C., Sharpe, S., & Thomson, R. (1992a). Pleasure, pressure, and
power: Some contradictions of gendered sexuality. Sociological Review, 645–674.
Holland, J., Ramanzanoglu, C., Scott, S., Sharpe, S., & Thomson, R. (1992b). Risk, power
and the possibility of pleasure: Women and safer sex. AIDS Care, 4, 273–283.
Inazu, J. K., & Fox, G. L. (1980). Maternal influence on the sexual behavior of teen-age
daughters. Journal of Family Issues, 1, 81–102.
Jacobs Institute of Women’s Health. (1995). In J. A. Horton (Ed.), The women’s health data
book. A profile of women’s health in the United States (2nd ed.). Washington, DC: Elsevier.
Kelaghan, J., Rubin, G. L., Ory, H. W., & Layde, P. M. (1982). Barrier-method contraceptives
and pelvic inflammatory disease. Journal of the American Medical Association, 248,
184–187.
Krishnan, V. (1990). A causal approach to the study of fertility and familism. Social Biology,
37, 59–68.
Land, H. (1994). AIDS and women of color. Families in Society, 1994, 355–361.
Levine, O. H., Britton, P. J., James, T. C., Jackson, A. P., & Hobfoll, S. E. (1993). The
empowerment of women: A key to HIV prevention. Journal of Community Psychology,
21, 320–334.
Mays, V. M., & Cochran, S. D. (1988). Issues in the perception of AIDS risk and risk reduction
activities by Black and Hispanic/Latina women. American Psychologist, 43, 949–957.
Michael, R. T., Gagnon, J. H., Laumann, E. O., & Kolodny, R. C. (1994). Sex in America:
A definitive survey. Boston: Little Brown.
Newcomb, M. D., Romero, G. J., Wyatt, G. E., Tucker, M. B., Wayment, H. A., Vargas-
Carmona, J., Solis, B., & Mitchell-Kernan, C. (1998). Acculturation, sexual risk taking,
and health promotion among Latinas. Journal of Counseling Psychology, 45, 454–467.
Nicholas, L., & Durrheim, K. (1995). Religiosity, AIDS, and sexual knowledge, attitudes,
beliefs, and practices of Black South-African first-year university students. Psychological
Reports, 77, 1328–1330.
Novey, P., & Novey, T. (1983). Don’t make daddy mad or teaching women how to negotiate
with men. Women, 13, 97–103.
Park, B. J., Stergachis, A., Scholes, D., Hendrick, F. E., Holmes, K. K., & Stamm, W. E.
(1995). Contraceptive methods and the risk of Chlamydia trachomatous infection in young
women. American Journal of Epidemiology, 142, 771–778.
Poma, P. A. (1987). Pregnancy in Hispanic women. Journal of the National Medical Association,
79, 929–935.
Poulson, R. L., Eppler, M. A., Satterwhite, T. N., Wuensch, K. L., & Bass, L. A. (1998).
Alcohol consumption, strength of religious beliefs and risky sexual behavior in college
students. Journal of American College Health, 46, 227–232.
Riger, S. (1993). What’s wrong with empowerment. American Journal of Community Psychol-
ogy, 21, 279–292.
Rosenberg, M., & Simmons, R. G. (1971). Black and European American self esteem: The
urban school child. Washington, DC: American Psychological Association.
Sobo, E. J. (1993). One blood—The Jamaican body. Albany: State University of New
York Press.
St. Lawrence, J. S., Eldridge, G. D., Reitman, D., Little, C. E., Shelby, M. C., & Brasfield,
T. L. (1998). American Journal of Community Psychology, 26, 7–28.
Studer, M., & Thornton, A. (1987). Adolescent religiosity and contraceptive usage. Journal
of Marriage and the Family, 49, 117–128.
Tucker, M. B., & Mitchell-Kernan, C. (Eds.) (1995). The decline in marriage among African
Americans: Causes, consequences, and policy implications. New York: Russell Sage Foun-
dation.
UN Chronicle. (1994). Women and children: Increasingly targeted by HIV. UN Chronicle,
31, 56–57.
VanOss Marin, B., Tschann, J. M., Gomez, C. A., & Gregorich, S. (1998). Self-efficacy to
use condoms in unmarried Latino adults. American Journal of Community Psychology,
26, 53–71.
VanOss Marin, B., Tschann, J. M., Gomez, C. A., & Kegeles, S. M. (1993). Acculturation
and gender differences in sexual attitudes and behaviors: Hispanic vs. Non-hispanic White
unmarried adults. American Journal of Public Health, 83, 1759–1761.
Vargas, A. (1988). Literacy in the Hispanic community. Washington, DC: National Council
of La Raza.
White, J. L. (1984). The psychology of Blacks. Englwood Cliffs, NJ: Prentice-Hall.
Wilson, W. J. (1987). The truly disadvantaged. Chicago: University of Chicago Press.
Worth, D. (1990). Sexual decision-making and AIDS: Why condom promotion among vulnera-
ble women is likely to fail. Studies in Family Planning, 20, 297–307.
Wyatt, G. E. (1985). The Wyatt sexual history questionnairre. Los Angeles: UCLA.
Wyatt, G. E. (1992). The sociocultural context of African American and White American
Women’s rape. Journal of Social Issues, 48(1), 77–91.
Wyatt, G. E. (1994). The sociocultural relevance of sex research: Challenges for the 1990’s
and beyond. American Psychologist, 49, 748–754.
Wyatt, G. E. (1997). Stolen women: Reclaiming our sexuality, taking back our lives. New
York: Wiley.
Wyatt, G. E., et al. (1994). Final report 1990–1994: Sexual decision-making among Jamaicans.
Family Health International.
Wyatt, G. E., Carmona, J. V., Ashing-Giwa, K. T., Loeb, T. B., Chin, D., & Guthrie, D.
(1999). Predicting women’s HIV related risk taking with the sexual health model. Manu-
script submitted for publication.
Wyatt, G. E., Forge, N. G., & Guthrie, D. (1998). Family constellation and ethnicity: Current
and lifetime HIV-related risk taking. Journal of Family Psychology, 12, 93–101.
Wyatt, G. E., Myers, H., & Ashing-Giwa. (in press). Socio-cultural factors in sexual risk-
taking among Black men and women. In R. Staples (Ed.), The black family: Essays and
studies. Newbury Park, CA: Sage.
Wyatt, G. E., Newcomb, M. D., & Riederle, M. (1993). Sexual abuse and consensual sex:
Women’s developmental patterns and outcomes. Newbury Park, CA: Sage.
Wyatt, G. E., & Riederle, M. H. (1994). Reconceptualizing issues that affect women’s sexual
decision-making and sexual functioning. Psychology of Women Quarterly, 18, 611–625.
Wyatt, G. E., Tucker, B. M., Romero, G. J., Vargas-Carmona, J., Newcomb, M. D., Wayment,
H. A., Loeb, T. B., Solis, B. M., & Mitchell-Kernan, C. (1997). Adapting a comprehensive
approach to African American women’s sexual risk taking. Journal of Health Education,
28, 52–60.
Zelnik, M., & Kantner, J. F. (1980). Sexual activity, contraceptive use, and pregnancy among
metropolitan-area teenagers: 1971–1979. Family Planning Perspectives, 12, 230–237.

VB

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

VB

Uploaded by

Copyright:

Available Formats

Sex Roles, Vol. 42, Nos.

Factors Affecting HIV Contraceptive Decision-

We examined contraceptive decision-making among African American, Lat-

Women’s contraceptive patterns impact their sexual health and can

0360-0025/00/0400-0495$18.00/0  2000 Plenum Publishing Corporation

sion-making. High rates of unwanted sexual outcomes, including unin-

Although women may encounter risks depending on their contracep-

Factors Influencing Contraceptive Decision-Making

cultural expectations of marriage and children within a family context

Histories of Unwanted Sexual Outcomes. In order to identify factors

Purpose of the Study

This investigation is an exploratory study aimed at answering specific

We used stratified probability sampling and random digit telephone

Each participant was interviewed face-to-face by a trained female inter-

Table I. Demographic Characteristics of Random Sample (N ⫽ 724)

home, UCLA, or another location). Of the 242 Latinas, 99 were interviewed

The Los Angeles Structured Interview (LASI) consists of open- and

Demographic background was defined as personal characteristics and

Women’s self-reported perceptions of their religiosity was assessed by

Personal Histories of Sexually Transmitted Diseases

Personal Histories of Unintended Pregnancies

Respondents indicated the number of unintended pregnancies during

Reasons for Sex

It is important to understand the reasons why women engage in sexual

Who Decides About Contraception

Women who were currently using contraception indicated how they

Women reported their current contraceptive method. Responses were

The first step in data analysis involved data reduction. A principal

Table II. Factor Analysis of the Reasons for Sex

Factor 2. Sex for personal satisfaction and intimacy

Factor 3. Sex for procreation

1 Contraceptive methoda 1.00

included five sexual-related variables (STD history, unintended pregnan-

Ethnic Group Differences

Analysis of variance and subsequent post-hoc Bonferroni tests revealed

likely to report engaging in sex for self-enhancement and more likely to

Phase 1 Predictors of Who Decides About Contraception

Phase 1 was conducted to identify what characteristics enable women

Phase 2 Predictors of Contraceptive Nonuse

Phase 2 investigated factors associated with contraceptive nonuse in

Table V. Phase 1: Predictors of Who Decides About Contraception

Table VI. Phase 2: Predictors of Contraceptive Nonuse

Phase 3 Predictors of Ineffective Methods of Contraception Versus

(N ⫽ 574), univariate analyses were conducted to determine the correlates

Table VII. Phase 3: Predictors of Ineffective Methods of Contraception

Phase 4 Predictors of Pregnancy/Disease Prevention

Phase 4 was conducted to identify characteristics of women who use

Table VIII. Phase 4: Predictors of Pregnancy/Disease Prevention

A logistic regression of the predictors of the use of pregnancy/disease

This study attempted to broaden our understanding of women’s contra-

reaching older, single, African American women who demonstrate that

We have more work to do to minimize women’s risks for HIV and

Health Model (SHM) developed by Wyatt et al. (1999) attempts to explain

This research was funded by the National Institute of Mental Health,

You might also like