In many settings, condoms are well-known and widely available, yet premarital first intercourse is frequently unprotected. This detailed ethnographic study explores this mismatch in low-income areas of Mexico City. Methods include participant observation and 154 in-depth interviews with young people from marginalized areas. Two key overarching themes emerged: gender and communication. Young people reinterpreted traditional gender roles to allow premarital sex under certain circumstances. Spontaneity was favored because this allowed behavior to fit more closely to traditional norms, potentially making planning of condom use difficult. The barrier to condom use created by this desire for spontaneity was overcome by some young people in the study through prior discussion of coitus and verbal agreement in advance. Good communication allowed the desired spontaneity without jeopardizing protection. To increase condom uptake, interventions must include a focus on improving communication skills and take into account the fact that spontaneity is valued.
Young people’s sexual health is a major international concern, particularly in the context of the global HIV/AIDS pandemic (1). Condom use has a crucial role to play in the reduction of unintended pregnancy and disease, and encouraging condom use is a priority for those working with sexually active young people worldwide. Condom use is not straightforward because it is intricately bound into the process of a social (sexual) interaction, with all the complexities this implies (2). It has been consistently found, for instance, that knowledge of sexual health issues and of condoms is not linked in a clear-cut way to behavior (3). Better understanding of the reasons for condom use and non-use is essential to inform advice and interventions aimed at increasing uptake of condoms by sexually active young people, in order that messages are as relevant and targeted as possible. A large number of quantitative studies have been conducted worldwide and have identified some predictors of condom use at the population level (e.g. 4, 5- 8), yet there has been only limited exploration of the social and cultural contexts of condom use, which are recognized as crucial for understanding behavior (9).
First coitus outside marriage is a specific, highly memorable event with considerable symbolic significance both for men and for women. It is of particular interest because first coitus indicates and influences the pattern of subsequent sexual behavior (10). Young people who use contraception at first coitus are more likely to go on to use contraception in future coitus than those who do not (11). Unmarried young people worldwide frequently do not use any modern contraceptive method during first coitus (12). While it is clear that non-use is common, the reasons for this are not well understood. The principal reason recorded in quantitative surveys for non-use of contraception at first (unmarried) coitus, is that coitus was unexpected and thus contraceptive methods were not immediately available (e.g. in Latin America 13, 14, 15). This implies that planning is the key for contraceptive use, but it is difficult to draw conclusions from current data because reasons are only recorded in cases of non-use – reasons for use of condoms are not recorded. It is therefore impossible to assess whether or not coitus was planned in these latter cases.
This qualitative study conducted in Mexico City explores condom use at first premarital intercourse among young people aged 16 to 22 at the time of the study. In Mexico, one-fifth of the population is young (15-24 years) (16), of whom 83 percent are unmarried (17). Few detailed data are available but in one recent survey premarital sexual intercourse was reported by 42 percent of men and 14 percent of women aged 15-24 nationwide, rising to 61 percent of men and 24 percent of women in the capital (our calculations using dataset from 18)). The survey did not investigate contraceptive use at first coitus, but separate survey data for 13-19 year olds indicate that unmarried young people frequently fail to use modern methods of contraception at first coitus: around 59 percent of unmarried young women and 49 percent of unmarried young men (our calculations using data from (19)) – a finding with clear negative implications for health.
Premarital sexual activity in Mexico appears to be increasing: one study showed that young women aged 15-19 were twice as likely to have experienced a premarital pregnancy than older women, aged 45-49: 35 percent versus 17 percent (20). Teenage pregnancies outside marriage in Mexico are frequently unintended and commonly end in illegal, often unsafe abortion (21), or “shotgun” weddings (i.e. where men are forced to marry the girl they have made pregnant) (20, 22). Almost all new cases of HIV infection in Mexico occur via sexual transmission (23), with transmission via heterosexual sex predominant for new infections (24).
In Mexico, first coitus has particular characteristics and different behaviors are expected for men and for women. According to traditional stereotypes, women’s first sexual intercourse is within marriage, and associated with procreation; men’s occurs before marriage, and procreation is therefore not desirable. In this model, then, women’s sexual initiation is within a highly defined socially-prescribed arena and without use of contraception. The relationship, one of husband and wife, is expected to be romantic, and characterized by love between the partners and their mutual desire to spend their lives together. The circumstances of men’s sexual initiation today have not diverged a great deal from the traditional stereotype. Women’s sexual initiation, on the other hand, now frequently occurs outside marriage, and a tension arises between expected and actual behavior that affects both coitus itself and contraceptive behavior.
The two central research questions of this paper are as follows. What are the implications of this tension for meanings of sexual behavior for young women beginning their sexual activity outside marriage? What are the implications for use of contraception?
Young people’s sexual and reproductive behavior in Mexico has been investigated in past studies, yet there are still large gaps in knowledge and even basic estimates of sexual behavior are difficult to obtain. One recent study showed that there is little agreement in research projects even in terms of basic indicators such as proportion of young people who are sexually active (25).
The present study addresses the urgent need for a more detailed understanding of young people’s sexual behavior. It is unique in two main ways. First, the qualitative analysis is based on a very large number of in-depth interviews (N=154, a vast increase on the far smaller samples of 20-30 interviews commonly used elsewhere). A smaller number of interviews can reveal basic patterns of behavior, but cannot capture the range and complexity of behaviors possible in a large study such as this. Second, the analysis of this large sample of interviews is enriched further by the ethnographic data gathered during the extensive time spent living and working in marginalized communities with the young people who are the focus of this study. In the first part of this paper, we examine the social meanings of first coitus among young people and how these relate to traditional gender roles. We show how stereotypical gender roles form only one layer of meaning for young people, who articulate an alternative set of social rules. These rules allow new sexual behaviors which can depart from past norms, and which have consequent health implications. In the second part, we use these findings to identify and attempt to explain aspects of relationships leading to use and non-use of condoms and other contraceptives among unmarried young people in low-income areas of Mexico City. The factors related to contraceptive use and non-use identified in this study will facilitate the development of evidence-based interventions.