INTRODUCTION:Digital technologies have reshaped relationships and sexual practices, both in terms of sexual well-being and through the emergence of cyberharassment. However, evidence remains limited, however, on how these practices vary by gender, generation, sexual orientation, and social position. This article aims to describe the frequency of online sexual experiences and their correlates in a large national sample. METHODS:The study draws on CSF-2023, a cross-sectional survey of sexuality in France. The sample comprises 15,906 individuals aged 18-59 who reported information on their online practices. We analyze the frequency of these experiences and their associations with gender, generation, sexual orientation, and educational level, using univariate and multivariate analyses. RESULTS:Men reported online sexual experiences more often than women (58% vs. 46%). Sending intimate images was reported by 21% of women and 25% of men, and receiving them by 28% and 33% respectively. These practices were more frequent among younger respondents and among people who had same-sex partners, with older generations having taken them up later in life. A marked gender contrast emerged for negative experiences: while they affected 19% of women and 17% of men aged 18-59, the gap widened sharply among 18-29-year-olds (33% of women vs. 25% of men). Single women and people in poor health were more exposed; among men, risk was highest for those who had same-sex partners and a low level of education. CONCLUSION:Digital practices can be positive, but they can also lead to harmful exposure with deleterious effects, which particularly affect young women. There is a need to develop lifelong education about these new forms of intimate exchange, together with support measures for people confronted with these new forms of sexual violence.

INTRODUCTION:The 2023 national survey "Context of Sexualities in France" (CSF-2023) explores sexuality and sexual health in France. METHODS:Conducted between November 2022 and December 2023, CSF-2023 is a cross-sectional probability survey involving 21,259 respondents aged 15-89 in continental France. Participants were selected via random-digit dialing, completing a 33-min phone interview (Part 1), followed by a 30-min self-administered online questionnaire for those 18 and older (Part 2). Sexually active respondents aged 18-59 also participated in a sexually transmitted infection (STI) self-testing study. The survey collected data on sociodemographic characteristics, sexual attitudes, relationships, practices, gender expressions, and digital use for self-care and sexual practices. RESULTS:A total of 21,259 individuals completed the Part 1 survey (34% response rate). Of those, 12,906 individuals aged 18-89 completed Part 2 (71% of the 18-89 eligible group). Among the 13,686 individuals aged 18-59 offered STI testing, 4872 (32%) returned results; of the 2959 aged 18-29 offered Human Papillomavirus (HPV) testing, 811 (27%) participated. Post-stratification weights were applied to mitigate non-response bias for key sociodemographic traits, with minimal impact on sexual and reproductive health (SRH) indicators, reaffirming sample representativeness. Fieldwork highlighted the importance of not only adapting questionnaire design and sequencing, but also providing strong psychological and supervisory support to interviewers administering a large-scale survey on sensitive and sometimes distressing topics. CONCLUSION:CSF-2023 provides rich data to track trends in sexuality and sexual health in France, while expanding knowledge on emerging topics such as digital sexual health and SRH self-care. These findings can inform policy and programming, including the French National Strategy for Sexual Health and the World Health Organization European action plan for SRH. In parallel, the CSF-2023 fieldwork experience provides important methodological insights into the conduct of large-scale sexual health research, underscoring the central role of interviewer training, supervision, and psychological support in ensuring high-quality data collection on sensitive topics.

BACKGROUND:Military sexual trauma (MST) is a major public health concern, given its prevalence and mental health sequelae. This phenomenon is particularly prevalent among women in the US military, although more cases involve men given their overrepresentation. Little is known about MST and its consequences in other military settings, including in Europe.METHODS:This study draws from a national survey in the French military, including 1268 servicemen and 232 servicewomen. We conducted bivariate and multivariate analysis, using simple and multinomial logistic regressions to evaluate the associations between different forms of MST (repeated sexual comments alone/one form of sexual oppression (coercion, repeated verbal unwanted attention or assault)/ several sexual stressors) and symptoms of depression and of positive post-traumatic stress disorder (PTSD) screening scores.RESULTS:Women were both more likely to experience MST and to experience more severe forms of MST than men. Women were also more likely than men to report mental health symptoms (31% versus 18% for symptoms of depression and 4.0% versus 1.8% for positive PTSD screening scores). Different forms of MST were associated with different levels of psychological distress. Women reporting repeated sexual comments alone had higher odds of depressive symptoms (OR=3.1 [1.7, 5.5]) relative to women with no MST. Likewise, the odds of depressive symptoms were 6.5 times higher among women and 8.0 times higher among men who experienced several sexual stressors relative to those who reported no MST. We also found higher relative risk of subthreshold PTSD screening scores among women reporting any form of sexual stressor, including sexual comments alone (RRR = 4.5 [2.8, 7.4]) and an elevenfold increase in the relative risk of positive PTSD screen scores (RRR = 11.3 [2.3, 55.6]) among women who experienced several sexual stressors relative to women with no MST.CONCLUSION:MST is associated with mental health distress among service members in the French military, especially for women. The heightened risk of MST coupled with psychological sequelae call for preventive programs to reduce MST and for screening programs to provide adequate psychological support.

Background Sexual harassment (SH) is prevalent in military settings and dependent on the workplace environment. Few studies have investigated this issue in non-US military settings nor have examined how contextual and individual factors related to Military Sexual Trauma (MST) vary by gender. Methods This study draws on a national sexual survey in the French military including 1268 servicemen and 232 servicewomen. We examined four sexual stressors (repeated sexual comments, sexual coercion, repeated unwanted verbal sexual attention and sexual assault (SA)) and two combined measures of verbal SH (comments, unwanted attention) and MST (all forms). We conducted multivariate logistic regressions to identify contextual and individual factors related to these outcomes. Results 36.7% of women and 17.5% of men experienced MST in the last year and 12.6% and 3.5% reported SA. Factors associated with verbal SH differed from those related to SA. The odds of verbal SH were elevated among men who had sex with men (OR = 3.5) and among women officers (OR = 4.6) while the odds of SA were elevated among men less than 25 years (OR = 3.5) and women with less than a high school diploma (OR = 10.9). The odds of SH increased by 20% to 80% when men worked in units with higher female representation, higher prevalence of MST (sexual comments, or sexual assault, coercion, repeated unwanted attention) and lower acceptance of women in the miliatry. The odds of SA also increased by 70% among men working in units with higher female representation and higher prevalence of sexual oppression. The odds of SA against women were particular high (OR = 5.7) in units with a high prevalence of sexual assault, coercion, or repeated unwanted attention. Conclusion MST is common in the French military, with women experiencing more severe forms than men. Our resuls call for programmatic action to reduce workplace factors related to verbal SH and SA in the French military.

Background: Reliability of nonprobability online volunteer panels for epidemiological purposes has rarely been studied. Objectives: To assess the quality of a questionnaire on sexual and reproductive health (SRH) administered in a nonprobability Web panel and in a random telephone survey ( n = 8,992; n = 8,437, age 16–49 years). Especially, we were interested in the possible difference in the association of sociodemographic variables and some outcome variables in the two surveys that are in the reliability of analytical epidemiological studies conducted in such panels. Methods: Interventions to increase response rate were used in both surveys (four e-mail reminders, high number of call attempts and callbacks to refusals). Both were calibrated on the census population. Sociodemographic composition, effects of reminders, and prevalence were compared to their telephone counterpart. In addition, the associations of sociodemographic and sexual behaviors were compared in the two samples in multivariate logistic regressions. Results: The online survey had a lower response rate (20.0 percent vs. 44.8 percent) and a more distorted sociodemographic structure although the reminders improved the representativeness as did the analogous interventions on the telephone survey. Prevalences of SRH variables were similar for the common behaviors but higher online for the stigmatized behaviors, depending on gender. Overall, 29 percent of the 63 interactions studied were significant for males and 11 percent for women, although opposite effects of sociodemographic variables were rare (5 percent of the 171 tested for each gender). Conclusion: Nonprobability online panels are to be used with caution to monitor SRH and conduct analytical epidemiological studies, especially among men.

Background: Sexual health in the military comprises a range of concerns including sexually transmitted infections (STI), unintended pregnancy, sexual violence and sexual dysfunction. This study aims to estimate the prevalence of sexual health concerns by gender in the French military and compare these prevalences to estimates in the general population. Methods: COSEMIL, the first sexual health survey in the French military comprises a probability sample of 1500 military personnel. Chi-square tests were used to compare lifetime abortion, STIs and sexual assault, and recent sexual dysfunction and sexual satisfaction by gender and explore the association between these indicators and current sexual risk (condom use at last intercourse). Results: Women were more likely than men to declare negative sexual health outcomes, with the greatest difference related to sexual assault (24.3% versus 5.1% of males, p < 0.001) and sexual dysfunction hindering sexuality (15.2% of females versus 5.3% of males, p < 0.001). Women were also twice as likely to report ever having an STI (6.7% versus 3.4%, p = 0.03). Comparison with the French general population indicates lower percentages of STIs among military men (2.9% versus 4.9%) and higher percentages of abortion (17.6% versus 14.3%) forced sex (10.6% versus 7.4%) and sexual dysfunction (14.2% versus 9.3%) among military women. Conclusion: These results highlight gendered pattern of sexual health in the French military with women suffering greater sexual risks than men. Military health services should include women's health services to address the sexual and reproductive health gender gap.

Background: Assessing menstrual cycle function in the general population using a non-invasive method is challenging, both in non-industrialized and industrialized countries. Subjects and methods: The Observatory of Fecundity in France (Obseff) recruited on a nationwide basis a random sample of 943 women aged 18–44 years with unprotected intercourse. A sub-study was set up to assess the characteristics of a menstrual cycle by using a non-invasive method adapted to the general population. Voluntary women were sent a collection kit by the post and requested to collect urine samples on pH strips, together with daily recording of reproductive-related information during a full menstrual cycle. A total of 48 women collected urine every day, whereas 160 women collected urine every other day. Immunoassays were used to measure pregnanediol-3–α–glucuronide, estrone-3-glucuronide and creatinine. Ovulation occurrence and follicular phase duration were estimated using ovulation detection algorithms, compared to a gold standard consisting of three external experts in reproductive medicine. Results: Every other day urine collection gave consistent results in terms of ovulation detection with every day collection (intraclass coefficient of correlation, 0.84, 95% confidence interval, 0.76–0.98). The proportion of anovulatory menstrual cycles was 8%. The characteristics of the ovulatory cycles were length 28 (26–34), follicular phase 16 (12–23), luteal phase 13 (10–16) days median (10th–90th percentiles). Discussion-Conclusion: Assessing menstrual cycle characteristics based on urine sample spot only collected every other day in population-based studies through a non-invasive, well accepted and cost-limited procedure not requiring any direct contact with the survey team appears feasible and accurate.

Introduction Sexually Transmitted Infections (STIs) have always represented a public health concern in the military, yet most studies rely on self-reports among non-random samples of military populations. In addition, most of the studies exploring STI rates among the military focus on US service members. This paper assesses the prevalence and correlates of STIs in the French military using biomarkers and compares self-reported versus diagnosed STIs. Methods Data are drawn from the COSEMIL study, a national sexual health survey conducted in the French military in 2014 and 2015. A random sample of 784 men and 141 women aged 18–57 years completed a self-administered questionnaire and provided biological samples for STI testing. We used logistic regression modeling to identify the correlates of STI diagnosis and self-reports. Results The prevalence of diagnosed STIs was 4.7% [3.8–5.9], mostly due to Chlamydia trachomatis. This rate was four times higher than the 12 months self-reported rate of 1.1% [0.6–2.3]. Reported STI rates were similar among men and women (1.1% versus 1.8%), but diagnosed STI rates were twice as high among females versus males (10.4% versus 4.1%, p = 0.007). There were significant differences in the determinants of reported versus diagnosed STIs. In particular, age and sexual orientation were associated with reported STIs, but not with diagnosed STIs. Conversely, STI counseling and depression were associated with STI diagnosis but not with STI reports. Conclusion This study underlines the need to use biomarkers in population-based surveys, given the differential and substantial underreporting of STIs. Results also highlight the need for programmatic adaptation to address gender inequalities in STI rates, by developing women’s health services in the French military. Addressing such needs not only benefits women but could also serve as a strategy to reduce overall STI rates as most military women have military partners, increasing the risk of internal transmission.

Objectives: This study is to assess frequency and correlates of women's reports of unintended pregnancy risk in the general population in France.Study design: Data are drawn from the FECOND survey, a national probability survey on sexual and reproductive health conducted in France in 2010. We identified 2969 women ages 15-49 years who had heterosexual intercourse in the 4 weeks prior to the survey and who were at potential risk of unintended pregnancy. We evaluate women's reports of unintended pregnancy risk in the last 4 weeks and identify correlates of such reports using logistic regression modeling.Results: Fifteen percent of women thought that they could have become pregnant in the last 4 weeks without wanting to do so. Reports of unintended pregnancy risk were higher among women in very difficult financial situations (OR=1.87 [1.32-2.65]) and foreign-born women (OR=1.53 [1.03-2.29]). Exposure in the form of contraceptive practices and errors in use of contraception were the strongest correlates of women's reports of unintended pregnancy risk, yet among the 9.8% of women who reported inconsistent use of contraception or unprotected intercourse in the last 4 weeks, 63% did not think they could have become pregnant unintentionally.Conclusions: Significant discrepancies between pregnancy exposure and women's report of unintended pregnancy risk call for better SRH educational programs to improve pregnancy awareness in the general population. On the other hand, targeted interventions toward women who report being at risk of unintended pregnancy may contribute toward reducing unintended pregnancies given the frequency of such events. (C) 2016 Elsevier Inc. All rights reserved.

Objective To describe contraceptive practices of men in a relationship in France, where use of female-controlled methods is predominant, and to explore their involvement in managing contraception within the couple. Study design Data are drawn from a national probability cross-sectional survey on sexual and reproductive health conducted in France in 2010. The study sample comprised 3373 men aged 15–49, 1776 of whom were asked about their current contraceptive practices after they reported that they were fecund and sexually active and did not currently want a child. Analyses were performed with logistic regression models. Results Few men aged 15–49 with a partner did not use contraception (3.4%). Most reported using only a female method (71.7%), 20.4% only cooperative methods, such as condoms, withdrawal and the rhythm method and 4.5% both. Among contraceptive users, withdrawal (7.7%) was more likely to be used by men with low incomes or low educational levels. Condom use was reported as a contraceptive method by 18.9% of men. Its prevalence was higher for those in new and noncohabiting relationships (36.1%) and lower for those in cohabiting relationships (12.4%), in which STIs/HIV prevention is less of a concern. Conclusion Men's high awareness of contraceptive practices and their use of some cooperative methods reveal their involvement in contraceptive practices within the context of relationships. Condom use is associated with the prevention of STIs/HIV for noncohabiting men, but men who live with their female partner seem to use condoms mainly as a contraceptive method. Withdrawal appears to be associated with low level of education and financial difficulties. Finally, having engendered a pregnancy that was terminated appears to influence men's contraceptive practices. Implications Studying men's contraceptive practices helps to understand their involvement in contraceptive management within relationships.

STUDY QUESTION:What are the characteristics and circumstances of pregnancies men report as unintended in France?SUMMARY ANSWER:Pregnancies reported as unintended were most prevalent among young men with insecure financial situations, less stable relationships and inconsistent use of contraception or false assumptions about their partner's use of contraception.WHAT IS KNOWN ALREADY:Efforts to involve men in family planning have increased over the last decade; however, little is known about factors associated with men's pregnancy intentions and associated contraceptive behaviours.STUDY DESIGN, SIZE, DURATION:The data presented in this study were drawn from the nationally representative FECOND study, a population-based survey conducted in France in 2010. The sample comprised 8675 individuals (3373 men), aged 15-49 years, who responded to a telephone interview about socio-demographics and topics related to sexual and reproductive health. The total refusal rate was 20%.PARTICIPANTS/MATERIALS, SETTING, METHODS:This study included 2997 men, of whom 664 reported 893 recent pregnancies (in the 5 years preceding the survey). Multivariate Poisson's regression with population-averaged marginal effects was applied to assess the individual and contextual factors associated with men's intentions for recent pregnancies. The contraceptive circumstances leading to the unintended pregnancies were also assessed.MAIN RESULTS AND THE ROLE OF CHANCE:Of all heterosexually active men, 5% reported they had experienced an unintended pregnancy with a partner in the last 5 years. A total of 20% of recent pregnancies reported by men were qualified to be unintended, of which 45% ended in induced abortion. Of pregnancies following a previous unintended pregnancy, 68% were themselves unintended. Among all heterosexually active men, recent experience of an unintended pregnancy was related to age, mother's education, age at first sex, parity, contraceptive method history, lifetime number of female partners and the relationship situation at the time of survey. Recent unintended pregnancies were also related to pregnancy order and to the financial and professional situation at the time of conception. The majority of unintended pregnancies occurred when men or their partners were using contraceptives; 58% of contraceptive users considered that the pregnancy was due to inconsistent use and 39% considered that it resulted from method failure. Half of the non-users who reported an unintended pregnancy thought that their partner was using a contraceptive method. The relative risk of non-use of a contraceptive method during the month of conception of a recent unintended pregnancy was higher among those without a high school degree (IRR = 2.9, CI 1.6, 5.2) and higher among men for whom the pregnancy interfered with education (IRR = 1.8, CI 1.0, 3.1) or work (IRR = 1.9, CI 1.1, 3.6).LIMITATIONS, REASONS FOR CAUTION:From the perspective of men, the unintended pregnancy rates may be underestimated due to a combination of underreporting of abortion and post-rationalization of birth intentions. Our use of a dichotomous measure of unintended pregnancy is unlikely to fully capture the multidimensional construct of pregnancy intentions.WIDER IMPLICATION OF THE FINDINGS:These results call for gender-inclusive family planning programmes, which fully engage men as active participants in their own rights.STUDY FUNDING/COMPETING INTERESTS:The FECOND study was supported by a grant from the French Ministry of Health, a grant from the French National Agency of Research (#ANR-08-BLAN-0286-01; PIs N.B., C.M.), and funding from National Institute of Health and Medical Research (INSERM) and the National Institute for Demographic Research (INED). None of the authors have competing interests.

The media debate in late 2012 and early 2013 on contraceptive pills did not reduce contraceptive prevalence, but the use of oral contraception decreased, falling from 50% in 2010 to 41% in 2013. A portion of women opted for other methods, notably IUDs (among the most educated), condoms, or “natural” methods (among the most disadvantaged). New social inequalities in contraceptive use appeared. The 2013 debate contributed to a diversification of contraceptive practices, although the pill remains dominant.

OBJECTIVE:The relation between levels of contraceptive use and the incidence of induced abortion remains a topic of heated debate. Many of the contradictions are likely due to the fact that abortion is the end point of a process that starts with sexual activity, contraceptive use (or non-use), followed by unwanted pregnancy, a decision to terminate, and access to abortion. Trends in abortion rates reflect changes in each step of this process, and opposing trends may cancel each other out. This paper aims to investigate the roles played by the dissemination of contraception and the evolving norms of motherhood on changes in abortion rates.METHODS:Drawing data from six national probability surveys that explored contraception and pregnancy wantedness in France from 1978 through 2010, we used multivariate linear regression to explore the associations between trends in contraceptive rates and trends in (i) abortion rates, (ii) unwanted pregnancy rates, (iii) and unwanted birth rates, and to determine which of these 3 associations was strongest.FINDINGS:The association between contraceptive rates and abortion rates over time was weaker than that between contraception rates and unwanted pregnancy rates (p = 0.003). Similarly, the association between contraceptive rates and unwanted birth rates over time was weaker than that between contraceptive rates and unwanted pregnancy rates (p = 0.000).

Objective: While the intra-uterine device (IUD) is the second most popular contraceptive method in France, its use remains low among women most at risk of unintended pregnancies. Acknowledging the conjoint role of women and physicians in contraceptive decision making, we investigate the determinants of RID use and IUD recommendations from the user and prescriber perspectives.Study design: Data are drawn from 2 national probability surveys (population-based and physician surveys) on sexual and reproductive health in France. The population based survey comprised 3,563 women ages 15-49 at risk of an unintended pregnancy in 2010 and the physician survey included 364 general practitioners (GPs) and 401 gynecologists practicing in private offices in 2010-2011. Analyses were performed using logistic regression models.Results: Altogether, 21.4% of women were IUD users, with substantial differences by age and parity. Less than 1% of young women (<25 years) and 3% of nulliparous were current IUD users in 2010. The odds of IUD use were four times higher in women followed by a gynecologist as compared to a GP. Mirroring these results, gynecologists were more likely to recommend IUDs than GPs. Misconception about IUD risks was widespread among women and providers. Medical training and information, professional practice settings, and ever use of IUDs also informed physician's likelihood of recommending IUDs, regardless of specialty.Conclusions: The study reveals the intersection of individual and professional influences on contraceptive use patterns. The considerable age discrepancy in IUD use in France, with very few young women most at risk of an unintended pregnancy using the method, reflects a knowledge gap shared by users and providers. These findings suggest there are significant opportunities to improve contraceptive care in France.Implications: This study stresses the need to inform women and doctors about the benefits and risks of IUDs for all women. Substantial efforts are required to improve the medical curriculum, in order to promote evidenced based family planning counseling and provide GPs with the technical skills to insert IUDs. (C) 2014 Elsevier Inc. All rights reserved.

Objective: To evaluate the effect of question wording on national estimates of pregnancy intentions.Design: Data drawn from a national probability survey.Setting: The FECOND study in France in 2010.Patient(s): Five thousand two hundred and seventy-two women and 3,373 men who reported 11,603 pregnancies.Intervention(s): Participants randomly assigned to answer 1 of 2 questions on whether they had planned or wanted each of their pregnancies.Main Outcomes Measure(s): Generalized estimated equation regression models used to test for differences in pregnancy intentions by question wording.Result(s): The use of different wording yielded a 6% point difference in estimates: 33.5% pregnancies were "unplanned," and 27.4% were "unwanted." The addition of information on reasons for not using contraception at the time of conception lead to significant recoding, which resulted in a significant reduction in the wording effect: 23.7% (95% CI 22.4-25.0) of pregnancies were unplanned, and 21.2% (95% CI 19.9-22.5) were unwanted. Results from the multivariate analysis confirm the greater chance of reporting an unplanned as compared with an unwanted pregnancy (relative risk 1.25 [95% CI 1.17-1.33]), even after recoding (relative risk 1.15 [95% CI 1.06-1.24]).Conclusion(s): This study shows the strong effect of question wording on estimates of pregnancy intentions. The results also support the value of adding information on reasons for nonuse of contraception when assessing pregnancy intentions. (C) 2014 by American Society for Reproductive Medicine.

In France, only a minority of people wish to remain childless, and the proportion reporting this choice has remained stable for the last two decades. In statistical terms, reporting a wish to remain childless is more frequent among persons who are not in a union, among highly educated women and among men with a low educational level or at the end of their reproductive life. Data from the Fecond survey (2010) and from a qualitative interview-based survey indicated that more than half of the persons reporting a wish to remain childless are in a union and that the majority give libertarian reasons for this choice, such as being happy without children and a desire for freedom. Running counter to the family norm, these people affirm a positive life choice focusing on personal fulfilment.

OBJECTIVE:We investigate trends in contraceptive behaviors in France and how they may have contributed to fluctuations in unintended pregnancy rates over time and across subgroups of the population between 2000 and 2010.STUDY DESIGN:Data are drawn from three national surveys in France, comprising 4714 women ages 15 to 49 in 2000, 8613 in 2005 and 5260 in 2010. We used multinomial and simple logistic regression models to explore trends in contraceptive behaviors over time. We estimated trends in unintended pregnancy rates in relation to population shifts in contraceptive behaviors between 2000 and 2010.RESULTS:A third of women were not using contraception at the time of the surveys. However, only 2.4% in 2000, 3.2% in 2005 and 2.4% in 2010 had an unmet need for contraception (p=.002). Among contraceptive users, user-dependent hormonal methods decreased from 59% in 2000 to 52% in 2010 (p<.0001), while long-acting reversible methods increased from 22% to 24% (p=.04). Changes in contraceptive behaviors resulted in fluctuations in unintended pregnancy rates estimated to have risen from 3.16% to 3.49% between 2000 and 2005, and to have decreased to 3.26% in 2010. Small changes in unmet need for contraception exerted the largest effects.CONCLUSION:This study indicates that changes in contraceptive behaviors over the past decade in France have potentially resulted in significant fluctuations in unintended pregnancy rates. Our results also demonstrate that a simple algorithm combining contraceptive behaviors and typical-use failure rates may be an acceptable proxy for monitoring trends in unintended pregnancies.IMPLICATIONS:This study offers a framework towards assessing trends in unintended pregnancies, when data on abortions and unintended births are not available. In the context of high contraceptive coverage, gaps of use undermine efforts to improve contraceptive effectiveness, as small fluctuations in unmet need contribute significantly to trends in unintended pregnancy rates.

STUDY QUESTION:Who initiates contraception before, at the time or after first sexual intercourse and how does timing of initiation affect future sexual and reproductive health (SRH) outcomes?SUMMARY ANSWER:Earlier initiation was associated with current utilization of more effective contraception, but had no impact on future unintended pregnancy, abortion or sexually transmitted infection rates, while later initiation was linked to higher rates of unintended pregnancies and abortions.WHAT IS KNOWN ALREADY:Contraceptive behaviour at first intercourse is associated with later SRH outcomes.STUDY DESIGN, SIZE, DURATION:Data were drawn from the FECOND study, the last national SRH study in France, conducted in 2010-2011 by phone among 8645 individuals aged 15-49 years.PARTICIPANTS/MATERIALS, SETTING, METHODS:Analysis was performed among 1552 women under the age of 30 years who were sexually experienced and had used contraception at some point. We used logistic regression models to identify factors associated with timing of contraception initiation relative to first intercourse (earlier, at the time and later) and its predictive value on future sexual and reproductive outcomes.MAIN RESULTS AND THE ROLE OF CHANCE:Timing of contraceptive initiation across all three categories (earlier, at the time and later initiators) was dependent on women's age at the time of the survey, country of birth, education level, ease of discussing sex with mother and age of first sex. Using at the time initiators as a reference, later initiators had higher odds of unintended pregnancy [odds ratio (OR) = 1.8] and abortion (OR = 1.9), while earlier initiators were more likely to be using more effective contraception at the time of the survey (OR = 1.8).LIMITATIONS, REASONS FOR CAUTION:The exclusion of sexually inexperienced women, a quarter of which had ever used the pill, may have reduced the scope of our analysis on the relevance of contraceptive initiation for non-contraceptive benefits.WIDER IMPLICATIONS OF THE FINDINGS:The promotion of early initiation of contraception may contribute to long-term use of more effective methods of contraception.STUDY FUNDING/COMPETING INTERESTS:The FECOND study was supported by a grant from the French Ministry of Health, a grant from the French National Agency of Research (#ANR-08-BLAN-0286-01; PIs N. Bajos, C Moreau) and funding from the National Institute of Health and Medical Research (INSERM) and the National Institute for Demographic Research (INED). None of the authors have a conflict of interest.

Objective While the intra-uterine device (IUD) is the second most popular contraceptive method in France, its use remains low among women most at risk of unintended pregnancies. Acknowledging the conjoint role of women and physicians in contraceptive decision making, we investigate the determinants of IUD use and IUD recommendations from the user and prescriber perspectives. Study design Data are drawn from 2 national probability surveys (population-based and physician surveys) on sexual and reproductive health in France. The population based survey comprised 3,563 women ages 15–49 at risk of an unintended pregnancy in 2010 and the physician survey included 364 general practitioners (GPs) and 401 gynecologists practicing in private offices in 2010–2011. Analyses were performed using logistic regression models. Results Altogether, 21.4% of women were IUD users, with substantial differences by age and parity. Less than 1% of young women (<25 years) and 3% of nulliparous were current IUD users in 2010. The odds of IUD use were four times higher in women followed by a gynecologist as compared to a GP. Mirroring these results, gynecologists were more likely to recommend IUDs than GPs. Misconception about IUD risks was widespread among women and providers. Medical training and information, professional practice settings, and ever use of IUDs also informed physician’s likelihood of recommending IUDs, regardless of specialty. Conclusions The study reveals the intersection of individual and professional influences on contraceptive use patterns. The considerable age discrepancy in IUD use in France, with very few young women most at risk of an unintended pregnancy using the method, reflects a knowledge gap shared by users and providers. These findings suggest there are significant opportunities to improve contraceptive care in France. Implications This study stresses the need to inform women and doctors about the benefits and risks of IUDs for all women. Substantial efforts are required to improve the medical curriculum, in order to promote evidenced based family planning counseling and provide GPs with the technical skills to insert IUDs.