Developmental models

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What is contraceptive use?
Researchers have used several different classifications of contraception in an attempt to
predict contraceptive use. For example, contraception has been characterized as:
I coitus-independent (the pill) or coitus-dependent (the condom);
I reliable (the pill, condom) or unreliable (rhythm method);
I female-controlled (the pill, IUD) or male-controlled (the condom);
I prescription-based (the pill, IUD) or prescription-independent (the condom).
In addition, different measures of actual behaviour have been used when predicting
contraception use:
I at first ever intercourse;
I at most recent intercourse;
I at last serious intercourse;
I at last casual intercourse.
Who uses contraception?
The National Survey of Sexual Attitudes and Lifestyles (Wellings et al. 1994) examined
the sexual behaviour of nearly 20,000 men and women across Britain. This produced a
wealth of data about factors such as age of first intercourse, homosexuality, attitudes to
sexual behaviours and contraception use. For example, Figure 8.1 shows the proportion
of respondents who used no contraception at first intercourse. These results suggest that
the younger someone is when they first have sex (either male or female), the less likely
they are to use contraception.
The results from this survey also show what kinds of contraception people use
at first intercourse. The data for men and women aged 16–24 years are shown in
Figure 8.2 and suggest that the condom is the most popular form of contraception;
however, many respondents in this age group reported using no contraception, or
unreliable methods, such as withdrawal or the safe period.
The different measures of contraception use have implications for interpreting
findings on contraception. Sheeran et al. (1991) discussed these problems and analysed
the literature on contraceptive use in ‘never married’ individuals aged 13–25 years, and
suggested that models used to examine contraceptive use for pregnancy avoidance
can be described as either developmental models or decision-making models. The focus on
sex as risky resulted in a need to understand risk-taking behaviour. Developmental
models are more descriptive, whereas decision-making models examine the predictors
and precursors to this behaviour.
Developmental models
Developmental models emphasize contraception use as involving a series of stages. They
suggest that the progress through these stages is related to sexual experience and an
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Fig. 8-1 Percentage using no contraception at first intercourse, by age at first intercourse
(after Wellings et al. 1994)
increasing role for sexuality in the individual’s self-concept. Therefore, they describe the
transition through the different stages but do not attempt to analyse the cognitions that
may promote this transition.
Lindemann’s three-stage theory
Lindemann (1977) developed the three-stage theory of contraception use, which
suggests that the likelihood of an individual using contraception increases as they
progress through the three stages:
1 Natural stage: at this stage intercourse is relatively unplanned, and the individual
does not regard themselves as sexual. Therefore, contraception use is unlikely.
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Fig. 8-2 Contraception use at first intercourse in those aged 16–24 (after Wellings et al. 1994)
2 Peer prescription stage: at this stage the individual seeks contraceptive advice from
friends, sexual intercourse is more frequent and most contraception involves less
effective methods.
3 Expert stage: at this stage, the individual has incorporated sexuality into their
self-concept and will seek professional advice and plan contraceptive use.
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