Sexual activity and contraceptive use among children entering out-of-home care.

This study explored the prevalence of reported sexual activity of a cohort of children entering out-of-home care and the ability of selected factors to explain reported sexual activity and use or nonuse of contraceptives. It found that children as young as age 8 reported sexual activity, and that more than one-third of the children age 8 to 18 reported being sexually active. Of those who were sexually active, more than one-third were not using contraceptives. Using logistic regression, five variables are identified as having importance in explaining sexual activity. Two variables had some limited ability to explain contraceptive use. Implications of these findings are discussed and suggestions for policy and practice are made. An estimated 445,000 children were in out-of-home care in 1993 [Curtis et al. 1995]. While the rapid increase in the number of children entering care may be leveling off, fewer children are leaving care [Children's Defense Fund 1995]. Approximately 70% of the children in out-of-home care live in family foster homes, with the remainder living in group homes, residential treatment centers, or institutional settings. Children in out-of-home care are usually in the legal custody of the state, which then has the enormous responsibility for providing resources that guarantee their "adequate care." Adequate care involves identifying and meeting the children's developmental needs, including elements of sexual development [Child Welfare League of America 1988, 1995; Mayden 1996]. Despite both public (see e.g., Hymowitz [1994]; Wallis [1985]) and professional concern with the consequences of teen sexuality [Blair & Hein 1994; O'Reilly & Sevgi 1985], however, little attention seems to have been given to sexual activity and its consequences for children in care, particularly in the social work literature. Though family planning and sexuality are often mentioned in discussions of independent-living programs for adolescents in care, little research on the prevalence of sexual activity and contraceptive use among children in out-of-home care has been published. The purpose of the present study was to examine (1) the prevalence of reported sexual activity and (2) the use of contraceptives in a cohort of children entering out-of-home care, and (3) to examine the relative importance of selected factors in explaining the children's sexual activity and (4) their use of contraceptives. Background Because of the circumstances precipitating their placement into care (e.g., maltreatment) and social characteristics such as poverty, children in out-of-home care are among some of our most vulnerable children. Most are in care because of some form of abuse or neglect, many are in poor health (e.g., Chernoff et al. [1994]; Gruber [1978]; Hochstadt et al. [1987]; Schor [1982]), and the majority are at high risk for medical and psychosocial problems (e.g., Jenkins & Norman [1969]; Kinard [1980]; Mouzakitis [1984]). The placement experience entails separation from familiar surroundings and significant others. This often leaves children feeling vulnerable, rejected, and unworthy [Brockhaus & Brockhaus 1982; Halfon et al. 1992; Molin 1988]. Many children come into care out of crisis situations and soon experience changes in placement. Therefore, although placement in out-of-home care is intended to be therapeutic, it also may add to a child's risk for problems [Fine 1989; Schor 1988]. Although much is known about the demographic characteristics and health status of children in out-of-home care, information concerning their sexual activity or their use of contraceptives is limited. Some of the many specific or related studies on the health status of children in care do include some information; others do not. For example, Kavaler and Swire [1983] do not appear to mention sexual activity or sexually transmitted diseases (STDs) in their book Foster-Child Health Care. Several other studies mention sexual activity only in the context of behavioral or health habit assessments (e. …