Next Article in Journal
Investigating the Relationship Between Quality and Quantity of Participation in an Online Community-Based Exercise Program: A Mixed-Methods Study
Previous Article in Journal
Physical Activity Intensity in Youth with Chronic Pain With and Without Healthy Weight: A Preliminary Study
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Disabilities
Volume 5
Issue 3
10.3390/disabilities5030082
disabilities-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Examining the Moderating Role of Formal Sex Education on Contraceptive Use Among Individuals with Sensory Disabilities

by
Luis Enrique Espinoza
1,
Amanda M. Hinson-Enslin
2,*,
Heather F. de Vries McClintock
3,
Paris G. Rangel
4 and
Alina M. Jordan
2
1
College of Nursing and Health Sciences, Texas A&M University-Corpus Christi, Corpus Christi, TX 78412, USA
2
Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Fairborn, OH 45324, USA
3
Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA 19038, USA
4
Purple Communications, Inc., Austin, TX 78717, USA
*
Author to whom correspondence should be addressed.
Disabilities 2025, 5(3), 82; https://doi.org/10.3390/disabilities5030082
Submission received: 18 July 2025 / Revised: 9 September 2025 / Accepted: 10 September 2025 / Published: 16 September 2025
Versions Notes

Abstract

This study examined the association between formal sex education (FSE), sensory disability status, and contraceptive use among U.S. women. Women with disabilities face barriers to contraceptive decision-making, such as limited accessible FSE content and topics. Data were weighted and analyzed from the 2011–2019 National Survey of Family Growth among women 15–25 years of age. Multivariable logistic regression and moderation analysis examined the association between sensory disability status, contraceptive use during last sexual encounter, and FSE topics. Women with hearing loss or both hearing loss and vision loss were less likely to use contraceptives during last sexual encounter than women without sensory disability (hearing loss: adjusted odds ratio (aOR): 0.36; 95% confidence interval (CI): 0.14, 0.96; both: aOR: 0.28; CI: 0.08, 0.91). Exploratory moderation analysis showed women with vision loss who received FSE on birth control methods (aOR: 6.14; 95% CI: 1.70, 22.23) and on sexually transmitted infections (aOR: 28.24; 95% CI: 1.71, 46.63). The estimates were based on small numbers of individuals within each subgroup and wide confidence intervals, and thus should be interpreted with caution. The findings point to differences in contraceptive use according to sensory disability status, indicating future studies need larger sample sizes to better understand the role of FSE for women with sensory disability.

1. Introduction

The majority of women in the United States use contraception within their lifetime; however, some groups choose not to use contraception because of side effects, religious beliefs, and limited access to contraception education [1]. Adolescents between 15 and 17 years of age have the lowest reported rates of contraceptive use during sex, but usage increases as they transition into adulthood [1]. This may be attributed in part to formal sex education (FSE) which has been shown to improve the sexual health of adolescents [2,3,4,5,6]. Despite its benefits, many adolescents and young adults do not report receiving comprehensive FSE, particularly content related to available contraceptive methods [7]. Improvements in both FSE access and contraceptive use have been attributed to the decline of adolescent pregnancy rates from the 1990s until the 2020s [8,9,10,11,12]. However, despite these trends, the rate of sexually transmitted infections (STIs) is on the rise among adolescents and young adults [13].
While over 70% of female adolescents report contraceptive use during first sex, disparities in FSE persist among subpopulations [14]. Individuals who are racially and ethnically minoritized, those with lower socioeconomic backgrounds, and individuals with disabilities experience worse sexual health outcomes—including less access to FSE and reduced contraceptive use—than the general population [2,15]. However, a Canadian study found no distinction in the use of contraception between young people with and without disabilities [16].
Additional studies have identified significant health disparities among individuals with disabilities. Women with physical or sensory disabilities are less likely to use reversible contraception and are more likely to undergo sterilization compared to those without disabilities [17,18]. Nearly 40% of women with disabilities were at risk of unplanned pregnancy, and nearly 30% did not use contraception [19]. Multiple barriers contribute to these disparities, including inaccessible health information, a lack of FSE policy standards, limited provider training, and inaccessible contraception counseling [20,21].
Women with disabilities are also disproportionally less likely to receive FSE content about contraceptive methods compared to women without disabilities [22]. This may be due to several factors, including inaccessible sexual health information and contraception resources, incomplete health information, a lack of policies and standards for FSE, and insufficient training for educators and healthcare professionals, all of which influence decisions regarding contraceptive use [20,21]. In comparison to women without disabilities, women with disabilities are proportionately more likely not to use contraception during sex and are less likely to receive FSE about contraceptive use [22]. While some studies have found no differences in FSE exposure by disability status [16,22], others highlight that FSE among individuals with disabilities is not a homogeneous experience. Individuals with sensory disabilities, such as vision or hearing loss, face unique challenges during FSE, including a lack of accommodations, limited shared decision-making opportunities with providers, and inadequate communication with family members [20]. These factors may explain why women with sensory disabilities have lower rates of contraceptive use [23,24]. Furthermore, a systematic review indicated that individuals who are deaf or hard of hearing lack knowledge about contraception methods [23]. Moreover, there are limited studies that explore FSE and contraception use among women with sensory disabilities.
Despite growing recognition of these barriers, national-level studies that disaggregate disability types and examine how FSE influences contraceptive use—especially during last sexual encounter—remain limited. Research frequently categorizes individuals with disabilities into broad or limited groups; however, there is a need to disaggregate these subpopulations, as they are not homogenous and have distinct sexual health needs. Therefore, there is a need to examine contraceptive use outcomes among individuals with sensory disabilities to guide accessible FSE [25].
This study focuses specifically on women due to the disproportionate burden they carry in reproductive decision-making and contraceptive use [26]. Gendered expectations around pregnancy prevention, paired with ableist assumptions about sexuality and reproduction, place women with sensory disabilities at a unique risk for negative sexual health outcomes [20,26]. Previous research has also shown that women, more than men, are often the primary recipients and targets of sex education content related to contraception and reproductive health [26]. Moreover, women with disabilities are more likely to experience reproductive coercion, inaccessibility of common contraceptive information, and structural barriers in accessing contraception—further warranting a gender-specific analysis [20,27,28]. By focusing on young women, this study aims to explore how formal sex education (FSE) interacts with sensory disability status to influence contraceptive behavior, a public health issue that intersects with gender, disability, and health equity. We hypothesize that women with sensory disability are less likely to use contraceptives during sex compared to women without sensory disabilities; however, receiving FSE—particularly on birth control methods and sexually transmitted infections—moderates this association, increasing the likelihood of contraceptive use among women with sensory disabilities. Understanding how FSE and the relationship to contraception use during sex can provide insights into improving FSE interventions for women with sensory disabilities. Therefore, the purpose of this study is to examine the relationship between formal sex education and contraceptive use during sex among U.S. women aged 15–25 years with sensory disabilities, compared to their peers without disabilities.

2. Materials and Methods

2.1. Sample

For this current study, public female respondent files from the 2011–2019 National Survey of Family Growth (NSFG) were used. The NSFG is a national household survey that conducts a cross-sectional survey of noninstitutionalized males and females aged 15 to 49 that live in the U.S. [29,30,31,32]. The NSFG can produce national estimates of sexual activity, reproductive health outcomes, family planning, and other sexual and reproductive health topics. The NSFG’s data collection methodology has been published by the US Department of Health and Human Services [29,30,31,32]. Four data collection cycles (2011–2013, 2013–2015, 2015–2017, and 2017–2019) were combined to ensure a sufficient sample size for sensory disability categories and to eliminate quasi-complete separation. The final sample consisted of 3142 women who answered the two sensory disability questions (i.e., hearing and vision problems), FSE topic questions, had a valid response for family income, and were not currently pregnant. The study restricts its scope to individuals between the ages of 15 and 25 years. We limited the analytic sample to those aged 15–25 years in order to target adolescents and young adults as they are at the stage when exposure to FSE is relatively recent and decisions around contraceptive use are more likely to change. This age range is consistent with the global public health usage of ages 15–24 as “youth”, and it includes the tail end of adolescence into early adulthood, when transitions in schooling, partnership formation, and contraceptive use may be salient [26]. Every single participant disclosed having health insurance and engaging in vaginal intercourse with another person.

2.2. Measures

2.2.1. Dependent Variable

Contraceptive use at the last sexual encounter was assessed by the following question: “The last time that you had sex… did you, yourself, use any method to prevent pregnancy or sexually transmitted diseases?” If respondents answered yes, they reported the specific contraceptive method used. We categorized any respondent who did not answer yes as not using a contraceptive method.

2.2.2. Independent Variables

Sensory disability status was assessed by combining the responses to the self-reported hearing and vision problem questions to categorize sensory disability status. The hearing problem question asked respondents if they had “any serious difficulty hearing?” Responses included yes and no. The vision problem question asked respondents if they had “any serious difficulty seeing?” Responses included yes and no. We created a four-level categorical variable by combining binary responses to the questions on vision and hearing problems: No sensory disability, vision loss, hearing loss, and both. Although this allows for a uniform approach to classify respondents across a nationally representative sample, the set of items does not take into account the severity or onset of the condition, the use of assistive technology, or any other functional limitations. As such, the resultant categories oversimplify the disability experience and likely obscure important heterogeneity within each of the resultant groups. We chose this measure as it is consistently available in the NSFG across survey years, enabling us to look at population-level patterns, but likely underestimates the complexity of disability status. We retained a four-category sensory disability measure to represent conceptually different single- and dual-sensory difficulties. Because the “both” subgroup was very small (n = 16), we applied Firth’s penalized likelihood logistic regression to models that included that category. Estimates for the “both” subgroup are reported for exploratory purposes only. Moderator-by-disability interaction estimates are likely to be biased and affected by separation due to the sparseness of cells with relatively few observations in some subgroups (e.g., vision loss × topic, hearing loss × topic). We therefore consider moderation results exploratory and interpret them cautiously; we place more emphasis on wide CIs and instability than on point estimates. In line with this, we refrain from making inference about very large or very small ORs that are associated with very wide CIs. We focus on making inferences about main-effect models; interaction results can be used to form hypotheses to be tested in future work with appropriately sized subgroups.
To determine the extent to which participants had received FSE, participants were asked to indicate whether they had been provided seven different sex education topics before the age of 18. Respondents were asked if they received FSE (at school, church, community center or some other location) on the following topics: 1. say no to sex; 2. birth control methods; 3. where to obtain birth control; 4. condom use education; 5. sexual transmitted infections transmission; 6. HIV/AIDS prevention; and 7. abstinence till marriage. These questions served as the basis for the development of seven dichotomous indicators. Additionally, we developed an FSE scale using a seven-point scale (0–7), which tallied the number of FSE topics each respondent received [2]. Cronbach’s α was calculated as 0.746. We evaluated the internal consistency of the FSE items (Cronbach’s α = 0.746), which supports treating the FSE as a single composite measure. We recognize that individual topics vary, but previous work has operationalized FSE exposure as the number of topics discussed [2,3]. As a sensitivity analysis, we also fit models with each topic entered separately, which showed substantively similar patterns. The aim was to determine how well these seven items measured FSE. A higher value on the FSE scale indicated that the individual received more FSE topics.

2.2.3. Covariates

The study demographics included the following: age, race/ethnicity [determined by combining the race and Hispanic variables], household family income, educational level, marital status, age at first intercourse, pregnancy intention status, frequency of attending religious services and number of children in the household. Sexual intercourse characteristics included the following: had ever had anal intercourse with a man, had ever engaged in oral intercourse (performed or received) with a man, had ever received oral intercourse from a man, had ever performed oral intercourse on a male, had ever performed oral intercourse on female, and condom use during sex with a male.

2.3. Data Analysis

Statistical analyses were carried out using the IBM® SPSS software, version 23.0 (IBM Corp., Armonk, NY, USA). The SPSS complex samples add-on module was used to manage the complicated survey design of the public NSFG female files, applying the appropriate sample and design weights for all analyses. Frequencies and weighted percentages were calculated for study characteristics; chi-square (χ2) was used for categorical variables and ANOVA (F-test) for continuous variables to compare these characteristics and sensory disability status (Table 1). Multivariable logistic regression was completed to assess the association between the two predictors (sensory disability status and FSE) and contraceptive use during last sexual encounter, as well as the moderation of sensory disability status and contraceptive use by FSE (Table 2). To examine moderation, we also fit models with interaction terms between sensory disability status and each FSE topic. Significant interactions were probed by computing adjusted odds ratios of contraceptive use within levels of sensory disability status stratified by FSE topic exposure. Model assumptions for logistic regression analyses (linearity of continuous covariates with the logit, assessed using Box–Tidwell tests; absence of multicollinearity, assessed with variance inflation factors <2; and sufficient cell size per parameter), was evaluated and met. The small sample sizes for some subgroups, in particular, for women who reported both vision and hearing difficulty (n = 16), may have resulted in biased and unstable estimates due to sparse data bias. Penalized logistic regression was considered as a possible solution.

3. Results

Table 1 shows the study characteristics of U.S. women based on their sensory disability status. Over 70% (n = 173) of women with a sensory disability reported contraceptive use during their last sexual encounter. It was more common for women with sensory disabilities to report receiving sex education on most topics than not across all FSE topics.

3.1. Demographics

Over 90% of the women (n = 2901) studied were aged between 18 and 25 years old. Most respondents (48.9%; n = 1538) were non-Hispanic White, less than one-fourth (23.1%; n = 727) were non-Hispanic Black, 23.7% (n = 745) were Hispanic, and 4.2% (n = 132) were from other racial-ethnic origins. Most women (n = 222; 92.1%) with vision loss, hearing loss, or both were aged 18–25 years old and were a racial-ethnic minority (almost 60%). Compared to women without a sensory disability, women with vision loss only or both sensory disabilities were more likely to have household incomes less than USD 40,000 and less likely to have a minimum high school/GED. Most women with a sensory disability were more likely to be unmarried than had ever been married. Women with sensory disabilities first engaged in sexual intercourse at younger ages and were likely to have an unintended pregnancy. Women with a sensory disability were more likely to attend religious services regularly (weekly, once a month or monthly) than to not attend at all.

3.2. Sexual Intercourse Characteristics

Higher proportions of women with sensory disabilities reported performing and receiving oral intercourse than anal sex with a man. Higher proportions of women reported performing oral intercourse on a male than on a female. In the unadjusted model, about one-third (32.4%; n = 78) of women with a sensory disability reported condom use during their last sexual encounter with a male partner.

3.3. Sensory Disability Status and Contraceptive Use

As shown in Table 2, there was a significant association between sensory disability status and contraceptive use at last sexual encounter. Women with hearing loss were 64% less likely to use contraceptives during sex than women with no sensory disability (aOR: 0.36; 95% CI: 0.14, 0.96). Women who had both sensory disabilities (vision and hearing loss) were 72% less likely to use contraceptives at during sex than women with no sensory disability (aOR: 0.28; 95% CI: 0.08, 0.91).

3.4. FSE and Contraceptive Use

There was a significant association between sex education on sexually transmitted infections (STIs) and contraceptive use during sex. Women who received sex education on STIs were 1.17 times more likely to use contraceptives than women who did not receive sex education on this topic (aOR: 2.17; 95% CI: 1.08, 4.39). However, there was no association between the number of FSE topics and contraceptive use during last sexual encounter (aOR: 1.06; 95% CI: 0.98, 1.14).

3.5. Moderation of Sensory Disability and Contraceptive Use by FSE

Due to the relatively small sample size of individuals categorized as having both sensory disabilities (n = 16), they were omitted from further examination via moderation analysis on FSE topics (see Table 2). The exploratory moderation results showed several potential signals for interactions. The vision loss × “methods to prevent pregnancy” sex education interaction among women was positive (aOR: 6.14; 95% CI: 1.70, 20.23), as was the vision loss × STI education (aOR: 28.24; 95% CI: 1.71, 46.63). However, both are associated with very wide CIs, which is due to small subgroup counts and results in unstable estimates. These estimates are consistent with potential effect modification, but the tests are not statistically reliable and should only be used for generating a hypothesis. In contrast, the hearing loss × “where to obtain birth control” sex education interaction was negative (aOR: 0.02; 95% CI: 0.001, 0.23). This estimate is also very unstable and based on small counts. The vision loss × HIV/AIDS prevention sex education interaction was also negative (aOR: 0.01; 95% CI: 0.001, 0.11). Given the limited internal validity of these moderation estimates, the confidence intervals are wide, and estimates should not be interpreted as precise or definitive. Finally, we found that the number of FSE topics was not associated with contraceptive use during last sexual encounter among those with one or more sensory disabilities (vision loss, hearing loss or both) (vision loss: aOR: 0.94; 95% CI: 0.84, 1.06; hearing loss: aOR: 0.84; 95% CI: 0.69, 1.01). We do not place much emphasis on the size of these moderated odds ratios, and report their sign and imprecision.

4. Discussion

The present study compared the associations between FSE and contraceptive use during last sexual encounter in women with and without sensory disabilities. When compared to women without sensory disabilities, women with vision loss, hearing loss, and both disabilities received proportionately similar FSE, as noted in Table 1. In this study, women with sensory disabilities began having sexual intercourse at younger ages compared to their counterparts without sensory disabilities and were less likely to have unintended pregnancies (Table 1). Additionally, women with sensory disabilities were more likely to receive FSE on all topics, and most women with sensory disabilities reported using contraceptives during sex. Women with sensory disabilities were generally more likely to receive a lower salary than women without sensory disabilities (Table 1). However, pertaining to the moderation analysis, the adjusted model indicated that women with vision loss were more likely to report the use of contraception when the FSE topics were about birth control methods and STIs (Table 2). In our moderation analysis, women with vision loss who had received sex education on STI transmission were substantively more likely to report contraceptive use compared with women without sensory disabilities who had not received sex education on STI transmission. These estimates were very large and had wide confidence intervals due to sparse data in this subgroup. The instability of these estimates indicates the association observed might be entirely or partially due to limited sample sizes. This limitation is not ideal for the internal validity of the moderation analysis. The huge odds ratios may be an artifact of sparse data rather than real effect sizes. We interpret these moderation results as initial indicators for further exploration.
Comparing these results with past research is noteworthy when considering the inconsistent results. Namkung et al. [22] previously found no difference in contraceptive use between women with non-cognitive disabilities, including those with sensory disabilities, and women without disabilities. Further studies have found comparable results, noting no difference in contraceptive use between populations with disabilities and without [16,18]. Other research has indicated that women with disabilities are less likely to use contraceptives compared to women without disabilities [24]. Our study shows that contraceptive use varies between those with vision loss and hearing loss, rather than treating all disabilities as the same, which might explain why prior studies found no clear differences [15,16,17,18,19]. Grouping disabilities into one category could potentially mask the results for disadvantaged populations, and significant differences in contraceptive use among those subpopulations go unnoticed. The differences noticed between the vision loss and hearing loss groups reinforce the importance of considering each population separately. Previous research that has considered individuals with various disabilities separately indicated that common barriers to contraceptive use are present, but there are variations present between disability groups [20]. Horner-Johnson et al. [23] also reported that women with hearing loss were less knowledgeable about contraceptives than hearing women. The variations in barriers to contraceptive use could contribute to the differences noticed in contraceptive use between vision loss and hearing loss populations. Moreover, individuals with vision loss and hearing loss indicated that inaccessible information and limited opportunities to discuss contraception with medical providers hindered their contraceptive decision-making [20]. Additionally, the finding that women with hearing loss are less knowledgeable regarding contraceptive use is consistent with our finding that women with hearing loss are less likely to use contraceptives than women without disabilities.
While contraceptive use was higher among women with vision loss when they received FSE on some of the topics assessed in this study, these same women were also less likely to be using contraception after receiving FSE that included HIV/AIDS education compared to women with no disability. It should be noted that these estimates are quite unstable due to the small numbers of women in these subgroups and wide confidence intervals. This outcome contrasts with the results regarding FSE on birth control methods and STIs, indicating that the topics covered during FSE are important for contraceptive use. Similarly, previous research shows that comprehensive sex education increases the likelihood of using contraceptives during sex when compared to non-comprehensive sex education [7].

4.1. Limitations

The study’s limitations include the sample being restricted to women aged 15 to 25 which limits the generalizability to older women. More inclusive age ranges should be considered to improve the generalizability of the results found in this study. Additionally, data collection via a survey method leaves the findings prone to self-reporting bias. Survey methods also do not provide insight regarding the rationale behind responses, and further research is needed to better understand the rationale behind them. Another limitation of the study is that the timing and format of FSE were not available to survey participants. Moreover, due to the cross-sectional nature of the NSFG dataset, it is not possible to establish causation. Lastly, it is important to note that vision loss and hearing loss groups are broad categories inclusive of subpopulations. The adjusted model produced a large odds ratio, but it is unclear if this truly reflects the effect, due to the limited data used to estimate it. This will have to be tested further with larger samples. We did account for a number of sociodemographic covariates, including family income, education, and geographic region, but residual confounding by other unmeasured sociodemographic or psychosocial factors cannot be ruled out. In addition, the cell sizes in the moderation analyses were quite small (n = the number of subgroups in the disability × FSE topic). Sparse data can produce unstable estimates and inflate odds ratios, and it is of concern that the internal validity of these moderation interactions has been threatened. Therefore, the moderation results are to be considered exploratory and hypothesis generating only, and no strong inferences can be made from the size of the effect sizes. These factors may affect both access to formal sex education and contraceptive use in ways that are not entirely accounted for by our measures, and it is possible that our effect estimates may thus be a product of both sex education and unmeasured, but related, contextual factors. Further research with more detailed covariate data and a longitudinal design would be needed to more adequately account for this possible source of confounding.

4.2. Future Research

While these results show a gap in contraceptive use, future research can expand on the mechanisms of FSE, and contraception use among women with sensory disabilities. Further research can investigate (1) the barriers and facilitators of contraceptive use, (2) the development, implementation, and evaluation of FSE, and (3) identify FSE interventions, topics, and teaching strategies that are effective and evidence-based among women with sensory disabilities. Finally, investigating why women with hearing loss and vision loss choose to use or not use contraceptives can help us understand the patterns found in this study and guide future FSE programs tailored for these groups. Lastly, given that hearing loss and vision loss are general terms, further research within the subpopulations of women with sensory disabilities about FSE and contraceptive use would be beneficial in intervention development to work with disability service organizations to improve disability-centered efforts.

5. Conclusions

Overall, the current study established significant associations regarding contraceptive use by women with sensory disabilities and previous FSE. Specifically, women with vision loss are more likely to use contraceptives following FSE about birth control and STIs and less likely to use contraceptives following FSE about HIV/AIDs. Women with hearing loss were less likely to use contraceptives following FSE about birth control methods. The implications of the results can serve as the basis of future research to further investigate the rationale, barriers, and facilitators impacting the decision behind contraceptive use and non-use by women with sensory disabilities. Once the associations and the causality behind the discrepancies in contraceptive use by women with sensory disabilities is better understood, FSE curriculum and healthcare can be improved with evidence-based accommodations tailored for specific populations, such as partnering with disability service organizations to codevelop and review FSE materials.

Author Contributions

Conceptualization, L.E.E., A.M.H.-E. and H.F.d.V.M.; methodology, L.E.E., A.M.H.-E. and H.F.d.V.M.; formal analysis, L.E.E.; writing—original draft preparation, L.E.E., A.M.H.-E., H.F.d.V.M., P.G.R. and A.M.J.; writing—review and editing, L.E.E., A.M.H.-E., H.F.d.V.M., P.G.R. and A.M.J.; project administration, L.E.E. and A.M.H.-E. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study does not require Institutional Review Board (IRB) review because it involves secondary data analysis with de-identified that is publicly available.

Informed Consent Statement

Not applicable.

Data Availability Statement

The datasets analyzed during the current study are publicly available at the CDC’s website, under the 2011–2013, 2013–2015, 2015–2017, and 2017–2019 female respondent public files Available online: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Datasets/NSFG/sas/ (accessed on 20 June 2024).

Conflicts of Interest

Author Paris G. Rangel is affiliated with Purple Communications, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Disability Language/Terminology Positionality Statement

This study uses person-first language (e.g., “women with sensory disabilities”) in accordance with common conventions in public health and medical research, which prioritize acknowledging the individual before their disability. This approach aligns with entities such as the CDC and WHO, which advocate for respectful, person-centered language in health communication. The terms sensory disabilities, vision loss, and hearing loss were selected for their clarity, specificity, and alignment with how these conditions are categorized in epidemiological research and national survey instruments such as the National Survey of Family Growth (NSFG). “Sensory disabilities” serves as an inclusive, functional umbrella term for disabilities that affect sensory input, while “vision loss” and “hearing loss” reflect terminology used in disability surveillance and clinical settings to describe functional limitations without making assumptions about identity or diagnosis. While some communities, particularly within the Deaf and Blind cultures, may prefer identity-first language (e.g., “Deaf person”), this study uses broader public health framing. The analytic categories are based on self-reported functional limitations rather than cultural affiliation or medical diagnosis. Thus, the terminology is intended to be respectful, inclusive, and consistent with the disciplinary and data source context.

References

  1. Daniels, K.; Abma, J.C. Contraceptive Methods Women Have Ever Used: United States, 2015–2019; National Health Statistics Reports, No. 195; National Center for Health Statistics: Hyattsville, MD, USA, 2023.
  2. Espinoza, L.E.; Talleff, J.L.; Espinoza, L.E.; Rouse, R. Racial-Ethnic Disparities Between Sex Education and Contraceptive Use Method at the Last Sexual Encounter Among Adolescent Females in the USA. Sex Res. Soc. Policy 2023, 20, 134–144. [Google Scholar] [CrossRef]
  3. Espinoza, L.E. Formal and Parental Sex Education Differences Among Hispanic Young Women by Nativity Status. Sex Educ. 2019, 19, 15–24. [Google Scholar] [CrossRef]
  4. Espinoza, L.E.; Rabl, A.; Espinoza, L.E. The Contraceptive Behavior of Young Women Raised in Foster Care. Am. J. Health Stud. 2019, 34, 106–112. [Google Scholar] [CrossRef]
  5. Townes, A.; Guerra-Reyes, L.; Murray, M.; Rosenberg, M.; Wright, B.; Long, L.; Herbenick, D. ‘Somebody That Looks Like Me’ Matters: A Qualitative Study of Black Women’s Preferences for Receiving Sexual Health Services in the USA. Cult. Health Sex. 2022, 24, 138–152. [Google Scholar] [CrossRef]
  6. Wood, R.; Hirst, J.; Wilson, L.; Burns-O’Connell, G. The Pleasure Imperative? Reflecting on Sexual Pleasure’s Inclusion in Sex Education and Sexual Health. Sex Educ. 2019, 19, 1–14. [Google Scholar] [CrossRef]
  7. Cheedalla, A.; Moreau, C.; Burke, A.E. Sex Education and Contraceptive Use of Adolescent and Young Adult Females in the United States: An Analysis of the National Survey of Family Growth 2011–2017. Contracept. X 2020, 2, 100048. [Google Scholar] [CrossRef] [PubMed]
  8. Osterman, M.J.K.; Hamilton, B.E.; Martin, J.A.; Driscoll, A.K.; Valenzuela, C.P. Births: Final Data for 2020; National Vital Statistics Reports, No. 17; Centers for Disease Control and Prevention: Atlanta, GA, USA, 2022; Volume 70. Available online: https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-17.pdf (accessed on 20 June 2024).
  9. Martin, J.A.; Hamilton, B.E.; Osterman, M.J.K.; Driscoll, A.K. Births: Final Data for 2019; National Vital Statistics Reports, No. 2; National Center for Health Statistics: Hyattsville, MD, USA, 2021; Volume 70.
  10. Bahar, Y.Z.; Gold, M.A. Providing Long-Acting Reversible Contraception to Adolescents: A Review. Clin. Obstet. Gynecol. 2020, 63, 561–573. [Google Scholar] [CrossRef]
  11. Faculty of Sexual & Reproductive Healthcare Clinical Guidance. Progesterone-Only Injectable Contraception: Clinical Effectiveness Unit; Royal College of Obstetrics & Gynecologists: London, UK, 2019; Available online: https://www.cosrh.org/Public/Public/Documents/fsrh-ceu-guidance-progestogen-only-injectables.aspx (accessed on 9 September 2025).
  12. Di Meglio, G.; Crowther, C.; Simms, J. Contraceptive Care for Canadian Youth. Paediatr. Child Health 2018, 23, 271–277. [Google Scholar] [CrossRef]
  13. The Lancet Child Adolescent. Youth STIs: An Epidemic Fuelled by Shame. Lancet Child Adolesc. Health 2022, 6, 353. [Google Scholar] [CrossRef] [PubMed]
  14. Abma, J.C.; Martinez, G. Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2015–2019; National Vital Statistics Reports; Centers for Disease Control and Prevention: Atlanta, GA, USA, 2023. Available online: https://www.cdc.gov/nchs/data/nhsr/nhsr196.pdf (accessed on 9 September 2025).
  15. Holdsworth, E.; Trifonova, V.; Tanton, C.; Kuper, H.; Datta, J.; Macdowall, W.; Mercer, C.H. Sexual Behaviours and Sexual Health Outcomes Among Young Adults with Limiting Disabilities: Findings from the Third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMJ Open 2018, 8, e019219. [Google Scholar] [CrossRef] [PubMed]
  16. Brown, H.K.; Ouedraogo, M.; Pablo, L.; Evans, M.; Vandermorris, A. Contraception Use Among Female Youth with Disabilities: Secondary Analysis of a Canadian Cross-Sectional Survey. Disabil. Health J. 2023, 16, 101445. [Google Scholar] [CrossRef]
  17. Wu, J.P.; McKee, M.M.; McKee, K.S.; Meade, M.A.; Plegue, M.; Sen, A. Female Sterilization Is More Common Among Women with Physical and/or Sensory Disabilities than Women without Disabilities in the United States. Disabil. Health J. 2017, 10, 400–405. [Google Scholar] [CrossRef]
  18. Wu, J.P.; McKee, K.S.; McKee, M.M.; Meade, M.A.; Plegue, M.A.; Sen, A. Use of Reversible Contraceptive Methods Among US Women with Physical or Sensory Disabilities. Perspect. Sex Reprod. Health 2017, 49, 141–147. [Google Scholar] [CrossRef]
  19. Mosher, W.; Hughes, R.B.; Bloom, T.; Horton, L.; Mojtabai, R.; Alhusen, J.L. Contraceptive Use by Disability Status: New National Estimates from the National Survey of Family Growth. Contraception 2018, 97, 552–558. [Google Scholar] [CrossRef] [PubMed]
  20. Horner-Johnson, W.; Klein, K.A.; Campbell, J.; Guise, J.M. “It Would Have Been Nice to Have a Choice”: Barriers to Contraceptive Decision-Making Among Women with Disabilities. Womens Health Issues 2022, 32, 261–267. [Google Scholar] [CrossRef] [PubMed]
  21. Schmidt, E.K.; Hand, B.N.; Havercamp, S.; Sommerich, C.; Weaver, L.; Darragh, A. Sex Education Practices for People with Intellectual and Developmental Disabilities: A Qualitative Study. Am. J. Occup. Ther. 2021, 75, 7503180060. [Google Scholar] [CrossRef]
  22. Namkung, E.H.; Valentine, A.; Warner, L.; Mitra, M. Contraceptive Use at First Sexual Intercourse Among Adolescent and Young Adult Women with Disabilities: The Role of Formal Sex Education. Contraception 2021, 103, 178–184. [Google Scholar] [CrossRef]
  23. Horner-Johnson, W.; Moe, E.L.; Stoner, R.C.; Klein, K.A.; Edelman, A.B.; Eden, K.B.; Andresen, E.M.; Caughey, A.B.; Guise, J.M. Contraceptive Knowledge and Use Among Women with Intellectual, Physical, or Sensory Disabilities: A Systematic Review. Disabil. Health J. 2019, 12, 139–154. [Google Scholar] [CrossRef] [PubMed]
  24. Kelly, S.M.; Kapperman, G. Sexual Activity of Young Adults Who Are Visually Impaired and the Need for Effective Sex Education. J. Vis. Impair. Blind. 2012, 106, 519–526. [Google Scholar] [CrossRef]
  25. Long-Bellil, L. Disability Inclusion in Sexual and Reproductive Health in the United States. Oxf. Res. Encycl. Glob. Public Health 2022. [Google Scholar] [CrossRef]
  26. Aantjes, C.J.; Govender, K. Are We Getting Any Closer to Including Men and Boys in Sexual and Reproductive Health? A Multi-Country Policy Analysis on Guidance to Action in East and Southern Africa. Int. J. Sex. Health 2024, 36, 464–483. [Google Scholar] [CrossRef] [PubMed]
  27. Amos, V.; Lyons, G.R.; Laughon, K.; Hughes, R.B.; Alhusen, J.L. Reproductive Coercion Among Women with Disabilities: An Analysis of Pregnancy Risk Assessment Monitoring Systems Data. J. Forensic Nurs. 2023, 19, 108–114. [Google Scholar] [CrossRef] [PubMed]
  28. Biggs, M.A.; Schroeder, R.; Casebolt, M.T.; Laureano, B.I.; Wilson-Beattie, R.L.; Ralph, L.J.; Kaller, S.; Adler, A.; Gichane, M.W. Access to Reproductive Health Services Among People with Disabilities. JAMA Netw. Open 2023, 6, e2344877. [Google Scholar] [CrossRef] [PubMed]
  29. U.S. Department of Health and Human Services. Public Use Data File Documentation: 2011–2013. National Survey of Family Growth User’s Guide; U.S. Department of Health and Human Services: Hyattsville, MD, USA, 2021. Available online: https://www.cdc.gov/nchs/nsfg/nsfg_2011_2013_puf.htm (accessed on 4 June 2024).
  30. U.S. Department of Health and Human Services. Public Use Data File Documentation: 2013–2015. National Survey of Family Growth User’s Guide; U.S. Department of Health and Human Services: Hyattsville, MD, USA, 2021. Available online: https://www.cdc.gov/nchs/nsfg/nsfg_2013_2015_puf.htm (accessed on 4 June 2024).
  31. U.S. Department of Health and Human Services. Public Use Data File Documentation: 2015–2017. National Survey of Family Growth User’s Guide; U.S. Department of Health and Human Services: Hyattsville, MD, USA, 2021. Available online: https://www.cdc.gov/nchs/nsfg/nsfg_2015_2017_puf.htm (accessed on 4 June 2024).
  32. U.S. Department of Health and Human Services. Public Use Data File Documentation: 2017–2019. National Survey of Family Growth User’s Guide; U.S. Department of Health and Human Services: Hyattsville, MD, USA, 2021. Available online: https://www.cdc.gov/nchs/nsfg/nsfg_2017_2019_puf.htm (accessed on 4 June 2024).
Table 1. The characteristics of U.S. women by sensory disability status, 2011 to 2019 National Survey of Family Growth (N = 3142).
Table 1. The characteristics of U.S. women by sensory disability status, 2011 to 2019 National Survey of Family Growth (N = 3142).
Sensory Disability Status
CharacteristicsNeither
(n = 2901)
n (%)		Vision Loss
(n = 154)
n (%)		Hearing Loss
(n = 71)
n (%)		Both
(n = 16)
n (%)		χ2p-Value
Contraceptive use during last sexual encounter 31.90.006
No523 (17.7)40 (26.6)20 (36.9)8 (42.3)
Yes2378 (82.3)114 (73.4)51 (63.1)8 (57.7)
Formal sex education topics
Say no to sex 2.20.752
No557 (20.9)33 (20.8)21 (14.6)2 (25.7)
Yes2344 (79.1)121 (79.2)50 (85.4)14 (74.3)
Birth control methods 2.40.749
No749 (26.2)47 (24.7)23 (22.9)5 (43.7)
Yes2152 (73.8)107 (75.3)48 (77.1)11 (56.3)
Where to obtain birth control 5.90.396
No1165 (41.6)67 (45.2)26 (38.7)8 (73.8)
Yes1736 (58.4)87 (54.8)45 (61.3)8 (26.2)
Condom use education 4.90.532
No1068 (38.2)50 (29.9)26 (35.9)5 (39.1)
Yes1833 (61.8)104 (70.1)45 (64.1)11 (60.9)
STIs Transmission 1.50.757
No258 (9.1)13 (7.9)5 (6.6)1 (2.1)
Yes2643 (90.9)141 (92.1)66 (93.4)15 (97.9)
HIV/AIDS prevention 1.00.907
No456 (16.5)24 (16.7)12 (16.6)3 (27.8)
Yes2445 (83.5)130 (83.3)59 (83.4)13 (72.2)
Abstinence till marriage 23.40.015
No976 (33.0)45 (25.3)28 (53.1)4 (58.6)
Yes1925 (67.0)109 (74.7)43 (46.9)12 (41.4)
Formal sex education scale (α = 0.746)5.1 a (0.1 b)5.3 a (0.2 b)5.1 a (0.3 b)4.3 a (0.6 b)0.018 c0.892
Demographics
Age (in years) 6.00.244
15–17222 (7.1)12 (8.3)5 (2.3)2 (19.6)
18–252679 (92.9)142 (91.7)66 (97.7)14 (80.4)
Race/ethnicity 22.00.385
non-Hispanic White1438 (52.9)54 (38.6)39 (53.9)7 (46.7)
non-Hispanic Black664 (21.1)48 (30.3)10 (14.5)5 (37.3)
Hispanic677 (21.1)46 (27.7)18 (24.5)4 (15.9)
non-Hispanic other 122 (4.9)6 (3.4)4 (7.1)–
Household family income 43.40.034
Less than USD 20,0001053 (35.9)70 (42.0)36 (31.3)12 (84.6)
USD 20,000–USD 39,999790 (27.2)42 (24.7)15 (18.8)3 (8.8)
USD 40,000–USD 74,999643 (21.2)24 (14.5)14 (42.8)1 (6.6)
USD 75,000 or more415 (15.7)18 (18.7)6 (7.1)–
Educational level
Less than high school diploma or GED571 (18.4)36 (22.0)18 (20.5)9 (64.7)
High school diploma or GED992 (31.6)56 (31.9)30 (50.1)6 (28.7)
Some college883 (33.1)51 (39.2)13 (13.0)1 (6.6)
Associate’s or Bachelor’s degree434 (16.4)11 (7.0)9 (15.9)–
Graduate degree21 (0.6)–1 (0.5)–
Marital status 7.70.333
Currently married394 (12.1)16 (6.6)8 (10.1)–
Divorced, separated, widowed, or annulled60 (1.7)4 (1.7)1 (0.5)1 (4.4)
Never married2447 (86.2)134 (91.7)62 (89.4)15 (95.6)
Age at first sexual intercourse (in years)16.3 a (0.1 b)15.4 a (0.3 b)15.6 a (0.5 b)14.8 a (0.5 b)6.9 c0.009
Pregnancy intention status 10.00.217
Unintended1491 (54.9)75 (50.4)43 (69.5)11 (71.5)
Intended1410 (45.1)79 (49.6)28 (30.5)5 (28.5)
Frequency of attending religious services 12.30.692
At least weekly622 (20.7)40 (19.7)12 (16.1)5 (22.1)
At least once a month547 (18.6)33 (18.1)14 (7.8)3 (22.5)
Less than monthly702 (25.5)38 (28.4)15 (36.8)2 (13.1)
Never1030 (35.3)43 (33.8)30 (39.3)6 (42.3)
Number of children in the household0.5 a (0.03 b)0.5 a (0.1 b)0.2 a (0.1 b)0.1 a (0.1 b)4.0 c0.048
Sexual Intercourse Characteristics
Ever had anal intercourse with a man 21.30.046
No1873 (63.4)99 (61.6)35 (39.4)9 (52.7)
Yes1028 (36.6)55 (38.4)36 (60.6)7 (47.3)
Ever engaged in any oral intercourse (performed or received) with a man 4.10.231
No212 (6.8)12 (5.7)2 (1.4)2 (6.6)
Yes2689 (93.2)142 (94.3)69 (98.6)14 (93.4)
Ever received oral intercourse from a man 3.70.475
No321 (10.6)16 (6.6)5 (7.3)2 (6.6)
Yes2580 (89.4)138 (93.4)66 (92.7)14 (93.4)
Ever performed oral intercourse on male 3.50.558
No386 (11.8)22 (13.5)6 (5.9)3 (8.3)
Yes2515 (88.2)132 (86.5)65 (94.1)13 (91.7)
Performed oral intercourse on a female 30.30.020
No2514 (86.9)121 (75.1)58 (76.7)11 (61.0)
Yes387 (13.1)33 (24.9)13 (23.3)5 (39.0)
Condom use during last sexual encounter with a male 7.20.424
No1822 (60.5)105 (67.9)49 (70.8)9 (63.5)
Yes1079 (39.5)49 (32.1)22 (29.2)7 (36.5)
Note: STIs, Sexually transmitted infections; HIV, Human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; GED, general educational development. Percentages are weighted. a Weighted mean. b Weighted standard error. c F-statistic.—no respondents present.
Table 2. Multivariable logistic regression results for predicting contraceptive use during last sexual encounter, 2011 to 2019 National Survey of Family Growth (N = 3142).
Table 2. Multivariable logistic regression results for predicting contraceptive use during last sexual encounter, 2011 to 2019 National Survey of Family Growth (N = 3142).
PredictorsOR (95% CI)aOR (95% CI) †
Sensory disability status
NeitherReferenceReference
Vision loss0.58 (0.34, 0.99) *0.65 (0.36, 1.18)
Hearing loss0.34 (0.15, 0.77) *0.36 (0.14, 0.96) *
Both disabilities0.26 (0.07, 1.00)0.28 (0.08, 0.91) *
Formal sex education topics (all topics Reference = No)
Say no to sex1.17 (0.82, 1.66)1.14 (0.80, 1.63)
Birth control methods1.29 (0.86, 1.93)1.23 (0.84, 1.81)
Where to obtain birth control0.86 (0.60, 1.23)0.83 (0.59, 1.17)
Condom use education 0.92 (0.65, 1.31)0.96 (0.67, 1.36)
Sexual transmitted infections transmission2.41 (1.21, 4.80) *2.17 (1.08, 4.39) *
HIV/AIDS prevention 0.78 (0.41, 1.46)0.80 (0.43, 1.48)
Abstinence till marriage0.95 (0.71, 1.26)0.88 (0.64, 1.20)
Formal sex education (FSE) scale (7-point scale)1.98 (1.00, 1.17)1.06 (0.98, 1.14)
Moderation Analysis (n = 3126)
Vision loss and say no to sex FSE1.43 (0.43, 4.81)1.33 (0.35, 5.08)
Hearing loss and say no to sex FSE1.22 (0.25, 5.89)0.69 (0.10, 4.88)
Vision loss and birth control methods FSE5.19 (1.48, 18.23) *6.14 (1.70, 22.23) **
Hearing loss and birth control methods FSE10.42 (0.72, 51.01)7.74 (0.45, 33.54)
Vision loss and where to obtain birth control FSE0.81 (0.27, 2.47)0.56 (0.16, 1.98)
Hearing loss and where to obtain birth control FSE0.02 (0.002, 0.26) **0.02 (0.001, 0.23) **
Vision loss and condom use education FSE1.19 (0.30, 4.64)1.46 (0.40, 5.36)
Hearing loss and condom use education FSE0.38 (0.11, 1.40)0.26 (0.05, 1.32)
Vision loss and sexual transmitted infections transmission FSE31.61 (1.54, 648.87) *28.24 (1.71, 46.63) *
Hearing loss and sexual transmitted infections transmission FSE0.13 (0.01, 2.44)0.51 (0.01, 4.93)
Vision loss and HIV/AIDS prevention FSE0.004 (0.001, 0.11) ***0.01 (0.001, 0.11) **
Hearing loss and HIV/AIDS prevention FSE13.65 (1.62, 115.24)8.00 (0.32, 199.44)
Vision loss and abstinence till marriage FSE0.86 (0.27, 2.69)0.84 (0.24, 2.97)
Hearing loss and abstinence till marriage FSE2.70 (0.39, 18.93)2.99 (0.17, 52.68)
Vision loss and formal sex education scale FSE0.93 (0.84, 1.03)0.94 (0.84, 1.06)
Hearing loss and formal sex education scale FSE0.85 (0.73, 1.00)0.84 (0.69, 1.01)
Note. OR, odds ratio; aOR, adjusted odds ratio; CI, confidence interval; HIV, Human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome. * p < 0.05; ** p < 0.01; *** p < 0.001. † After controlling for age, race/ethnicity, household family income, educational level, marital status, age at first intercourse, pregnancy intention status, frequency of attending religious services, number of children in household, previous anal intercourse with a man, previous engagement in oral intercourse (performed or received) with a man, previously received oral intercourse from a man, previously performed oral intercourse on male, previously performed oral intercourse on a female, and condom use during last sexual encounter with male. The FSE scale was run independently of the individual FSE topics. The scale is for 0 to 7 topics. In moderation analysis, respondents with both disabilities were not included due to the small sample size (n = 16), which produced quasi-complete separation. Moderation interaction terms are based on small subgroup counts; interpret as exploratory.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Espinoza, L.E.; Hinson-Enslin, A.M.; de Vries McClintock, H.F.; Rangel, P.G.; Jordan, A.M. Examining the Moderating Role of Formal Sex Education on Contraceptive Use Among Individuals with Sensory Disabilities. Disabilities 2025, 5, 82. https://doi.org/10.3390/disabilities5030082

AMA Style

Espinoza LE, Hinson-Enslin AM, de Vries McClintock HF, Rangel PG, Jordan AM. Examining the Moderating Role of Formal Sex Education on Contraceptive Use Among Individuals with Sensory Disabilities. Disabilities. 2025; 5(3):82. https://doi.org/10.3390/disabilities5030082

Chicago/Turabian Style

Espinoza, Luis Enrique, Amanda M. Hinson-Enslin, Heather F. de Vries McClintock, Paris G. Rangel, and Alina M. Jordan. 2025. "Examining the Moderating Role of Formal Sex Education on Contraceptive Use Among Individuals with Sensory Disabilities" Disabilities 5, no. 3: 82. https://doi.org/10.3390/disabilities5030082

APA Style

Espinoza, L. E., Hinson-Enslin, A. M., de Vries McClintock, H. F., Rangel, P. G., & Jordan, A. M. (2025). Examining the Moderating Role of Formal Sex Education on Contraceptive Use Among Individuals with Sensory Disabilities. Disabilities, 5(3), 82. https://doi.org/10.3390/disabilities5030082

Article Metrics

Back to TopTop