Unwanted Sexual Activity among U.S. Women early in the COVID-19 Pandemic

ABSTRACT

Background Female sexual activity and, accordingly, birth rates, tend to decline in times of stress, such as a pandemic. Additionally, when resources are scarce or exogenous conditions are threatening, some women may engage in sexual activity primarily to maintain socioeconomic security. Having unwanted sex may indicate sexual activity in exchange for economic security. Objective To describe patterns and correlates of unwanted sex, defined as having sex more frequently than desired, among U.S. women early in the COVID-19 pandemic. Study Design The National U.S. Women’s Health COVID-19 Study was conducted in April 2020, using a nested quota sample design to enroll 3,200 English-speaking women (88% cooperation rate) ages 18-90 years recruited from a research panel. The quota strata ensured sufficient sample sizes in sociodemographic groups of interest, namely racial and ethnic sub-groups. Patterns of sexual activity, including unwanted sex early in the pandemic, were described. To further elucidate the experiences of women reporting unwanted sex, open-ended responses to an item querying “how the coronavirus pandemic is affecting your sex life” were assessed using conventional content analysis. Logistic regression analyses - adjusting for sociodemographic characteristics, self-reported health and pre-pandemic health-related socioeconomic risk factors (HRSRs), including food insecurity, housing instability, utilities and transportation difficulties and interpersonal violence - were used to model the odds of unwanted sex by pandemic-related change in HRSRs. Results The proportion of women who were sexually active early in the pandemic (51%) was about the same as in the 12 months pre-pandemic (52%), although 7% became active and 7% became inactive. Eleven percent of sexually active women were having unwanted sex in the early pandemic. Rates of anxiety, depression, traumatic stress symptoms and each of the five HRSRs assessed were about 2 times higher among women having unwanted sex compared to others (p-values <0.001). Women having unwanted sex were also 5 times more likely than others to report increased frequency of sex since the pandemic (65% vs 13%, p<0.001) and 6 times more likely to be using emergency contraception (18% vs 3%, p<0.001). Women reporting unwanted sex commonly described decreased libido or interest in sex related to mood changes since the pandemic, having "more sex," fear or worry about transmission of the virus due to sex, and having sex to meet the partner's needs. Among sexually active women, odds of unwanted sex (adjusting for demographic, reproductive and health factors) were higher among women with one (aOR 2.0, 95% CI 1.1, 3.8) and two or more pre-pandemic HRSRs (aOR 6.0, 95% CI 3.4, 10.6). Among sexually active women with any pre-pandemic HRSRs, those with new or worsening transportation difficulties early in the pandemic were particularly vulnerable to unwanted sex (aOR 2.7, 95% CI 1.7, 4.3). Conclusions More than one in ten sexually active U.S. women was having unwanted sex early in the COVID-19 pandemic. Socioeconomically vulnerable women, especially those with new or worsening transportation problems due to the pandemic, were more likely than others to engage in unwanted sex. Pandemic response and recovery efforts should seek to mitigate unwanted sexual activity and related health and social risks among women.