International travel is popular worldwide, yet its implications for sexual and reproductive health are not fully understood. Few studies have examined the contextual factors that shape women’s sexual and contraceptive behaviors—and thus, their risk of unintended pregnancy and sexually transmitted infections (STIs)—while traveling outside their home country. In this qualitative study, female university students with recent (n = 25) or upcoming (n = 19) travel outside the U.S. completed semi-structured interviews from October 2015 to March 2017. Transcripts were analyzed for themes related to contraceptive and sexual behaviors: (1) participants’ pre-travel expectations of sex; (2) the circumstances surrounding sexual encounters with men while traveling; (3) negotiation about condom and contraception use with partners; and (4) factors affecting contraceptive adherence. Participants generally expected to be abstinent during travel, citing myriad rationales that included personal values, no perceived opportunities for sex, and the nature of the trip. Some travelers had unexpected sexual encounters, involving health-protecting behaviors and risk-taking (e.g., unprotected sex, substance use). New sexual partnerships were fueled by increased attention from men, situational disinhibition, and perceived heightened intimacy. International travel brought many contraceptive considerations (adequacy of supplies, access to refrigeration, time zone differences, etc.) as well as obstacles that triggered contraceptive lapses and discontinuation. Pill users described the most challenges, while travelers using intrauterine devices expressed appreciation for their maintenance-free contraception. This study suggests complex associations between international travel and young women’s sexual and reproductive health. Some travelers were more vulnerable to situational risk factors, while others may have been more insulated. We identify potential intervention opportunities via clinical services, education, and policy to reduce young women’s risk of adverse sexual and reproductive health outcomes while traveling abroad. We urge greater recognition of and conversations about contraceptive lapse and unintended pregnancy as potential health risks for female travelers of reproductive age, just as clinical guidelines acknowledge travel-associated STI.
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Bailey, J. A., Fleming, C. B., Catalano, R. F., Haggerty, K. P., & Manhart, L. E. (2012). Romantic relationship characteristics and alcohol use: Longitudinal associations with dual method contraception use. Journal of Adolescent Health,50, 450–455. https://doi.org/10.1016/j.jadohealth.2011.09.008.
Bauer, I. (2009). Relationships between female tourists and male locals in Cuzco/Peru: Implications for travel health education. Travel Medicine and Infectious Disease,7, 350–358. https://doi.org/10.1016/j.tmaid.2009.09.002.
Bellis, M. A., Hale, G., Bennett, A., Chaudry, M., & Kilfoyle, M. (2000). Ibiza uncovered: Changes in substance use and sexual behaviour amongst young people visiting an international night-life resort. International Journal of Drug Policy,11, 235–244. https://doi.org/10.1016/S0955-3959(00)00053-0.
Bellis, M. A., Hughes, K., Thomson, R., & Bennett, A. (2004). Sexual behaviour of young people in international tourist resorts. Sexually Transmitted Infections,80, 43–47. https://doi.org/10.1136/sti.2003.005199.
Berdychevsky, L., & Gibson, H. J. (2015). Phenomenology of young women’s sexual risk-taking in tourism. Tourism Management,46, 299–310. https://doi.org/10.1016/j.tourman.2014.07.008.
Bloor, M., Thomas, M., Hood, K., Abeni, D., Goujon, C., Hausser, D., … Nieto, J. A. (1998). Differences in sexual risk behaviour between young men and women travelling abroad from the UK. Lancet,352, 1664–1668. https://doi.org/10.1016/S0140-6736(98)09414-8.
Brown, L., & Stephan, Y. S. (2013). Anonymous and uninhibited: Sexual encounters during the international sojourn. Journal of Tourism and Cultural Change,11, 35–47. https://doi.org/10.1080/14766825.2013.768626.
Brown, J. L., & Vanable, P. A. (2007). Alcohol use, partner type, and risky sexual behavior among college students: Findings from an event-level study. Addictive Behaviors,32, 2940–2952. https://doi.org/10.1016/j.addbeh.2007.06.011.
Cabada, M. M., Montoya, M., Echevarria, J. I., Verdonck, K., Seas, C., & Gotuzzo, E. (2003). Sexual behavior in travelers visiting Cuzco. Journal of Travel Medicine,10, 214–218. https://doi.org/10.2310/7060.2003.40508.
Center for Reproductive Rights. (2017). The world’s abortion laws 2017. Retrieved from http://worldabortionlaws.com.
Centers for Disease Control and Prevention. (2017a). 2016 sexually transmitted disease surveillance. Retrieved from https://www.cdc.gov/std/stats16/default.htm.
Centers for Disease Control and Prevention. (2017b). CDC Yellow Book 2018: Health information for international travel. New York: Oxford University Press.
Cooper, M. L. (2010). Toward a person x situation model of sexual risk-taking behaviors: Illuminating the conditional effects of traits across sexual situations and relationship contexts. Journal of Personality and Social Psychology,98, 319–341. https://doi.org/10.1037/a0017785.
Crosby, R. A., DiClemente, R. J., Salazar, L. F., Wingood, G. M., McDermott-Sales, J., Young, A. M., & Rose, E. (2013). Predictors of consistent condom use among young African American women. AIDS and Behavior,17, 865–871. https://doi.org/10.1007/s10461-011-9998-7.
Croughs, M., Van Gompel, A., de Boer, E., & Van den Ende, J. (2008). Sexual risk behavior of travelers who consulted a pretravel clinic. Journal of Travel Medicine,15, 6–12. https://doi.org/10.1111/j.1708-8305.2007.00160.x.
Dahlman, D., & Stafstrom, M. (2013). Female Swedish backpackers in Vietnam: A hypotheses generating study on sexual health risks while travelling. Travel Medicine and Infectious Disease,11, 243–249. https://doi.org/10.1016/j.tmaid.2013.04.005.
Daniels, K., Daugherty, J., Jones, J., & Mosher, W. (2015). Current contraceptive use and variation by selected characteristics among women aged 15–44: United States, 2011–2013 (National Health Statistics Reports No. 86). Hyattsville, MD: National Center for Health Statistics.
de Graaf, R., van Zessen, G., & Houweling, H. (1998). Underlying reasons for sexual conduct and condom use among expatriates posted in AIDS endemic areas. AIDS Care, 10, 651–665. https://doi.org/10.1080/09540129848280.
DiClemente, R. J., Salazar, L. F., & Crosby, R. A. (2007). A review of STD/HIV preventive interventions for adolescents: Sustaining effects using an ecological approach. Journal of Pediatric Psychology,32, 888–906. https://doi.org/10.1093/jpepsy/jsm056.
Downing, J., Hughes, K., Bellis, M. A., Calafat, A., Juan, M., & Blay, N. (2010). Factors associated with risky sexual behaviour: A comparison of British, Spanish, and German holidaymakers to the Balearics. European Journal of Public Health,21, 275–281. https://doi.org/10.1093/eurpub/ckq021.
Durant, L. E., & Carey, M. P. (2000). Self-administered questionnaires versus face-to-face interviews in assessing sexual behavior in young women. Archives of Sexual Behavior,29, 309–322. https://doi.org/10.1023/A:1001930202526.
Egan, C. E. (2001). Sexual behaviours, condom use and factor influencing casual sex among backpackers and other young international travellers. Canadian Journal of Human Sexuality,10, 4–58.
Eiser, J. R., & Ford, N. (1995). Sexual relationships on holiday—A case of situational disinhibition. Journal of Social and Personal Relationships,12, 323–339. https://doi.org/10.1177/0265407595123001.
Elliott, L., Morrison, A., Ditton, J., Farrall, S., Short, E., Cowan, L., & Gruer, L. (1998). Alcohol, drug use and sexual behaviour of young adults on a Mediterranean dance holiday. Addiction Research,6, 319–340. https://doi.org/10.3109/16066359808993310.
Finer, L. B., & Philbin, J. M. (2013). Sexual initiation, contraceptive use, and pregnancy among young adolescents. Pediatrics,131, 886–891. https://doi.org/10.1542/peds.2012-3495.
Finer, L. B., & Zolna, M. R. (2016). Declines in unintended pregnancy in the United States, 2008–2011. New England Journal of Medicine,374, 843–852. https://doi.org/10.1056/NEJMsa1506575.
Foster, D. G., Hulett, D., Bradsberry, M., Darney, P., & Policar, M. (2011). Number of oral contraceptive pill packages dispensed and subsequent unintended pregnancies. Obstetrics and Gynecology,117, 566–572. https://doi.org/10.1097/AOG.0b013e3182056309.
Glasier, A. (1999). Emergency contraception in a travel context. Journal of Travel Medicine,6, 1–2. https://doi.org/10.2310/7060.1999.00001.
Institute of International Education. (2017). U.S. study abroad data from the 2017 Open Doors report. Retrieved from https://www.iie.org/Research-and-Insights/Open-Doors/Data/US-Study-Abroad.
Kenyon, D. B., Sieving, R. E., Jerstad, S. J., Pettingell, S. L., & Skay, C. L. (2010). Individual, interpersonal, and relationship factors predicting hormonal and condom use consistency among adolescent girls. Journal of Pediatric Health Care,24, 241–249. https://doi.org/10.1016/j.pedhc.2009.06.014.
Kotchick, B. A., Shaffer, A., Forehand, R., & Miller, K. S. (2001). Adolescent sexual risk behavior: A multi-system perspective. Clinical Psychology Review,21, 493–519. https://doi.org/10.1016/S0272-7358(99)00070-7.
Kusunoki, Y., & Upchurch, D. M. (2011). Contraceptive method choice among youth in the United States: The importance of relationship context. Demography,48, 1451–1472. https://doi.org/10.1007/s13524-011-0061-0.
Lejelind, E., Westerling, R., Fugl-Meyer, K. S., & Larsson, K. (2017). Condom use among Swedes while traveling internationally: A qualitative descriptive study. Nursing & Health Sciences,19, 257–263. https://doi.org/10.1111/nhs.12341.
Lewis, C. T., & de Wildt, G. (2016). Sexual behaviour of backpackers who visit Koh Tao and Koh Phangan, Thailand: A cross-sectional study. Sexually Transmitted Infections,92, 410–414. https://doi.org/10.1136/sextrans-2015-052301.
Marcantonio, T., Angelone, D. J., & Sledjeski, E. (2016). Using a pattern-centered approach to assess sexual risk-taking in study abroad students. Journal of American College Health,64, 165–173. https://doi.org/10.1080/07448481.2015.1085058.
Maticka-Tyndale, E., & Herold, E. S. (1997). The scripting of sexual behaviour: Canadian university students on spring break in Florida. Canadian Journal of Human Sexuality,6, 317–328.
Maticka-Tyndale, E., Herold, E. S., & Mewhinney, D. (1998). Casual sex on spring break: Intentions and behaviors of Canadian students. Journal of Sex Research,35, 254–264. https://doi.org/10.1080/00224499809551941.
Matteelli, A., Schlagenhauf, P., Carvalho, A. C. C., Weld, L., Davis, X. M., Wilder-Smith, A., … Casteli, F. (2013). Travel-associated sexually transmitted infections: An observational cross-sectional study of the GeoSentinel surveillance database. Lancet Infectious Diseases,13, 205–213. https://doi.org/10.1016/s1473-3099(12)70291-8.
Mewhinney, D., Harold, E., & Maticka-Tyndale, E. (1995). Sexual scripts and risk-taking of Canadian university students on spring break in Daytona Beach, Florida. Canadian Journal of Human Sexuality,4, 273–288.
Miles, M., Huberman, A., & Saldaña, J. (2014). Qualitative data analysis: A methods sourcebook. Thousand Oaks, CA: Sage Publications.
National Travel and Tourism Office, U.S. Department of Commerce. (2017a). 2016 profile of U.S. resident travelers visiting overseas destinations (outbound). Retrieved from https://travel.trade.gov/outreachpages/download_data_table/2016-Outbound-Profile.pdf.
National Travel and Tourism Office, U.S. Department of Commerce. (2017b). U.S. citizen travel to international regions, 2016. Retrieved from https://travel.trade.gov/view/m-2016-O-001/index.html.
Ragsdale, K., DiFranceisco, W., & Pinkerton, S. D. (2006). Where the boys are: Sexual expectations and behaviour among young women on holiday. Culture Health & Sexuality,8, 85–98. https://doi.org/10.1080/13691050600569570.
Sanford, C., McConnell, A., & Osborn, J. (2016). The pretravel consultation. American Family Physician,94, 620–627.
Senn, N., de Valliere, S., Berdoz, D., & Genton, B. (2011). Motivational brief intervention for the prevention of sexually transmitted infections in travelers: A randomized controlled trial. BMC Infectious Diseases,11, 300. https://doi.org/10.1186/1471-2334-11-300.
Sonfield, A., Hasstedt, K., & Gold, R. B. (2014). Moving forward: Family planning in the era of health care reform. New York: Guttmacher Institute.
Stebleton, M. J., Storia, K. M., & Cherney, B. T. (2013). The high impact of education abroad: College students’ engagement in international experiences and the development of intercultural competencies. Frontiers: The Interdisciplinary Journal of Study Abroad,22, 1–24.
Steenland, M. W., Rodriguez, M. I., Marchbanks, P. A., & Curtis, K. M. (2013). How does the number of oral contraceptive pill packs dispensed or prescribed affect continuation and other measures of consistent and correct use? A systematic review. Contraception,87, 605–610. https://doi.org/10.1016/j.contraception.2012.08.004.
Thomas, M. (2005). ‘What happens in Tenerife stays in Tenerife’: Understanding women’s sexual behaviour on holiday. Culture, Health & Sexuality,7, 571–584. https://doi.org/10.1080/13691050500256807.
Trussell, J. (2011). Contraceptive failure in the United States. Contraception,83, 397–404. https://doi.org/10.1016/j.contraception.2011.01.021.
Vivancos, R., Abubakar, I., & Hunter, P. R. (2010). Foreign travel, casual sex, and sexually transmitted infections: Systematic review and meta-analysis. International Journal of Infectious Diseases,14, e842–e851. https://doi.org/10.1016/j.ijid.2010.02.2251.
Weinstock, H., Berman, S., & Cates, W. (2004). Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000. Perspectives on Sexual and Reproductive Health,36, 6–10. https://doi.org/10.1363/3600604.
Westley, E., Kapp, N., Palermo, T., & Bleck, J. (2013). A review of global access to emergency contraception. International Journal of Gynaecology and Obstetrics,123, 4–6. https://doi.org/10.1016/j.ijgo.2013.04.019.
Whelan, J., Belderok, S., van den Hoek, A., & Sonder, G. (2013). Unprotected casual sex equally common with local and Western partners among long-term Dutch travelers to (sub)tropical countries. Sexually Transmitted Diseases,40, 797–800. https://doi.org/10.1097/OLQ.0000000000000013.
World Tourism Organization. (2016a). Affiliate members global report, Volume 13—The power of youth travel. Retrieved from https://www.e-unwto.org/doi/pdf/10.18111/9789284417162.
World Tourism Organization. (2016b). UNWTO tourism highlights, 2016 edition. Retrieved from https://www.e-unwto.org/doi/pdf/10.18111/9789284418145.
Research funding was provided by an internal award from the Division of Epidemiology and Community Health, University of Minnesota School of Public Health. Dr. Martins’ efforts on data analysis and manuscript preparation were also funded, in part, by the University of Minnesota’s Center for Leadership Education in Maternal and Child Public Health (US-DHHS/HRSA T76-MC00005).
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Martins, S.L., Hellerstedt, W.L., Bowman, S.B. et al. International Travel as a Context for Sexual and Contraceptive Behaviors: A Qualitative Study of Young Women Traveling Outside the U.S.. Arch Sex Behav 49, 1039–1052 (2020). https://doi.org/10.1007/s10508-019-1400-2
- Sexual behavior
- Young adults