Despite the proven effectiveness of consistent condom use in preventing unwanted pregnancies and STIs, only 1% of the respondents use condoms with their most recent partner consistently. This, together with the low reach of various campaigns on contraceptive use throughout different forms of media, underscore the need to strengthen sex education and promote optimal reproductive health behaviors, such as consistent condom use, in the general population. After adjusting for other variables, only agency showed a strong evidence of being associated with consistent condom use, which has been demonstrated in a previous study [41]. Other variables, such as HIV knowledge, age, hearing about contraception in television, and number of children showed borderline significant associations with consistent condom use. These variables have been previously identified to be associated with consistent condom use [8–30].
Sexual agency has been defined “as the strategic negotiations of an individual to situate oneself and one’s choices in a social context, maintain relationships and make sense of experiences”. However, because each individual has different experiences and grew up in different environments, there are structural inequalities in sexual agency [42]. A qualitative study exploring sexual agency among young women in the Philippines found that many Filipino women have avoided or have no sexual agency, explaining that their first sexual experience was succumbing to coercion or emotional pressures of being with their partners, or worse, being raped [43]. In another study involving Filipino women, low sexual agency, measured by her inability to ask a partner to use condoms during intercourse, was found to be associated with experiencing intimate partner violence. [38]. Since we find that a woman’s ability to ask a partner to use condoms during intercourse is very strongly associated with consistent condom use, there should be measures to strengthen sexual agency among Filipino women. This could be done by educating and empowering them to make choices on their sexuality and reproductive health as early as puberty. The recent passage of the Philippine Reproductive Health Law, which has specific provisions for adolescent and youth reproductive health guidance and counseling, reproductive health education for adolescents, and prevention and management of reproductive health guidance and counselling, is a step in the right direction [44], but there may be a need to revisit its implementing rules and regulations and further strengthen its implementation considering that inconsistent condom use and teenage pregnancy is still prevalent in the country [7]. A recent paper on sexual agency advocates going beyond focusing solely on sex education interventions in promoting sexual agency. Instead, they advocate for improving living conditions, education, and social support, opining that these have greater effect on improving sexual agency than sex education interventions [45]. The association between sexual agency and consistent condom use also highlights the need for a more intensified information and education campaign to promote modern contraceptive methods, particularly consistent condom use, among older women no longer reached by school-based sex education.
The other variables with borderline significant associations with consistent condom use – HIV knowledge, age, number of children, and hearing about contraception via television – have been shown to be associated with consistent condom use in previous studies as well [8–30]. The association between number of children and consistent condom use is intuitive; women who have had many children would tell their partners to use condoms consistently to prevent conception. The association between HIV knowledge and hearing about contraception via television with consistent condom use highlight the need to continue information and education campaigns on HIV via television, as this medium has been shown to be the most effective in encouraging consistent condom use. In information and education campaigns promoting HIV knowledge, the importance of modern forms of contraception, which includes condoms, should be highlighted. However, in doing so, misperceptions on modern contraceptive methods should be addressed [46]. More importantly, a nuanced understanding of how pleasure, power, and inequalities should be considered in devising interventions to promote modern contraceptive methods [47]. The consideration on pleasure is particularly salient in the Philippine context as the perception that condoms are not comfortable to use and causes displeasure has been found to be a barrier to condom use in a previous review. The same review mentions the need for a “collaborative, culturally-sensitive, and population-specific approach to develop and implement acceptable, sustainable and successful condom use interventions” [8]. This study adds that more than just condom use, interventions should focus on promoting consistent condom use as the benefits of preventing STIs and unwanted pregnancies can only come from consistent use of condoms. More importantly, the prevention of teenage pregnancy by consistent condom use also protects women from the stigma and economic hardship brought about by teenage pregnancy. Lastly, the negative association between age and consistent condom use may mean that younger women are more likely to use condoms consistently, which is a welcome sign after many years of reproductive health activism and shows that reproductive health policies in the recent years are starting to bear fruit, but it is noteworthy that consistent condom use remains poor and such associations are weak.
Many variables would have shown a significant result, if not for the low number of people who has the outcome (261 in the descriptive analysis and only 200 left in multivariate analyses). This resulted in wide confidence intervals, non-significant result for factors supposedly associated with the outcome, and residual confounding as we are constrained to select only the most powerful confounders to be included in the final model. We would have wanted to control for the effect of other known determinants of consistent condom use, such as religion, but ultimately decided against it for the sake of parsimony. How the outcome variable is defined also raises possible issues in misclassification. The outcome variable is a combination of two questions – the first one asking if they had used condoms in their most recent intercourse with their most recent partner – and a follow-up question asking if they had used condoms consistently in the past 12 months. This implies that some respondents may be using condoms consistently with their most recent partner, but may not be with their other partners, hence answering that they are current non-users of contraception, and yet still get classified as using condoms consistently with their most recent partner. Alternatively, this could just be an inconsistency in how respondents report their data on contraceptive use and intention, and on condom use, which is quite common in studies using self-report data. Lastly, we have also excluded around half of respondents who have missing data for consistent condom use and/or partner variables, which potentially means selection bias due to missing data and limits the generalizability of our findings to Filipino women who currently have partners in their relationship.