Social trends

In the 1960s, young men and women increasingly delayed marriage in order to pursue higher education. The median age of marriage among women rose from 20 in 1955 to 22 in 1979 (Bureau of the Census, 1999), while the number of young adults attending college more than quadrupled in that same time period (Bureau of the Census, 1998). The rising age at first marriage, combined with a growing number of students living away from parents' direct supervision, provided the time and freedom for young, single adults to explore their sexuality.

Women were not only delaying marriage and attending college; they were also entering the labor force at increasing rates. In the period between 1948 and 1987, the labor force participation of mothers with preschoolers increased five-fold (Bureau of Labor Statistics, 1988). A combination of factors, including women's rising wages, consumerism, and changing attitudes, facilitated women's workforce participation in the post-World War II period (Cain, 1966; Bowen and Finegan, 1969; Gordon and Kammeyer, 1980). In the 1970s, high inflation and economic uncertainty encouraged families to adopt new work-family arrangements and further accelerated women's entry into the labor force (Edwards, 2001). The transition from homemaking to paid labor-force participation increased women's autonomy and provided opportunities for sexual liaisons (Gillmore et al., 1999).

The movement of women into the workforce has also been linked to increases in the rate of divorce (Heer and Grossbard-Schectman, 1981; Corley and Woods, 1991; Davanzo and Rahman, 1993). Indeed, the incidence of divorce per 1000 married women aged 14 and over increased from 9.2 in 1960 to 20.3 in 1975 (Bureau of the Census, 1976). As a result of the increasing divorce rate, the proportion of sexually experienced, unmarried adults also increased (Kinsey et al., 1953). The increasing prevalence of divorce, the growing number of educated women, and the increasing accessibility of financial independence were all slowly altering the traditional landscape of sexual behavior and disease.

The introduction of the use of oral contraceptives (aka "the pill") in the early 1960s fueled these trends and the sexual revolution (Asbell, 1995; Watkins,

2001). Its effectiveness gave women unprecedented control over their fertility, offering them sexual freedom that had previously only belonged to men. The pill enabled couples to have intercourse as an expression of love or for physical pleasure separate from procreation. The social impact of the pill was profound and ultimately provided, in concert with other social trends, the momentum for the Women's Liberation Movement. The publication of a report from the Kennedy Administration's Commission on the Status of Women (United States President's Commission on the Status of Women, 1963) and Betty Friedan's The Feminine Mystique (Friedan, 1963), both of which documented discrimination against women in virtually every area of American life, were published in 1963 and marked the beginning of the Women's Liberation Movement. As it gained momentum, several legislative victories were celebrated by the movement, including the passage of Title VII of the Civil Rights Act of 1964, which made it illegal to practice employment discrimination on the basis of sex as well as race, religion, and national origin; of Title IX, in the Education Amendments of 1972, which forbade discrimination in the field of education; and of Roe vs. Wade in the US Supreme Court, which legalized abortion in all 50 states.

The Women's Liberation Movement challenged American ideology about female sexuality. A new literature emerged representing women's perspectives in sexual relationships; books such as the Joy of Sex (Comfort, 1972) focused on both men's and women's roles in the quest for better lovemaking, and became best sellers. As Gillmore and colleagues described, "The pressure on men to become competent lovers, for women to be orgasmic and assertive in their sexual desires changed the meaning and experience of sex for both men and women" (Gillmore et al., 1999). This revised ideology was accompanied by increasingly permissive attitudes about sex (Reiss, 1960; Glenn and Weaver, 1979). The recognition of women as sexually independent actors represented a new phase in American sexuality.

The sexual and social freedom this series of developments fostered in the 1960s and 1970s was reflected in dramatic increases in the rates of STI such as syphilis (Nakashima et al., 1996), gonorrhea (CDC, 2005a), chlamydia (Holmes, 1981), and genital herpes (Becker et al., 1985). Individuals at the forefront of social and sexual change in this period showed some specific vulnerability to STI. Young people (Zaidi et al., 1983), separated and divorced women (Manhart et al., 2004), women using the pill as their method of contraception (Berger et al., 1975; Richmond and Sparling, 1976; Arya et al., 1981), and women in general (Zaidi et al., 1983) were all more likely to be diagnosed with certain STI.

After two decades during which Americans experienced dramatic changes in marriage and divorce patterns, labor-force participation by women, and social attitudes towards sexuality, these social developments are continuing, but at a slower pace. The divorce rate has begun to stabilize, though it remains at the highest level ever recorded, with half of first marriages estimated to end in divorce (Glick, 1984; Norton and Moorman, 1987). The age at first marriage continues to increase as men and women seek additional education and work experience before marriage (Lugaila, 1992). In the US, the percentage of adults aged 15 and older who were married declined from 69.3 percent and 65.9 percent in 1960 to 57.1 percent and 54 percent in 2003 for men and women, respectively (US Census Bureau, 2003).

This less dramatic pace of social change has been reflected in trends of reported STI. Rates of syphilis and gonorrhea have declined nationwide in the past two decades. From a high of 467.7 cases per 100,000 population reported in 1975, the US gonorrhea rate declined by 76 percent to 113.5 (CDC, 2005b). While the number of reported cases of chlamydia has increased steadily among women since the 1980s, it is likely that this increase reflects the continued expansion of screening efforts and increased use of more sensitive diagnostic tests rather than an actual increase in new infections (CDC, 2005b).

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