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Adolescent pregnancies. Victims of sexual abuse in childhood appear more likely than other teens to become pregnant in adolescence. In the early 1990s studies in the US began to find a consistent association between sexual abuse in childhood and adolescent pregnancy (25, 37, 56). The studies also found a clear and consistent link between early sexual victimization and a variety of risk-taking behaviors, including early sexual debut, drug and alcohol use, more sexual partners, and less contraceptive use (148, 455).

Noting that programs have had difficulty reducing rates of adolescent pregnancy by providing sex education and access to contraception alone, researchers suggested that sexual victimization in childhood might help explain high-risk sexual activity and pregnancies among adolescents (37). Some have questioned whether it is the sexual victimization itself that contributes to the risk of adolescent pregnancy or whether both are caused by some third factor, such as an unhealthy and disorganized home life. Studies have shown that many of the factors that predispose a young child to sexual abuse, such as absent or dysfunctional parents, are also risk factors for adolescent pregnancy (314, 385).

Although the question is not fully resolved, three recent studies that examined the independent effects of sexual abuse and other factors suggest that sexual abuse itself has an effect on adult sexual behavior beyond the effect of family background (149, 314, 315). In all three studies victimization in childhood made an independent contribution to problems of mental health, sexuality, and social functioning in adults.

Researchers continue to explore the exact mechanism through which sexual abuse increases the risk of teenage pregnancy. Sexual abuse appears to contribute to teen pregnancy indirectly, by lowering the age at first intercourse and by increasing sexual risk-taking among young people (424). Studies in Barbados, New Zealand, Nicaragua, and the US confirm that, on average, sexual abuse victims start having voluntary sex significantly earlier than nonvictims (37, 149, 155, 199, 241, 336, 385, 424). Such studies also link sexual abuse to a variety of high-risk sexual behaviors in adolescence, including having sex with many partners, using drugs and abusing alcohol, not using contraception, and trading sex for money or drugs.

Childhood abuse has also been linked to unintended pregnancies among adult women. A study of 1,200 women in the US found that women who reported being psychologically, sexually, and/or physically abused, or whose mother was beaten by a partner, had higher rates of unintended first pregnancies than women who did not experience abuse. The likelihood that a woman's first pregnancy was unintended increased with both the number of different types of abuse she experienced and the frequency of abuse (114).

STIs including HIV/AIDS. Sexual abuse in childhood appears to increase the risk of sexually transmitted infections (STIs) among adults, largely through its effect on high-risk sexual behavior (98, 148, 149, 199, 239, 385, 389, 424, 455, 487). Several studies have linked a history of sexualabuse to selling sex for money or drugs (37, 229, 389, 423, 484). For example, researchers in Rhode Island, US, found that men and women who had been raped or forced to have sex in either childhood or adolescence were four times more likely than people who had not been abused to have worked in prostitution. They were also twice as likely to have multiple sexual partners in a single year and to have casual sex (487). Among women, victims of childhood sexual assault were twice as likely to be heavy consumers of alcohol and nearly three times as likely to become pregnant before the age of 18. While the abused women studied did not have higher rates of HIV, men who had experienced childhood sexual abuse were twice as likely to be HIV positive as men who did not, independent of a history of intravenous drug use or prostitution (487).

In a nationally representative study of men and women in Barbados, anthropologist Penn Handwerker found that sexual abuse was the most important determinant of high-risk sexual activity during adolescence, including both young age at first sexual intercourse and a high number of sexual partners (199). The direct effects of childhood sexual abuse on number of partners remained significant into the respondents' mid-thirties. For men, abuse in childhood also was closely linked to not using condoms in adulthood, even after accounting for other variables affecting condom use.

Abuse in childhood also increases the risk of sexually transmitted infection through its effect on drug use. Sexually abused or assaulted women often turn to drugs as a coping mechanism, in addition to engaging in such unhealthy behavior as unprotected sex and trading sex for money or drugs (21, 43, 162, 254, 349, 372, 412, 426).

In a study at an outpatient methadone maintenance clinic in the South Bronx of New York, early sexual abuse—especially incest—emerged as one of the most formative experiences in the lives of women addicted to such drugs as crack, cocaine, and heroin. A “sense of stigmatization and shame” leaves victims feeling “unloved, unlovable, and unable to say 'no' to things they do not want to do such as having sex or using drugs,” researchers concluded (482).

Not surprisingly, victims of other types of violence, most notably partner abuse, are also at increased risk of STIs. In the US state of North Carolina, for example, women who reported physical and sexual abuse by a partner were more than twice as likely to have experienced STIs as were other women, even after accounting for confounding variables. Data from India suggest that abusive men may be more likely to expose their wives to infection. Abusive men were significantly more likely to have engaged in extramarital sex and to have STI symptoms than were nonabusive men (286).