Association Between Contraceptive Efficacy Knowledge and Method Choice: A Behavioral Economics Lens [ID 2683608

Abstract

INTRODUCTION: Patients often use less effective contraception despite desire to avoid pregnancy, a decision considered “irrational” by neoclassical economic theory. “Bounded rationality,” a behavioral economics principle encompassing information failure, may underlie such decisions. We assess the role of bounded rationality on contraceptive decision-making by evaluating the relationship between contraceptive efficacy knowledge and contraceptive choice. METHODS: We used the Guttmacher’s publicly available “Continuity and Change in Contraceptive Use” dataset, a survey administered 2012–2014. Contraceptive effectiveness was grouped into Tier 1, Tier 2, “Other,” and “No Method” based on survey options and CDC classification. Contraceptive knowledge was assessed by two questions comparing effectiveness of oral contraceptive pills (OCPs) versus condoms and OCPs versus intrauterine devices (IUDs). We used logistic regression to calculate odds ratios (ORs) for the association between contraceptive tier used and contraceptive knowledge, adjusted for race/ethnicity and age, with each regression restricted to users of the two methods compared. RESULTS: Our sample included 4,634 respondents. 43.8% accurately compared OCPs and condoms; 30.1% accurately compared OCPs and IUDs. Answering that condoms are more effective than OCPs was associated with seven times greater odds of using other methods (OR 7.1; 95% CI, 4.5–11.1). Answering that OCPs are more effective than IUDs was associated with 0.01 odds of using Tier 1 over Tier 2 (95% CI, 0.005–0.05). CONCLUSION: Consistent with bounded rationality, respondents who incorrectly compared contraceptive efficacy were far more likely to use the less effective method. Contraception misconceptions, particularly regarding relative efficacy, should be assessed and addressed when offering patient-centered counseling.