Contraceptive History, Unintended Pregnancy, and Contraceptive Method Choice Among Urban Low-Income Women

Abstract

Nearly half of pregnancies in the United States are unintended, a proportion that has remained constant in the last decade. Half of unintended pregnancies occur among women not using any contraception, but little is known about how contraceptive history and contraceptive priorities predict contraceptive method choice. Among 1454 women not currently seeking pregnancy who completed a computer-based contraceptive assessment module at an urban reproductive health center, factors associated with not obtaining a contraceptive method were assessed. The 1454 participants were low-income (98% had incomes <200% federal poverty level), predominantly Hispanic (71%), and foreign-born (76%). None were seeking to become pregnant, but 15% did not obtain a method of contraception. In adjusted analyses, women who had ever had an unintended pregnancy-41% of the sample-were significantly more likely to leave their visit without receiving a method (adjusted odds ratio [AOR]=1.67, 95% confidence interval [CI]: 1.21-2.30), as were women who were not using contraception at the start of their visit (AOR=3.82, 95% CI: 2.73-5.35). In an adjusted model, prioritizing no hormones or the preference of not wanting to interrupt sex to use a method was not a significant predictor of obtaining a method. Analyses revealed that women at higher risk of unintended pregnancy identified by their contraceptive histories were significantly more likely to leave their healthcare visit without a method of contraception. Additional research is needed on ways to help women obtain effective, medically indicated contraceptive methods that fit their reproductive life goals, priorities, and preferences.