The impact of oral contraceptive initiation on young women's condom use in 3 American cities: missed opportunities for intervention.

Chelsea Morroni,Stephen Heartwell,Mimi Zieman,Sharon Edwards,Carolyn Westhoff,Ronald H Gray

doi:10.1371/journal.pone.0101804

Chelsea Morroni, Stephen Heartwell + Show 4 more

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https://doi.org/10.1371/journal.pone.0101804

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Abstract

PurposeTo describe women’s condom use and assess predictors of consistent condom use and dual method use in the 6 months after the initiation of oral contraception (OC).MethodsWe conducted a planned secondary cohort analysis among women less than 25 years of age initiating oral contraceptives at public family planning clinics in Atlanta, Dallas and New York City, USA, as part of a randomized trial. These clinics provide care to predominantly African American or Hispanic women of low socioeconomic status. Participants completed interviews at enrollment and at 6 months after OC start. We used multivariate logistic regression to assess factors associated with consistent condom and dual method use at 6 months.Results1281 participants met the inclusion criteria for this analysis. At enrollment prior to OC start, 28% were consistent condom users. In the six months after initiation of oral contraception, only 14% always used a condom and 4% always used dual methods. In multivariate analysis, receiving basic advice to always use a condom after OC initiation from a provider during the baseline clinic consultation was associated with a 50% increase in the odds of using condoms consistently. Only 28% of participants were given this condom use advice.ConclusionsThis study documents a decline in women’s condom consistent use subsequent to initiation of the oral contraceptive and suggests that opportunities for positive intervention around condom use among women starting hormonal methods are being missed. Basic condom use advice, which is neither time consuming nor resource dependent, was associated with increased consistent use and should be immediately implemented in all family planning services.

Highlights

Oral contraception is one of the leading methods of contraception in the United States (U.S), used by 50% of contraceptors under 25 years of age. [1] Oral contraceptives (OC) have good contraceptive efficacy with typical use annual failure rates of 9%. [2] They have the benefit of not requiring male involvement
In the U.S, young minority women are at greatest risk of all of the negative health outcomes associated with sexual activity, including unintended pregnancy [3,4] and sexually transmitted infections (STIs)/HIV infection. [5,6] Teenagers and young adults comprise more than half of reported gonorrhea and three-quarters of reported Chlamydia infections despite making up only 25% of the sexually active population
We report levels of condom use among young, minority women in the U.S before and after initiation of oral contraception, examine how initiation of oral contraception influences condom use, and identify factors associated with consistent condom and dual method use after initiation of oral contraception

Summary

Introduction

Oral contraception is one of the leading methods of contraception in the United States (U.S), used by 50% of contraceptors under 25 years of age. [1] Oral contraceptives (OC) have good contraceptive efficacy with typical use annual failure rates of 9%. [2] They have the benefit of not requiring male involvement. Representative survey data show that despite high rates of unplanned pregnancy and STI, U.S women seldom combine condoms with highly effective contraceptives for optimal protection: estimates of dual use range from as low as 3–5% among Hispanic and African American youth [8] to 7.3–12% among all women of reproductive age [9,10] to 14–20% in certain teenage populations. Most of the cross-sectional studies have documented an inverse relationship between use of long-term contraceptive methods, including oral contraception, and condom use [7,15,16,17], and the scant prospective data generally show a decline in condom use among previously consistent condom users who initiate hormonal Most studies of the relationship between hormonal contraceptive initiation and condom use have been cross-sectional [7,13,14,15,16,17], making inferences about the temporal relationship between hormonal method initiation and changes in condom use difficult, or they have been methodologically limited by small sample sizes or less stringent definitions of consistent condom and dual method use [13,14,15,16,17,18,19,20].

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