Current Contraception Research Articles

Contraception usage and the desired number of offspring of Indigenous women from the Gomeroi lands.

To describe the current contraception usage patterns from a cohort of Australian Indigenous women, including their ideal family size and spacing between children. Cross-sectional analysis of data (2012-2019). Data are from a longitudinal study, the Gomeroi gaaynggal (babies from Gomeroi lands) program, based in rural and remote Gomeroi lands in New South Wales. Women carrying an Indigenous baby who enrolled during pregnancy were eligible for the study. The mother and child are then followed for up to 10years. Contraception usage in the postnatal period was recorded, as well as whether they were sexually active, whether they wanted more children and their preferred spacing between children. Medical, social and demographic information was also collected. These measures were self-reported via an online tool (Survey Monkey® ) at their first visit to the study following the birth of their child. Ninety-nine women were included in the analysis. Most women reported that they were sexually active at the time they were questioned about their contraceptive usage. The most popular contraception choices were condoms, the oral contraceptive pill and implant rods. Those answering that they did not want more children had a median of three children already. Those who wanted more children had a median of one child. The majority of the women stated that 2-3years between babies was ideal. The sampled women had clear beliefs about their ideal family size, in which contraceptive usage played an important part.

The Effects of Postpartum Long-Acting Reversible Contraceptive Insertion From the Medicaid Payer Perspective [26J

INTRODUCTION: This Markov model was created to determine the difference in unintended pregnancies, costs, and cost effectiveness with immediate versus standard placement of postpartum long-acting reversible contraception (ppLARC), which includes intrauterine devices (IUDs) and implants. METHODS: This Markov model examines a theoretical cohort of 1,000 women whose obstetrical care was paid for by North Carolina Medicaid and who requested ppLARC prior to discharge from their delivery hospitalization from the perspective of NC Medicaid. Probability inputs came from the literature and cost inputs are from NC Medicaid fee schedules. Markov cycles were weekly with an 18 month time horizon. During the time horizon postpartum, a woman could continue with her current contraceptive method, change to a different method, or become pregnant. Pregnancy is an absorbing state with five different outcomes. Probabilistic sensitivity analyses were conducted on key model parameters. RESULTS: Immediate ppLARC would result in 182 fewer unintended pregnancies and save North Carolina $624,372 over two years. Immediate ppLARC was cost saving, with an ICER of $3,435 saved per unintended pregnancy prevented. In sensitivity analyses, immediate ppLARC remained cost saving except when parameters were varied widely from expected values. CONCLUSION: Immediate post-partum insertion of long-acting reversible contraceptives was found to be associated with cost-savings and fewer unintended pregnancies.

The Effects of Postpartum Long-Acting Reversible Contraceptive Insertion From the Medicaid Payer Perspective [OP03-2C

INTRODUCTION: This model was created to determine the difference in short interval pregnancies, costs, and cost effectiveness with immediate versus standard placement of postpartum long-acting reversible contraception (ppLARC), which includes intrauterine devices and implants. METHODS: This Markov model examines a theoretical cohort of 1,000 women whose obstetrical care was paid for by North Carolina Medicaid (NC Medicaid) and who requested ppLARC prior to discharge from their delivery hospitalization from the perspective of NC Medicaid. Short interval pregnancy was defined as conception prior to 18 months from delivery. Probability inputs came from the literature and cost inputs are from NC Medicaid fee schedules. Markov cycles were weekly with an 18 month time horizon. During the time horizon postpartum, a woman could continue with her current contraceptive method, change to a different method, or become pregnant. Pregnancy is an absorbing state with five different outcomes. Probabilistic sensitivity analyses were conducted on key model parameters. RESULTS: Immediate ppLARC would result in 182 fewer unintended short interval pregnancies and save North Carolina $624,372 over 18 months. Immediate ppLARC was cost saving, with an incremental cost-effectiveness ratio of $3,435 saved per short interval pregnancy prevented. In sensitivity analyses, immediate ppLARC remained cost saving except when parameters were varied widely from expected values. CONCLUSION: Immediate post-partum insertion of long-acting reversible contraceptives was associated with cost-savings and fewer short interval pregnancies.

Identifying a Golden Opportunity: Adolescent Interest in Contraceptive Initiation in a Pediatric Emergency Department.

Objectives: Contraception use reduces teen pregnancy, and long-acting reversible contraception is recommended as first-line treatment. Since many adolescents use the emergency department (ED) as a primary source of health care, it is a potential site of contraceptive counseling and provision. We surveyed female adolescents to assess desire for contraceptive counseling and initiation/change during an ED visit. Materials and Methods: This was a cross sectional study of a convenience sample of female ED patients aged 16-21 years in an urban pediatric ED. Participants completed an anonymous questionnaire about sexual health, contraceptive use, and interest in contraceptive counseling. The primary outcome was adolescent interest in starting/changing contraception during an ED visit. Results: Three hundred eighty-one patients (mean age 19.1 ± 1.6 years) completed the survey. Most (80.5%) had been sexually active with a male partner, and 110 (28.2%) had previously been pregnant. Two-thirds were interested in discussing contraception and 22.5% were likely to start or change contraception during the ED visit. Those who wanted to start or change contraception were more likely to be sexually active with a male partner (93% vs. 82%, p = 0.02) and to report that they were not satisfied with their current contraception (44% vs. 21%, p = 0.0003). Fifteen (17%) of the adolescents likely to start or change contraception were interested in progestin implant initiation in the ED. Conclusions: Adolescents were interested in initiating or changing contraception during the ED visit, providing an important opportunity to discuss and initiate effective contraception.

Changes in the prevalence and profile of users of contraception in Britain 2000–2010: evidence from two National Surveys of Sexual Attitudes and Lifestyles

AimTo describe prevalence and trends in contraceptive method use in Britain through a comparison of the second and third National Surveys of Sexual Attitudes and Lifestyles (Natsal-2 and Natsal-3).MethodsCross-sectional probability...

Contraceptive methods of privately insured US women with congenital heart defects

The American Heart Association recommends women with congenital heart defects (CHD) receive contraceptive counseling early in their reproductive years, but little is known about contraceptive method use among women with CHD. We describe recent female sterilization and reversible prescription contraceptive method use by presence of CHD and CHD severity in 2014. Using IBM MarketScan Commercial Databases, we included women aged 15 to 44 years with prescription drug coverage in 2014 who were enrolled ≥11 months annually in employer-sponsored health plans between 2011 and 2014. CHD, CHD severity, contraceptive methods, and obstetrics-gynecology and cardiology provider encounters were identified using billing codes. We used log-binomial regression to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to compare contraceptive method use overall and by effectiveness tier by CHD presence and, for women with CHD, severity. Recent sterilization or current reversible prescription contraceptive method use varied slightly among women with (39.2%) and without (37.3%) CHD, aPR = 1.04, 95% CI [1.01-1.07]. Women with CHD were more likely to use any Tier I method (12.9%) than women without CHD (9.3%), aPR = 1.41, 95% CI [1.33-1.50]. Women with severe, compared to non-severe, CHD were less likely to use any method, aPR = 0.85, 95% CI [0.78-0.92], or Tier I method, aPR = 0.84, 95% CI [0.70-0.99]. Approximately 60% of women with obstetrics-gynecology and <40% with cardiology encounters used any included method. There may be missed opportunities for providers to improve uptake of safe, effective contraceptive methods for women with CHD who wish to avoid pregnancy.

What Women Want: Factors Impacting Contraceptive Satisfaction in Privately Insured Women.

To identify factors associated with high contraceptive method satisfaction among privately insured, adult women in Pennsylvania. We used cross-sectional survey data collected in 2014 from 874 privately insured women participating in the MyNewOptions study who were currently using contraception. Binomial logistic regression assessed the relationship of contraceptive attributes, attitudes, and sociodemographic variables with contraceptive method satisfaction. More than one-half of the analytic sample (53%) was "very satisfied" with their current contraceptive method. The strongest predictors of high method satisfaction were having a method that was easy to use (adjusted odds ratio [aOR], 2.65; 95% confidence interval [CI], 1.79-3.91), high perceived method effectiveness (aOR, 2.52; 95% CI, 1.68-3.78), cost not being a factor in method selection (aOR, 2.88; 95% CI, 2.08-4.00), and not being troubled by side effects (aOR, 2.27; 95% CI, 1.54-3.34). In contrast with previous studies, long-acting reversible contraception (i.e., intrauterine devices and contraceptive implant) was not independently associated with high method satisfaction, but other hormonal methods were (versus nonprescription methods; aOR, 2.48; 95% CI, 1.65-3.75). The strongest predictors of high method satisfaction were having a method that was easy to use and effective and for which cost was not a factor in method selection.

Knowledge, Attitude and Practice of Emergency Contraception among Married Women Attending Antenatal Clinics, Makkah (2018)

Background: Despite the advancements in current methods of contraception, unintended pregnancies are still widespread in the Kingdom of Saudi Arabia which adversely impact the well-being and health of women and their families. Objectives: To determine the level of knowledge, attitude and utilization of emergency contraception among women attending ante-natal clinics at primary health care centers in Makkah, 2018. Subjects and methods: A cross-sectional study was conducted at antenatal care clinics, Ministry of Health (MOH) PHC centers in Makkah city. A multi-stage random sample of married Saudi women in the childbearing age who were attending those clinics was recruited. Data were collected using a self-administered questionnaire composed of three main sections; socio-demographic data of the participants, questions regarding knowledge of EC use and statements assessed attitude and barriers to use EC. Results: The study included 191 women with a response rate of 100% their age ranged between 18 and 49 year old’s with a mean of 31.7 and standard deviation (SD) of ±5.3 years. 78.5% of the participants knew that there is a way to prevent pregnancy in case of having unprotected sex. Internet was the commonest EC source of knowledge (45.4%), followed by doctor or family planning provider (33.4%). Majority of the participants who were aware of the existence of a method to prevent pregnancy in case of an unprotected sex (n=150) knew correctly the time of using emergency contraceptive pills or IUD (99.3% and 92.7%, respectively) though only 16.2% of the studied women reported ever using emergency contraception to prevent pregnancy. Primary school educated women had the highest percentage of the EC attitude score, rank was 128.04 while postgraduate women had the lowest percentage of the score, rank of 24.07), p=0.001. Conclusion: The present study`s results reveal high level of awareness knowledge regarding emergency contraception. However, low utilization was notices mainly due to religious concerns.

Motivational interviewing to promote long-acting reversible contraception among Rwandan couples wishing to prevent or delay pregnancy

Few family-planning programs in Africa base demand creation and service delivery on theoretical models. Motivational interviewing is a counseling modality that facilitates reflection on the benefits and disadvantages of a health outcome to encourage behavior change. We evaluate a couples-focused joint family-planning and HIV counseling intervention using motivational interviewing to enhance uptake of long-acting reversible contraception (Paragard copper intrauterine device or Jadelle hormonal implant) among Rwandan couples. In this experimental study, couples receiving care at 8 government health clinics in Kigali, the capital city, were referred from a parent study of couples who did not want more children or wanted to wait at least 2 years for their next pregnancy. Long-acting reversible contraception methods were offered on site following joint HIV testing and family-planning counseling. At the first follow-up visit 1 month after enrollment in the parent study, couples who had not yet chosen a long-acting reversible contraception method were interviewed separately using motivational interviewing and then brought together and again offered long-acting reversible contraception. Following motivational interviewing, 78 of 229 couples (34%) requested a long-acting reversible contraception method (68 implant and 10 intrauterine device). Long-acting reversible contraception uptake after motivational interviewing was associated with the woman being Catholic (vs Protestant/Muslim/other, adjusted odds ratio, 2.87, 95% confidence interval, 1.19-6.96, P= .019) or having an income (vs no income, adjusted odds ratio, 2.54, 95% confidence interval, 1.12-5.73, P= .025); the couple having previously discussed long-acting reversible contraception (adjusted odds ratio, 8.38, 95% confidence interval, 2.54-27.59, P= .0005); either partner believing that unplanned pregnancy was likely with their current method (adjusted odds ratio, 6.67, 95% confidence interval, 2.77-16.11, P< .0001); or that they might forget to take or make an appointment for their current method (adjusted odds ratio, 4.04, 95% confidence interval, 1.32-12.34, P= .014). Neither partner mentioning that condoms also prevent HIV/sexually transmitted infection was associated with long-acting reversible contraception uptake (adjusted odds ratio, 2.86, 95% confidence interval, 1.17-7.03, P= .022), as was the woman citing long-term duration of action of the implant as an advantage (adjusted odds ratio, 5.41, 95% confidence interval, 1.86-15.76, P= .002). The woman not listing any side effects or disadvantages of implants was associated with long-acting reversible contraception uptake (adjusted odds ratio, 5.42, 95% confidence interval, 2.33-12.59, P < .0001). Clinic location (rural vs urban), couple HIV status, and concerns about negative economic effects of an unplanned pregnancy were significant in bivariate but not multivariate analysis. Encouraging couples to reflect on the benefits and disadvantages of long-acting reversible contraception methods, the likelihood of unplanned pregnancy with their current contraception, and the impact of an unplanned pregnancy is an effective motivational interviewing technique in family-planning counseling. One third of couples who did not want a pregnancy for at least 2 years but had not chosen a long-acting reversible contraception method when provided with standard family-planning counseling did so after motivational interviewing. Involving the male partner in family-planning discussions facilitates joint decision making about fertility goals and contraceptive choice. Combining family planning and joint HIV testing for couples allows targeted focus on dual-method use with discordant couples, who are advised to use condoms for HIV/sexually transmitted infection prevention along with a more effective contraceptive for added protection against unplanned pregnancy.

Choices and services related to contraception in the Gaza strip, Palestine: perceptions of service users and providers

BackgroundReliable contraception enables women and men to plan their family sizes and avoid unintended pregnancies, which can cause distress and anxiety, but also increase maternal mortality. This study explored potential barriers to contraceptive use for women in the Gaza Strip, Palestine from user and provider perspectives.MethodsA convenient sample was used to recruit women, who were current contraception users, from three healthcare clinics that provide family planning care, two governmental and one non-governmental. A 16-item questionnaire was completed by 204 women, including socio-demographic data, contraceptive use and eight questions exploring user experience. Additionally, 51 women attended focus groups for a deeper insight into their contraceptive use experience and potential barriers. Furthermore, 14 healthcare providers were interviewed about their experience with service provision. Quantitative data are presented as means and frequencies and qualitative data were analysed item by item and are presented in themes jointly with the quantitative data.ResultsWomen reported usage of only three main modern methods of contraception with 35.2% using intrauterine devices, 25.8% combined oral contraception and 16.4% condoms, while only 3.1% used the hormonal implant. Expectations from family planning services were low with most women attending the clinic having already decided their contraceptive method with decisions being made by husbands (41.2%) or women jointly with their partner (33.3%), only 13.7% took advice from service providers. Healthcare providers experienced high prevalence of beliefs that modern contraceptives cause infertility and cancer. Main barriers to effective family planning services were misconceptions of potential harm, poor availability and limited choice of contraceptive methods.ConclusionWomen’s contraceptive choices in Gaza are limited by prevalent misconceptions and fears as well as recurring shortages, negatively impacting fertility control. Men are a major factor in choosing a contraceptive method, however, they have limited access to information and therefore, potentially more misconceptions. Therefore, male community members need to be included in the delivery of information on contraceptives to increase women’s choice. Furthermore, greater access to long-acting reversible contraceptives, such as the hormonal implant, and improved availability might be key factors in improving contraceptive uptake in Gaza and, thus, reducing unintended pregnancies.

Improving access to contraception

Bioengineering Current long-acting contraceptive methods can be invasive and cumbersome, often restricting patient access to basic, yet critical, health care. Li et al. developed a microneedle patch that simplifies drug delivery and addresses limitations in current contraceptive methods. The patch has an effervescent backing that rapidly separates microneedles from the patch with little to no skin irritation. The patch requires no special intervention by the user, thus potentially providing a more accessible method of contraception. Sci. Adv. 10.1126/sciadv.aaw8145 (2019).

Unexpected pregnancy, experience of sexual violence and contraception among women who use cannabis or other illegal substance in the Great Paris Region: Data from the 2016 Health Barometer

Women who use psychoactive substances could have higher levels of unplanned pregnancy and of difficulties accessing long-term contraceptive methods than those who do not use these substances. General population data on this topic are rare, particularly in France. This study is based on data from the French Health Survey 2016, collected from women aged 15 to 49 years and living in the Great Paris region (N=1626). Use of illegal psychoactive substances (cannabis, substances used via intranasal or intravenous administration) were evaluated over the lifecourse and, for cannabis, over the 12 months preceding the study. Unplanned pregnancies were ascertained over the preceding 5 years, emergency contraception, abortion, and the experience of sexual violence during the lifecourse. We also studied the number of sexual partners in the preceding 12 months, as well as current contraception. Data were analyzed using weighted logistic regression models, adjusted for participants' sociodemographic characteristics and tobacco use. Women who use illegal substances have a higher probability than non-users to experience an unplanned pregnancy in the preceding 5 years (OR associated with lifecourse cannabis use: 1.61, 95% CI 1.00-2.58), to have used emergency contraception (ORs between 2.20 to 2.90), to have had an abortion (OR associated with lifecourse cannabis use: 1.77, 95% CI 1.26-2.49), and to have experienced sexual violence (ORs between 1.87 to 3.14). They also had more sexual partners than non-users, but did not differ in terms of contraception. In the general population, there is a relationship between women's use of illegal substances and their probability of experiencing sexual violence. These results should be brought to the attention of health professionals in contact with women, to help identify those who have addictive behaviors and identify their sexual and reproductive health needs.

Understanding Barriers to Contraception Screening and Referral in Female Adolescents and Young Adults with Cancer.

Background: Contraception screening and referral occur infrequently in cancer care for young women of reproductive age. Barriers to contraception screening and referral in this setting have not been thoroughly identified. Objectives: We sought to understand oncology clinicians' current practices and perceptions of barriers to screening and referring young women for adequate contraception during cancer treatment. Methods: We conducted individual semi-structured interviews with 19 oncology clinicians whom we recruited from an urban, northeast medical center. Participants included physicians, advanced practice clinicians, and nurses in surgical and medical oncology. The interview guide addressed core components of the Promoting Action on Research Implementation in Health Services framework, and subsequent directed content analysis identified themes indicative of barriers to contraception screening and referral. Findings: Participants varied significantly in their current contraception screening practices; many conflated early pregnancy diagnosis or pregnancy avoidance counseling with contraception, whereas others described inaccurate contraceptive recommendations for specific clinical scenarios. Participants also lacked clarity of roles and responsibilities within the oncologic care team for contraception and assumed that another team member had addressed contraception. Participants perceived themselves to lack adequate education about contraception, which precluded contraception discussions. Conclusion: We recommend cancer centers consider these possible barriers to contraception screening and referral by promoting development of institutional guidelines to standardize contraception screening and referral, clarifying roles and responsibilities for contraception discussions within the care team, and expanding oncology clinician education on contraception. National professional organizations should work to expand guidelines to inform and support this process in clinical practice.

How do women and health care professionals view hormonal long-acting reversible contraception? Results from an international survey

Purpose: Evidence from real-world settings is important to provide an accurate picture of health care delivery. We investigated use of long-acting reversible contraception (LARC) in women aged 15–49 years.Materials and methods: Two surveys, one of women and one of health care professionals (HCPs), were conducted in parallel across seven countries. Participating women completed an online survey to assess contraceptive awareness, current method of contraception, age, and experience with current contraceptive method. HCPs participated in an online survey to provide practice-level information and three anonymous charts of hormonal LARC users.Results: Of 6903 women who completed the survey, 3225 provided information about their current primary contraception method. Overall, 16% used LARC methods, while 52% used oral contraceptives (OCs). Of hormonal intrauterine system users, 72% described their experience as ‘very favourable’, compared with only 53% of women using OCs. Anonymous patient records (n = 1605) were provided by 550 HCPs who completed the online survey. Most women (64%) had used short-acting reversible contraception before switching to LARC. Physicians perceived 56–84% of LARC users to be highly satisfied with their current form of contraception.Conclusions: Although usage of LARC was low, most women using LARC were highly satisfied with their method of contraception.

Intimate partner violence and contraceptive use among married women in Nepal.

To examine relationships between lifetime experience of intimate partner violence (IPV), and current contraceptive use and method among married women of reproductive age in Nepal. A cross-sectional analysis of 2016 Nepal Demographic Health Survey data on contraceptive use and IPV experience among ever-married women of reproductive age. Weighted percentages were reported and multinomial logistic regression was used to assess associations between IPV (physical, sexual, emotional, or any form) and contraception use (modern reversible, sterilization, or traditional). Among 3562 women who responded to the violence module, 26% reported experiencing any form (physical, sexual or emotional) of IPV in their lifetime. Lifetime exposure to any form of IPV was associated with sterilization (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI], 1.12-2.00) and lifetime exposure to physical violence only was significantly associated with having been sterilized (aOR, 1.59; 95%CI, 1.17-2.16). Experience of violence, particularly physical violence, was found to be associated with sterilization in Nepal. Research is needed to understand the causes of this association, and the decision-making power dynamics related to contraceptive use, husbands' attitudes toward sterilization, and the reasons why sterilization-relative to other contraceptive options-was the contraceptive method of choice.

Health-related quality of life in undergraduate women using any contraceptive

ObjectiveThe aim of this research was to assess university students’ health-related quality of life whether they use some contraceptive method or not.MethodsThis research is a cross-sectional study. Female participants who studied a degree in health at the University of Seville (Spain) were recruited. Respondents completed a demographic questionnaire and health-related quality of life was measured with validated instrument SEC-QoL (Sociedad Española de Contracepción- Quality of Life) in Spanish that measured five dimensions: sexual, social, breast, menstrual and psychosocial.ResultsA total of 992 women aged 21.37 (3.6) years old participated in this study. Women who used a contraceptive method reached higher scores at the SEC-QoL questionnaire 47.09 (17.04) and 46.91 (18.73) than those that didn’t. Likewise, women who chose a hormonal method showed a better overall health-related quality of life, compared to those who used a non-hormonal method. Participants who used hormonal contraceptives obtained higher scores in all health-related quality of life domains (social, menstrual, breast and sexual), except psychological domain when compared to those who used a non hormonal method or none. Furthermore, a moderated mediation model showed that the effect of the current contraceptive method on health-related quality of life was partially explained by the moderated mediation of the time using this method, the reason for using it and the existence of a partner.ConclusionThe usage of hormonal contraceptives increases health-related quality of life in young women. Several variables regarding the experience with contraceptive methods should be considered in order to examine the effect on health-related quality of life in undergraduate women.

Who pays and how much? A cross-sectional study of out-of-pocket payment for modern contraception in Kenya

ObjectivesOut-of-pocket (OOP) payment for modern contraception is an understudied component of healthcare financing in countries like Kenya, where wealth gradients in met need have prompted efforts to expand access to...

Socio-demographic determinants and modern family planning usage pattern-an analysis of National Family Health Survey-IV data

Background: India, which accounts for world's 17.5 percent population, is the second most populous country in the world next only to China (19.4%). The major objective of the NFHS surveys has been to strengthen India’s demographic and health database, to anticipate and meet the country’s needs for data on emerging health and family welfare issues. The objectives of the study were to study the different background characteristics of women adopting different family planning methods and to analyze the associated socio-demographic factors..Methods: Secondary data analysis of NFHS 4 datasets obtained from DHS program portal. Appropriate statistical testing of associated socio-demographic variables done and interpreted accordingly.Results: Out of total 63696 couples, 99.2% women and 98.6% men knew modern method of contraception, 48.6% were currently using modern method of contraception and 7.4% traditional method. The majority (34%) women adopted female sterilization as current method of contraception. There is interstate variation in the contraceptive prevalence rate highest (80.60%) in Chandigarh compared to least (26.64%) in Goa. There is significant association observed between place of residence, religion, wealth index, women education, education of husband towards current contraceptive use.Conclusions: About 45% of population increase is contributed by births above two children per family. The adoption of appropriate method of contraception by couples made available through quality family planning services and empowering women by proper behavior change communication will help improve the present contraceptive prevalence rate especially among the vulnerable groups.

244. Parental Involvement In Contraceptive Access And Decision-Making: Qualitative Findings From Adolescent Contraceptive Users In Atlanta, GA

Increasing use of highly and moderately effective contraception has contributed to recent declines in unintended teen pregnancies, and efforts to improve access to these methods are ongoing. Many states allow minors to self-consent for contraceptive services in order to reduce confidentiality concerns as a barrier to care. However, there is growing attention to the positive role parents can play in adolescent healthcare, particularly through partnerships within the parent-adolescent-provider triad. Limited research has examined such a triadic approach in contraceptive care, for which confidentiality is especially important. Accordingly, we explored adolescents’ perceptions of parental involvement in contraceptive access and decision-making. We analyzed qualitative data from 17-19 year old contraceptive users in Atlanta, GA (n=30), including IUD and implant (n=10), oral contraceptive (n=10), and injectable (n=10) users. The clinic- and community-recruited sample was 60% African-American and 20% Hispanic. Participants completed a semi-structured, individual interview that addressed pregnancy and STI prevention goals and strategies. Participants were specifically asked how people in their life have shaped feelings about preventing pregnancy, as well as reasons for selecting their current and past contraceptive methods. Parents emerged as a salient factor during thematic analysis of de-identified transcripts using MAXQDA. Across contraceptive types, twenty-three participants described parents’, particularly mothers’, level of involvement with access to and/or decision-making about contraception. Many indicated that their mothers supported contraceptive use. For example, one implant user said, “My mother had found out that I had become sexually active and she wanted me to be protected. She didn’t want me to have a child while I still was a child.” In fact, participants described their mother’s roles during contraceptive initiation and continuation, including scheduling/attending appointments, consulting on method selection, and/or facilitating follow-up visits. In a few cases, mothers essentially chose their daughter’s method for them. In contrast, one participant recalled her mother’s instruction to seek contraceptive services independently because she was “not a little child anymore.” Some participants who sought contraception to regulate menstrual cycles and/or alleviate cramps emphasized these reasons to parents, even if they were sexually active. Other adolescents who had concerns about parental attitudes initiated contraception independently (in some cases, waiting until age eighteen), but then subsequently informed their mothers and experienced largely positive reactions. Some participants had not involved or informed their parents given discomfort discussing sexual activity and/or concern about parental reaction; though in several of these cases, parents had previously communicated a desire to support adolescents in preventing pregnancy. Our study documents maternal support for and direct involvement in contraceptive access and decision-making, underscoring the potential for a triadic approach to adolescent contraceptive care. Providers can promote parent-adolescent communication about pregnancy prevention and educate parents about why and how to support adolescent contraceptive access. However, adolescents also expressed concerns about parental reaction to sexual activity, reinforcing the importance of confidentiality and the need to carefully navigate a triadic approach across adolescent sexual development.

Do Adolescent Women's Contraceptive Preferences Predict Method Use and Satisfaction? A Survey of Northern California Family Planning Clients

PurposeContraceptive satisfaction may influence not only contraceptive use but also long-term engagement in care. We investigated the extent to which adolescent and young women's desired contraceptive features are associated with their current contraceptive method and if the presence of preferred features in their current method is associated with satisfaction. MethodsWe performed a secondary analysis of a cross-sectional survey at five Northern California family planning clinics, including women aged 13–24 years. Descriptive statistics and multivariate logistic regression identified associations between desired features and sociodemographic characteristics. Multivariate logistic regression was used to examine associations between desired features and current contraceptive method, as well as the presence of desired features and satisfaction with current method. ResultsAmong 814 participants, the features most frequently rated “very important” included effectiveness (87%, n = 685), safety (85%, n = 664), and side effects (72%, n = 562). Contraceptive feature preferences varied by age, race/ethnicity, intimate partner violence history, and sexually transmitted infection history. Having a preference for a specific contraceptive feature was not associated with using a method with that feature, except for sexually transmitted infection prevention (adjusted odds ratio [aOR]: 1.59, confidence interval [CI; 1.18–2.16]). However, respondents with preferences for effectiveness, partner independence, or privacy who used methods that were congruent with their preferences were more likely to express satisfaction (aOReffectiveness: 1.57, CI [1.03–2.37], aORpartner independent: 1.75 [1.03–2.96], and aORprivacy: 1.81 [1.01–3.23]). ConclusionAdolescent and young women have varied contraceptive preferences that are associated with demographics and reproductive health experiences. Adolescent and young women's use of contraceptive methods that matched their preferences may improve satisfaction and engagement in care.