Fertility Awareness Research Articles

MHealth technologies for pregnancy prevention: A challenge for patient-centred contraceptive counselling in Dutch general practice

Background A general practitioner (GP) standardly provides contraceptive counselling and care in the Netherlands. Recent years have seen the rise of mobile health technologies that aim to prevent pregnancy based on fertility awareness-based methods (FABMs). We lack high-quality evidence of these methods’ effectiveness and clarity on how healthcare professionals include them in contraceptive counselling. Objectives To analyse how Dutch healthcare professionals include pregnancy-prevention mobile health technologies (mHealth contraception) in contraceptive counselling and to propose practice recommendations based on our findings. Methods We used ethnographic methods, including semi-structured interviews with nine professionals who were recruited using purposive sampling, 10 observations of contraceptive counselling by four professionals, six observations of teaching sessions in medical training on contraception and reproductive health, one national clinical guideline, and seven Dutch patient decision aids. Data were collected between 2018 and 2021 and analysed inductively using praxiographic and thematic analysis. Results In contraceptive counselling and care, professionals tended to blend two approaches: 1) individual patient-tailored treatment and 2) risk minimisation. When interviewed about mHealth contraception, most professionals prioritised risk minimisation and forewent tailored treatment. Some did not consider mHealth contraception or FABMs as contraceptives or deemed them inferior methods. Conclusion To minimise risk of unintended pregnancy, professionals hesitated to include mHealth contraception or other FABMs in contraceptive consultations. This may hamper adequate patient-centred counselling for patients with preference for mHealth contraception. Based on these results, we proposed recommendations that foster a patient-tailored approach to mHealth contraceptives.

Hormonal Contraceptive Side Effects and Nonhormonal Alternatives on TikTok: A Content Analysis.

The use of hormonal contraceptives is decreasing in the United States alongside a growing interest in nonhormonal contraceptive options. Social media messaging may be contributing to this trend. TikTok thus offers a novel opportunity to understand how people share information about risks and alternatives for pregnancy prevention. To describe the availability and content of information about hormonal contraceptive side effects and nonhormonal contraceptive options on TikTok, we conducted a content analysis of 100 videos using the hashtags #birthcontrolsideeffects and #nonhormonalcontraception. We found that these videos were popular and often framed hormonal contraceptives and patient-provider interactions negatively, with users frequently discussing discontinuation of hormonal contraception and no plans for uptake of another contraceptive. When uptake of a new contraceptive method is mentioned, creators typically mention a fertility awareness-based method, which requires specialized knowledge to use safely and effectively. The risks and side effects of hormonal options were often overemphasized compared with the possible risks and side effects of nonhormonal options. This framing may suggest opportunities for providers and health educators to reassess how they counsel about contraceptive options. We conclude with recommendations for future research on TikTok and consider the policy implications of these findings.

Knowledge and Perceptions of the Billing’s Ovulation Method of Natural Family Planning among Married Women in Lagos, Nigeria

Background: Based on existing literature, it was observed that modern contraceptives are the most widely used family planning methods in Nigeria, and that they have serious side effects for their users. Despite these effects, women of reproductive age have made little or no effort to embrace Billing’s ovulation as an alternative family planning method. In order to better understand the dynamics surrounding the adoption of Billing’s ovulation method, this study examined the knowledge, perceived effectiveness, and spousal attitude toward the use of Billing’s ovulation as a method of natural family planning among married women in Lagos metropolis. Method: To accomplish this, a pure qualitative methodological approach was used, with in-depth interviews (IDI) used to collect qualitative data from (20) married women. Manual content analysis was used to analyze the collected data. Results: Findings showed that; high level of knowledge and awareness of BOM, positive perceptions of its efficacy, and a favorable spousal attitude toward BOM are indicators of the rate at which married women in Lagos metropolis use the Billing’s ovulation method as their preferred family planning alternative. Conclusion: The study then recommends that a rigorous sensitization program based on door-to-door intervention be launched to educate married women in Lagos metropolis on the need for Natural family planning as an alternative family planning method, particularly BOM, while teaching them the procedures and techniques in order to increase people’s access to natural family planning.

Fertility awareness and teenage pregnancy in rural western Uganda: a community-based cross-sectional study.

Teenage pregnancy (pregnancy among girls aged 13-19 years) is prevalent in Uganda but data about the associated factors are limited. To determine the prevalence and factors associated with teenage pregnancy in Buliisa district, western Uganda. We hypothesized that fertility awareness is associated with reduced likelihood of teenage pregnancy. In this cross-sectional study, we included girls aged 15-19 years and collected data using a structured questionnaire. The modified Poisson regression analysis was used to determine the association between fertility awareness and teenage pregnancy, adjusted for confounders, reported using adjusted prevalence risk ratio (aPR) and 95% confidence interval (CI). Of 246 teenagers, the prevalence of teenage pregnancy was 41.5% while fertility awareness was 56.7%. The age category 18-19 years (aPR, 3.44; 95% CI, 2.16-5.47), fertility awareness (aPR, 1.80; 95%CI, 1.30-2.51) and Muslim faith (aPR, 1.37; 95%CI, 1.04-1.80) were associated with increased likelihood of teenage pregnancy. Living with a father (aPR, 0.61; 95%CI, 0.48-0.76), mother (aPR, 0.65; 95%CI, 0.524-0.81), or both parents (aPR, 0.57; 95% CI, 0.43-0.76) was associated with a reduced likelihood of teenage pregnancy. The prevalence of teenage pregnancy in Bulisa district is high. There is a need to target teenagers with correct fertility information, including the engagement of parents and religious leaders.

Fertility education: recommendations for developing and implementing tools to improve fertility literacy†.

Many recent societal trends have led to the need for fertility education, including the age at which individuals become parents, the development of new reproductive technologies, and family diversity. Fertility awareness has emerged as a concept very recently and is increasingly gaining recognition. However, fertility education is often neglected as there is no consensus on the appropriate content, target populations, or on who should provide it. This article attempts to provide an overview of the use of interventions to improve fertility education. We emphasize the importance of delivering evidence-based information on fertility and reproductive health through various methods while providing guidelines for their standardization and systematization. Recommendations are provided to aid the development and implementation of fertility education tools, including: the establishment of a comprehensive understanding of the target populations; the incorporation of theories of behavioural change; the inclusion of the users' perspectives and the use of participatory research; and the use of specific guidelines for increasing engagement. By following these recommendations, it is expected that fertility education resources can contribute to improving fertility literacy, empowering individuals and couples to make informed reproductive decisions, and ultimately reducing the incidence of infertility and need for fertility treatment.

Evaluation of a fertility awareness-based shared decision-making tool part 2: Patient experiences

To assess patient experiences using a Shared Decision-Making (SDM) Tool for fertility awareness-based methods (FABMs) of family planning. The study employed a prospective crossover design to evaluate impact of the SDM tool compared to usual practice when discussing FABMs with patients. Patients completed pre- and post-office visit surveys and an online survey six months later. The primary outcomes evaluated the effect of the SDM tool on patient satisfaction and FABM continuity of use rates. There was no significant difference in likelihood of changing family planning methods immediately after the office visit; however, by six months a significantly larger proportion of patients had started or changed FABMs in the experimental group (52%, 34/66) compared to the control group (36%, 24/66) (p = 0.04). Significantly more patients who used the tool and changed their FABM after their visit reported increased satisfaction with their FABM compared to control (50% vs. 17%, p = 0.022). Use of the SDM tool increased persistent use of and satisfaction with chosen FABMs at six months. The novel SDM tool can enhance patients' understanding and facilitate the selection of a more suitable method leading to increased satisfaction.

Effect of a Nurse-Led Smartphone-Based Self-Tracking Program on Women's Fertility Awareness for the Appropriate Use of Infertility Treatment

Effect of a Nurse-Led Smartphone-Based Self-Tracking Program on Women's Fertility Awareness for the Appropriate Use of Infertility Treatment

Evaluating Pregnancy Rates in Fertility Awareness-Based Methods for Family Planning: Simulated Comparison of Correct Use to Avoid, Method-Related, and Total Pregnancy Rates.

Fertility awareness-based methods (FABMs) can be used by couples to avoid pregnancy, by avoiding intercourse on fertile days. Users want to know what the highest effectiveness (lowest pregnancy rate) would be if they use an FABM correctly and consistently to avoid pregnancy. In this simulation study, we compare two different measures: (1) the method-related pregnancy rate; and (2) the correct use pregnancy rate. We show that the method-related pregnancy rate is biased too low if some users in the study are not using the method consistently to avoid pregnancy, while the correct use pregnancy rate obtains an accurate estimate. In FABM studies, the method-related pregnancy rate is biased too low, but the correct use pregnancy rate is unbiased.

Promotion of an Algorithm-Based Tool for Pregnancy Prevention by Instagram Influencers.

Objective: Despite growing concerns that some digital algorithm-reliant fertility awareness-based methods of pregnancy prevention are marketed in an inaccurate, opaque, and potentially harmful manner online, there has been limited systematic examination of such marketing practices. This article therefore provides an empirical examination of how social media influencers have promoted the fertility tracking tool Daysy on Instagram. We investigate: (1) how the tool is framed in relation to pregnancy prevention using Health Belief Model (HBM) constructs, and (2) the promotional and disclosure practices adopted by influencers. Materials and Methods: We collected Instagram posts mentioning Daysy made between June 2018 and May 2022 using the tool CrowdTangle. Using a qualitative content analysis approach, we coded a random sample of 400 Daysy posts. This yielded 122 Instagram influencer posts promoting Daysy for pregnancy prevention that we coded for promotional content and HBM constructs. Results: Posts originated primarily from Europe (n = 62, 50.82%) and the United States (n = 37, 30.33%). Findings indicate that barriers to use (n = 18, 15.57%) and the severity of risks from unplanned pregnancy (n = 8, 6.56%) were rarely conveyed, whereas benefits of use (n = 122, 100%) and the severity of risks of hormonal contraception (n = 31, 25.41%) were covered more extensively. Only about one third of posts disclosed any formal relationship to the brand Daysy. Conclusions: With many posts emphasizing benefits and obscuring potential limitations, we argue that accurate and transparent information about the effectiveness and limitations of fertility tracking technologies is critical for supporting informed decision-making and, as such, should remain a public health priority.

A Pilot Study to Determine Fertility Awareness Levels of Nurses According to Their Marital and Having Children Status

A Pilot Study to Determine Fertility Awareness Levels of Nurses According to Their Marital and Having Children Status

Relationship Between Steroid Hormone Profile and Premenstrual Syndrome in Women Consulting for Infertility or Recurrent Miscarriage

To determine the relationships between luteal-phase steroidal hormonal profile and PMS for a large number of women attending a dedicated fertility clinic. This was a retrospective cross-sectional study on women attending a hospital-based clinic for fertility concerns and/or recurrent miscarriage. All participants were assessed with a women’s health questionnaire which also included evaluation of premenstrual symptoms. Day of ovulation was identified based on the peak mucus symptom assessed by the woman after instruction in a fertility awareness-based method (FABM). This enabled reliable timing of luteal-phase serum hormone levels to be taken and analysed. Between 2011 and 2021, 894 of the 2666 women undertaking the women’s health assessment had at least one evaluable serum luteal hormone test. Serum progesterone levels were up to 10 nmol/L lower for symptomatic women compared with asymptomatic women. This difference was statistically significant (p < 0.05) for the majority of PMS symptoms at ≥ 9 days after the peak mucus symptom. A similar trend was observed for oestradiol but differences were generally not statistically significant. ROC curves demonstrated that steroid levels during the luteal phase were not discriminating in identifying the presence of PMS symptoms. Blood levels for progesterone were lower throughout the luteal phase in women with PMS, with the greatest effect seen late in the luteal phase.

Predictors of fertility awareness among selected married women of childbearing age in Nigeria: a cross-sectional survey.

Increased fertility awareness can help infertile couples to achieve pregnancy. This study aimed to determine both the predictors and levels of fertility awareness among married Nigerian women of childbearing age. A nationwide cross-sectional survey. Data were collected via online and face to face questionnaires. Descriptive and inferential analysis were done with SPSS 25. Most respondents married between ages 24-29 years old (40%) and just over half had good fertility awareness (53%). The associated factors were age at menarche (X2 = 9.962, p = 0.007), geopolitical zone of residence (X2 = 17.301, p = 0.008), level of education (X2 = 64.843, p < 0.001), employment status (X2 = 9.319 p = 0.025) menstrual cycle charting (X2 = 66.392, p < 0.001), use of internet to increase awareness (X2 = 39.849, p < 0.001) and books (X2 = 58.855, p < 0.001). Fertility awareness was lower for those with secondary education than postgraduates (AOR=0.213, 95% CI 0.116-0.390, p < 0.001). Moreover, the odds of having good fertility awareness were less in those who did not chart their menstrual cycle (AOR=0.363, 95% CI 0.245-0.538, p < 0.001). Menstrual cycle charting and level of education were predictors of fertility awareness.

Let's Talk About Sex: Tyrolean Online Study on Reproductive Health Issues.

The way pupils and university students talk about sex does not reflect their real understanding of reproductive health issues. Therefore, we developed a survey for pupils and students in Tyrol, Austria, to evaluate the current state of knowledge. Two questionnaires with 39 items for pupils (n=369) and 53 items for university students (n=537) were developed, and an online survey was carried out in Tyrol, Austria, between April and July 2022. A sum score for each correct answer to ten identical items in both questionnaires was used to compare groups (range: 0-11 points), with analysis performed using independent sample t-test, analyses of variance (ANOVAs) and chi-square test. With regards to reproductive health issues and fertility awareness, female vs. male participants (p<0.001), university students vs. pupils (p<0.001) and medical students vs. other students (p<0.001) had greater knowledge. Participants who had already had sexual intercourse showed a broader knowledge of contraception and fertility (p<0.001).The age at which the decline of female fertility becomes relevant was misstated by the adolescents, who gave a mean age of 42.6 years compared to university students who asserted a mean age of 35.9 years (p<0.001). Overall, the lowest rate of correct answers was found with respect to emergency contraception (30.7%), while knowledge of contraceptive methods was comparatively high (99.2%). Substantial lack of knowledge of reproductive health issues exists, with differences found between pupils and university students, between genders, and according to field of study. Future health and fertility awareness programs at school and university should focus on gender-specific aspects to prevent unplanned pregnancies, sexually transmitted diseases, and childlessness.

A cross-sectional study on Polish Medical Students’ knowledge of Fertility Awareness-based Methods

Fertility Awareness-based Methods (FAMs) observe physiological signs to determine fertile and infertile phases in a women's cycle. WHO recommends to use both natural family planning (NFP) or FAM as a synonym. They may serve as methods for family planning as well as a procreation health monitor in restorative medicine and as a useful biomarker in management of reproductive-health disorders. Unfortunately, this knowledge is marginalized during medical education. A cross-sectional study was performed among 542 Polish medical students to assess their skills in NFP. The most common NFP method indicated by 84.9% students was the Calendar Method, the one with historical value. The Billings Method and Creighton Model System were known by 42% and 14% participants respectively, while Multi Index Methods were known by 26.4%. A total of 6% of the respondents use NFP themselves. The largest group of students (42%) assessed the effectiveness of NFP in avoiding pregnancy at about 50%. The results show little interest and incomplete knowledge in up to date NFP among future medical professionals. It seems there is an urgent need to introduce this subject into medical education as a valuable tool to understand and monitor procreation health as well as family planning method.

Prevalence and determinants of repeat induced abortion in Ethiopia: A systematic review and meta-analysis

IntroductionRepeat-induced abortion is the termination of pregnancy for more than one time using drugs or surgical intervention before the fetus reaches the age of viability. This study aimed to estimate the pooled prevalence of repeat-induced abortion and its determinants among women in Ethiopia. Materials and methodsPubMed, HINARI and Google Scholar were systematically searched for eligible studies. A random effect model was used to estimate the pooled prevalence. The Cochrane Q-statistics and I2 tests were used to assess heterogeneity between included studies. ResultsThe estimated pooled prevalence of repeat-induced abortion was 30.89% (95% CI: 28.88–32.91). Alcohol consumption (POR = 3.60, 95%CI: 2.26–5.74), assuming the procedure painless (POR = 2.79, 95%CI: 1.77–4.39), no fertility awareness (POR = 3.45, 95% CI: 1.05–11.36), and women with multiple sexual partners (POR = 4.31, 95% CI: 3.36–5.53) were significantly associated with repeat-induced abortion. ConclusionThe study revealed that about one in ten women who had a history of abortion experienced repeat-induced abortion. Alcohol consumption, no fertility awareness, assuming the procedure is painless, and having multiple sexual partners were significantly associated with repeat-induced abortion.

Study protocol for an individually randomized control trial for India's first roleplay-based mobile game for reproductive health for adolescent girls

BackgroundGo Nisha Go™ (GNG), is a mobile game combining behavioural science, human-centric design, game-based learning, and interactive storytelling. The model uses a direct-to-consumer (DTC) approach to deliver information, products, services, interactive learning, and agency-building experiences directly to girls. The game’s five episodes focus on issues of menstrual health management, fertility awareness, consent, contraception, and negotiation for delay of marriage and career. The game’s effectiveness on indicators linked to these issues will be measured using an encouragement design in a randomized controlled trial (RCT).MethodsA two-arm RCT will be conducted in three cities in India: Patna, Jaipur, and Delhi-NCR. The first arm is the treatment (encouragement) arm (n = 975) where the participants will be encouraged to download and play the game, and the second arm (n = 975) where the participants will not receive any nudges/encouragement to play the game. They may or may not have access to the game. After the baseline recruitment, participants will be randomly assigned to these two arms across the three locations. Participants of the treatment/encouragement arm will receive continuous support as part of the encouragement design to adopt, install the game from the Google Play Store at no cost, and play all levels on their Android devices. The encouragement activity will continue for ten weeks, during which participants will receive creative messages via weekly phone calls and WhatsApp messages. We will conduct the follow-up survey with all the participants (n = 1950) from the baseline survey after ten weeks of exposure. We will conduct 60 in-depth qualitative interviews (20 at each location) with a sub-sample of the participants from the encouragement arm to augment the quantitative surveys.DiscussionFollowing pre-testing of survey tools for feasibility of methodologies, we will recruit participants, randomize, collect baseline data, execute the encouragement design, and conduct the follow-up survey with eligible adolescents as written in the study protocol. Our study will add insights for the implementation of an encouragement design in RCTs with adolescent girls in the spectrum of game-based learning on sexual and reproductive health in India. Our study will provide evidence to support the outcome evaluation of the digital mobile game app, GNG. To our knowledge this is the first ever outcome evaluation study for a game-based application, and this study is expected to facilitate scalability of a direct-to-consumer approach to improve adolescent sexual and reproductive health outcomes in India.Trial registration number: ctri.nic.in: CTRI/2023/03/050447.

Influence of menstrual cycle and hormonal contraceptive use on MS symptom fluctuations: A pilot study.

In clinical practice, females with MS often report menstrually-related symptom fluctuations. Hypothetically, use of oral contraceptives (OCs) could reduce these fluctuations, particularly continuous OCs (11+ weeks of consistent exogenous hormones followed by 1 week placebo). To prospectively capture (1) whether neurologic and generalized symptoms vary with menstrual cycle phase and (2) whether type of contraception impacts symptom fluctuations. In this two-center pilot study, females with MS and a regular menstrual cycle prospectively tracked their menstrual cycles and completed symptom surveys for up to 6 months. Participants were categorized as 1) users of oral contraceptives, either a) cyclic or b) continuous, or 2) endogenously cycling, either c) hormonal intrauterine device (IUD) users or d) "none users" (e.g. no hormonal contraception; included condoms, copper IUD, tubal ligation, "fertility awareness methods"). There was no correction for multiple analyses. Altogether, 47/70 participants (67%) provided >4 weeks of data and were included in the analyses. Mean (SD) age was 35.0 (0.9) years, median (IQR) EDSS was 1.5 (1-2) and mean (SD) SymptoMScreen score was 10.4 (9.6). For endogenously cycling patients (IUD and none users), fatigue (MFIS) was lower in the perimenstrual period than in the luteal period (p<0.05). For continuous OC users, variability in symptoms was lower than for endogenously cycling females (MFIS: p<0.01; Daily Hassles, from Uplift & Hassles Survey: p<0.05) or cyclic OC users (MFIS: p<0.001). In this pilot study, symptom severity did not definitively fluctuate in relationship to the menstrual cycle in endogenously cycling participants. However, fatigue and daily hassles were less variable for participants using continuous OC than for cyclic OC users or no-OC users. Future confirmatory studies are warranted to further examine whether contraceptive choice can be leveraged to manage symptom fluctuation in cycling females with MS. Such studies could enroll larger cohorts over fewer cycles or employ incentivization and hormonal measurements to enhance participant retention and statistical power.

Survey Analysis of Quantitative and Qualitative Menstrual Cycle Tracking Technologies.

Background and Objectives: Digital health and personalized medicine are advancing at an unprecedented pace. Users can document their menstrual cycle data in a variety of ways, including smartphone applications (apps), temperature tracking devices, and at-home urine hormone tests. Understanding the needs and goals of women using menstrual cycle tracking technologies is the first step to making these technologies more evidence based. The purpose of this study was to examine the current use of these technologies and explore how they are being used within the context of common hormonal and reproductive disorders, like polycystic ovary syndrome (PCOS), endometriosis, and infertility. Materials and Methods: This was a cross-sectional study evaluating menstrual cycle tracking technology use. Participants were recruited in January-March 2023 using social media groups and a Marquette Method instructor email listserv. Data were collected using an electronic survey with Qualtrics. Data collected included participant demographics, menstrual cycle characteristics, reproductive health history, and menstrual cycle tracking behavior. Results: Three-hundred and sixty-eight participants were included in the analysis. Women had various motivations for tracking their menstrual cycles. Most participants (72.8%) selected "to avoid getting pregnant" as the primary motivation. Three hundred and fifty-six participants (96.7%) reported using a fertility awareness-based method to track and interpret their menstrual cycle data. The Marquette Method, which utilizes urine hormone tracking, was the most frequently used method (n = 274, 68.2%). The most frequently used cycle technology was a urine hormone test or monitor (n = 299, 81.3%), followed by a smartphone app (n = 253, 68.8%), and a temperature tracking device (n = 116, 31.5%). Women with PCOS (63.6%), endometriosis (61.8%), and infertility (75%) in our study reported that the use of tracking technologies aided in the diagnosis. Most participants (87.2%) reported a high degree of satisfaction with their use and that they contributed to their reproductive health knowledge (73.9%). Conclusions: Women in our study reported avoiding pregnancy as their primary motivation for using menstrual cycle tracking technologies, with the most frequently used being a urine hormone test or monitor. Our study results emphasize the need to validate these technologies to support their use for family planning. Given that most women in this study reported using a fertility awareness-based method, the results cannot be generalized to all users of menstrual cycle tracking technologies.

Connecting infertility beliefs with viewership of teen pregnancy media: the role of morality in understandings of fertility

ABSTRACT Popular media often contain storylines focused on pregnancy and infertility. These storylines have the potential to perpetuate stigmatization related to these issues. According to the differential susceptibility to media effects model (DSMM), lay infertility beliefs could serve as either predictors or outcomes of pregnancy-focused media viewership, with moral sanction theory and cultivation theory supporting competing hypotheses. Further, viewership could impact fertility awareness, meaning knowledge of physiological and medical factors related to fertility. The current study tested how viewership of 16 & Pregnant and Teen Mom is related to infertility beliefs and fertility awareness in an online survey. Participants (N = 990) were on average 39.5 years old, 53.9% female, 77.9% white, and 38.9% had more than a high school degree. Structural equation modeling revealed that infertility beliefs served as predictors, but not outcomes, of viewership. Participants with the stigmatizing belief that infertility is caused by being immoral, ungodly, or unmotherly/unfatherly were drawn to 16 & Pregnant and Teen Mom. However, the outcome of viewership was improved knowledge of the biological/medical aspects of fertility. Although scholars have cited concerns about 16 & Pregnant and Teen Mom, findings suggest that viewing these programs could have educational benefits beyond reducing teen pregnancy.

Contraceptive use among women seeking an early induced abortion in Sweden.

In spite of societal efforts to strengthen women's sexual and reproductive health in Sweden, many women have unmet contraceptive needs and the abortion rate remains high. The aim of this study was to investigate contraceptive use among abortion-seeking women. Swedish-speaking women seeking an induced abortion up to the end of gestational week 12 at seven hospitals filled out an anonymous paper questionnaire between January and June 2021. Data were analyzed using frequencies and cross-tabulations, and the Chi-square test was used to compare age-groups. Valid percentages are presented. In total, 623 women participated. Median age was 29 years and 13% were born outside the Nordic countries. In the year preceding the abortion, condoms (37%, n = 228) were the most commonly used contraceptive method, followed by short-acting reversible contraception (SARC) (35%, n = 213) and withdrawal (25%, n = 152). Around one in five (n = 113) had not used any method in the year preceding the abortion. Sixteen percent (n = 96) had changed contraceptive method in the last year. At the time around conception, 15% (n = 90) reported use of SARC and 2% (n = 12) of long-acting reversible contraception (LARC). Four out of 10 women (n = 268) reported non-use of contraception at the time around conception, with a higher proportion among adolescents (70%, n = 30, P = 0.001). Among the women who responded to why they had not used any method (n = 387), the main reasons were that they did not believe they could become pregnant at that time (37%, n = 144) or had negative experiences from using contraceptives (32%, n = 123). A majority (88%, n = 527) planned to use contraception after the abortion. Of the women who had decided on method, 55% (n = 271) planned to use LARC, and 38% (n = 188) planned to use SARC. The unmet need for contraception appears to be high among abortion-seeking women in Sweden. Many had discontinued contraception use during the last year, and the main reasons for avoidance were beliefs that one could not become pregnant and negative experiences of contraceptives. The underestimation of pregnancy risk indicates limited fertility awareness, thus our recommendation would be to strengthen the sexual and reproductive knowledge among this group.