Goleen Samari1, Diana G Foster2, Lauren J Ralph2, Corinne H Rocca2. 1. University of California, San Francisco, School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health (ANSIRH), Oakland, CA, USA; Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA. Electronic address: gs3038@columbia.edu. 2. University of California, San Francisco, School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health (ANSIRH), Oakland, CA, USA.
Abstract
OBJECTIVES: An understanding of the relationship between individuals' pregnancy preferences and contraceptive use is essential for appropriate patient-centered counseling and care. We examined the relationship between women's pregnancy preferences and contraceptive use using a new prospective measure, the Desire to Avoid Pregnancy (DAP) scale. STUDY DESIGN: As part of a study examining women's suspicion and confirmation of new pregnancies, we recruited patients aged 15 - 45 from seven reproductive health and primary health facilities in Arizona, New Jersey, New Mexico, South Carolina, and Texas in 2016-2017. We used multivariable logistic, multinomial logistic, and linear regression models to examine the associations among DAP scores (range: 0 - 4) and contraceptive use outcomes and identify factors associated with discordance between DAP and use of contraception. RESULTS: Participants with a greater preference to avoid pregnancy had higher odds of contraceptive use (aOR = 1.63, 95% CI: 1.31, 2.04) and used contraceptives more consistently (aβ = 8.9 percentage points, 95% CI: 5.2, 12.7). Nevertheless, 63% of women with low preference to avoid pregnancy reported using a contraceptive method. Higher preference to avoid pregnancy was not associated with type of contraceptive method used: women with the full range of pregnancy preferences reported using all method types. CONCLUSION: When measured using a rigorously developed instrument, pregnancy preferences were associated with contraceptive use and consistency of use. However, our findings challenge assumptions that women with the highest preference against pregnancy use more effective methods and that women who might welcome pregnancy do not use contraception. IMPLICATIONS: Women's preferences about pregnancy contribute significantly to their use of contraception. However, health care providers and researchers should consider that contraceptive features besides effectiveness in preventing pregnancy shape contraceptive decision-making and use.
OBJECTIVES: An understanding of the relationship between individuals' pregnancy preferences and contraceptive use is essential for appropriate patient-centered counseling and care. We examined the relationship between women's pregnancy preferences and contraceptive use using a new prospective measure, the Desire to Avoid Pregnancy (DAP) scale. STUDY DESIGN: As part of a study examining women's suspicion and confirmation of new pregnancies, we recruited patients aged 15 - 45 from seven reproductive health and primary health facilities in Arizona, New Jersey, New Mexico, South Carolina, and Texas in 2016-2017. We used multivariable logistic, multinomial logistic, and linear regression models to examine the associations among DAP scores (range: 0 - 4) and contraceptive use outcomes and identify factors associated with discordance between DAP and use of contraception. RESULTS:Participants with a greater preference to avoid pregnancy had higher odds of contraceptive use (aOR = 1.63, 95% CI: 1.31, 2.04) and used contraceptives more consistently (aβ = 8.9 percentage points, 95% CI: 5.2, 12.7). Nevertheless, 63% of women with low preference to avoid pregnancy reported using a contraceptive method. Higher preference to avoid pregnancy was not associated with type of contraceptive method used: women with the full range of pregnancy preferences reported using all method types. CONCLUSION: When measured using a rigorously developed instrument, pregnancy preferences were associated with contraceptive use and consistency of use. However, our findings challenge assumptions that women with the highest preference against pregnancy use more effective methods and that women who might welcome pregnancy do not use contraception. IMPLICATIONS: Women's preferences about pregnancy contribute significantly to their use of contraception. However, health care providers and researchers should consider that contraceptive features besides effectiveness in preventing pregnancy shape contraceptive decision-making and use.
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