Original Study
Low Acceptability of Certain Contraceptive Methods among Young Women

https://doi.org/10.1016/j.jpag.2017.11.008Get rights and content

Abstract

Study Objective

To examine what predicts low personal acceptability of 4 different contraceptive methods among young women.

Design

Cross-sectional survey.

Setting

Urban adolescent contraception clinic in Colorado.

Participants

Female clinic patients ages 13-24 initiating contraception from August 2011 to April 2012.

Interventions and Main Outcome Measures

Survey participants reported their personal acceptability for oral contraceptive pills, depot medroxyprogesterone, contraceptive implants, and intrauterine devices on a scale from 0 (low) to 10 (high). Responses of 0-4 were categorized as low personal acceptability. Demographic characteristics, reproductive history, and perceived contraceptive satisfaction of friends and family members were incorporated into multivariable and hierarchical logistic regression models to determine distinct predictors of low personal acceptability for each method.

Results

Surveys were completed by 1067 women. Participants' mean age was 20 (±2.6) years. Half (552/1067) were white, 26% (277/1067) Hispanic, and 8.5% (91/1067) black. Of participants who were aware of oral contraceptive pills 52% (535/1037) reported low acceptability of this method compared with 74% (645/876) of those aware of depot medroxyprogesterone. Fewer reported low acceptability of intrauterine devices (37% or 303/825) or implant (43% or 356/839), although fewer overall participants had heard of these methods. Each method had unique predictors of low personal acceptability, however, for all method models, significant predictors included knowing someone who had become pregnant while using that method or having a friend who dislikes that method.

Conclusion

Young women in this study with low personal acceptability of the 4 most common contraceptive methods had distinct demographic and reproductive health characteristics. Perceived negative experiences of friends and family members using contraception appeared most influential.

Introduction

Unplanned pregnancies among adolescents and young adults continue to be a public health challenge in the United States, despite historic declines in the past 2 decades.1, 2 Increased use of effective contraception has been 1 key strategy for preventing unplanned pregnancies.3 However, adolescents and young women are less likely to use highly effective methods, such as intrauterine devices (IUDs) and contraceptive implants, compared with older women.4, 5, 6

Women might present for a contraceptive visit with strong negative opinions about certain methods. Qualitative studies have elucidated young women's concerns about potential side effects, such as irregular bleeding or weight gain with certain methods, and the influence of negative peer and family experiences on adolescents' own contraceptive preferences.7, 8 Some young women have fear of pain with insertion of highly effective methods or express discomfort with methods that require provider removal for discontinuation.9, 10, 11 Women's negative preconceptions about certain methods might limit their willingness to try that method.12, 13

A recent study among young women seeking contraceptive services in an urban adolescent contraception clinic in Colorado showed that the strongest predictor of method choice was high personal acceptability of that method before the visit.14 These findings revealed less about the reasons participants did not choose other available methods. The purpose of the current study was to examine factors associated with low personal acceptability for contraceptive methods to understand why some adolescents avoid certain methods. We hypothesized that determinants of low personal acceptability will vary by method, and that having a friend or family member with a negative opinion about a method will be associated with a young woman's low preference for that method. Our hypotheses were informed by previous studies that have shown that adolescents' contraceptive preferences are influenced by the norms and attitudes of the individuals within their social network.15, 16, 17 This literature is small and limited to qualitative studies.8, 10, 18, 19 This large, survey study design allowed us to examine whether the opinions of young women's social networks, particularly friends and family members, predict contraceptive acceptability among young women seeking contraceptive services.

Section snippets

Setting and Participants

We recruited participants for this cross-sectional study from a Title X-funded adolescent contraception clinic in an urban setting in Colorado. The clinic serves more than 4000 patients aged 12-24 years annually for sexual and reproductive health services, including sexually transmitted infection screening and treatment, cervical cancer screening, immunizations, and provision of all Food and Drug Administration-approved contraceptive methods including IUDs and contraceptive implants. Patients

Sample Characteristics

Of 1178 patients approached, 1067 completed the survey (response rate, 91%). Ages ranged from 14 to 24 with a mean of 20 years. Most participants were white, sexually active with a male partner in the past month, and had never been pregnant (Table 1). Most were aware of or had used OCPs (97.2% (1037/1067) aware, 66.1% (686/1037) used) whereas fewer had experience with DMPA (82.1% (876/1067) aware, 17.8% (156/876) used), IUD (77.3% (825/1067) aware, 4.1% (34/825) used), or subdermal implant

Discussion

In this cross-sectional study of adolescents and young women seeking contraception, we found that a substantial proportion of participants reported low personal acceptability of various contraceptive methods. Age, race, and pregnancy history were important predictors of low acceptability of certain methods, with a history of pregnancy being associated with low acceptability of OCPs and being nulligravid with low acceptability of IUDs. We also identified that having friends and family who

Acknowledgments

The authors thank Gina Sucato, MD, MPH, for providing feedback on a draft of the manuscript.

References (30)

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    Adolescents may be less likely to choose LARC as their method than older women, perhaps because of adolescents’ negative thoughts around LARC, such as fear of insertion, discomfort with methods requiring provider removal if they choose to discontinue, and knowing someone such as a friend or family member who reported a negative experience with a LARC method (Hoopes et al., 2018). Many adolescents have limited knowledge of the LARC methods before a contraception-related appointment with a provider compared with their preappointment knowledge or familiarity with OCPs (Hoopes et al., 2018). According to Goldstein and Hubbard (2018), inadequate contraceptive services in primary care settings is a significant public health issue, and research has shown a strong link between contraceptive counseling and the use of contraception by individuals.

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Dr Hoopes received a Young Investigator Grant supported by Bayer and the North American Society for Pediatric and Adolescent Gynecology. Dr Akers has funding for an investigator-initiated study from Bayer Healthcare and the Society of Family Planning and funding from The John Templeton Foundation. Dr Teal reports she has served on scientific advisory boards of Actavis and Bayer Healthcare, and serves on a Data Monitoring Board for a study funded by Merck and Co. The University of Colorado Department of Obstetrics and Gynecology has received research funding from Bayer, Agile Therapeutics, Merck and Co, and Medicines360. No authors have additional conflicts of interest to disclose.

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