National Partnership for Women & Families

Monthly Women's Health Research Review

Women's Contraceptive Method Selection Associated With Risk of Pregnancy

 Summary of "How Do Pregnancy Intentions Affect Contraceptive Choices When Cost Is Not a Factor? A Study of Privately Insured Women," Carol Weisman et al., Contraception, May 19, 2015.

Although projections based on prior research suggest "that women will make contraceptive choices that are more compatible with their pregnancy intentions when they have no-cost access to a full range of contraceptive methods ... [s]urprisingly little is known about how women's pregnancy intentions are related to their contraceptive choices," according to Carol Weisman, professor of public health sciences and obstetrics and gynecology at Penn State College of Medicine, and colleagues.

Weisman and colleagues explained that the study aims to examine "contraceptive use by privately insured adult women who wish to avoid pregnancy for at least the next 12 months and have access to contraceptive coverage without cost-sharing." Specifically, they "hypothesize that in the context of access to contraception without cost-sharing, using prescription contraception will be a function primarily of pregnancy intentions" [emphasis removed]. According to the study, pregnancy intentions refer to both "the time frame in which the woman wishes to avoid pregnancy, and ... how strongly the woman feels about avoiding pregnancy."

Methods

The researchers recruited 987 women with private insurance plans between ages 18 and 40 who did not plan on becoming pregnant for at least the next 12 months. Study participants were recruited between April 2014 and August 2014 for the MyNewOptions project, which was a trial testing an online program "designed to empower women to make optimal contraceptive choices in the context of contraceptive coverage without cost-sharing."

According to the study, eligible participants "were not intending pregnancy in at least the next 12 months, sexually active with a male partner, and had Internet access."

Study participants were asked about their primary type of contraception -- including long-acting contraception, other prescription methods, non-prescription methods or no contraceptive method -- the timeframe of their pregnancy intentions and how important it was to them to avoid pregnancy at the present time. They also were asked about their pregnancy history, current partner status, frequency of sexual intercourse and various sociodemographic questions, such as age and education level.

Results

The researchers found that "pregnancy intentions were significantly associated with using LARCs and other prescription methods, versus no method, but not with using non-prescription methods." Meanwhile, the "intent to never have a baby is associated with increased odds of using both long-acting reversible contraceptives (LARCs) and other prescription methods," while a strong desire to avoid pregnancy "also is associated with increased use of LARCs."

According to the researchers, variables associated with pregnancy risk -- such as having a partner and a frequency of sexual intercourse of more than once per month -- "were more strongly associated than pregnancy intentions with using LARCs and other prescription methods." Variables associated with pregnancy risk "also were associated with significantly increased odds of using non-prescription methods versus no methods." Meanwhile, having at least one prior birth "was associated with significantly reduced odds of using other prescription contraception versus no contraception, and ever having an unintended pregnancy was associated with an over three-fold increased odds of using LARCs, versus no method."

Discussion

The researchers found that 58% of women used either LARCs or another form of prescription contraception, while 30% used non-prescription contraceptive methods. Overall, "the timing and strength of pregnancy intentions were significantly associated with the use of LARCs and other prescription contraception, compared with using no contraception." Weisman and colleagues wrote that "never wanting to have a baby was associated with use of LARCs and other prescription contraception, whereas finer gradations in the timing of intent," such as desiring pregnancy in two to five years compared with at least five years, "were not associated with type of contraception used."

"Contrary to our hypothesis, pregnancy intentions were not the strongest predictors of using prescription contraceptives that are covered without cost-sharing: current pregnancy risk exposure variables were more strongly associated with using LARCs and other prescription contraception, compared with no contraception," the researchers wrote. They added, "Greater frequency of sexual intercourse was associated with greatly increased odds of using all types of contraception, suggesting that greater situational exposure to pregnancy motivates women to contracept independent of other factors, including longer-term pregnancy intentions, prior pregnancy experience, and type of current relationship."

Weisman and colleagues expressed concern that "lower frequency of intercourse (once a month or less) is associated with lower odds of using prescription contraception, which could undermine longer-term pregnancy intentions if frequency of intercourse were to increase." Meanwhile, they found that "being in newer or premarital relationships in which pregnancy might not be readily accommodated is associated with increased use of prescription contraception," while marriage "was associated only with increased use of non-prescription methods."

In terms of pregnancy experience, the researchers found that "[e]ver having had an unintended pregnancy or abortion was associated only with LARC use." Meanwhile, the finding that "having one prior live birth (but not two or more) was associated with lower odds of using other prescription contraception could indicate that women who have begun their families are not using prescription contraception for birth spacing."

The researchers noted that their study "is a first step in understanding adult women's contraceptive choices in the context of access to medical contraception without cost-sharing."

They wrote that their findings showing the "strong impact of situational risk on use of any type of contraception, versus no method, is of concern if it means that women opt for easily obtainable non-prescription methods rather than more effective or longer-acting prescription methods." According to the researchers, "non-cost barriers to prescription contraception -- such as availability of providers or negative attitudes toward certain methods or their efficacy, safety or side effects -- [possibly] impede use of these methods even when cost is not a factor," as could certain insurance plan restrictions on coverage "despite [Affordable Care Act] requirements." Overall, they conclude that their findings underscore "[t]he importance of continuing to monitor the impact of ACA on contraceptive use patterns and of providing women with tools to make optimal contraceptive choices."