College of Public Health

CARE Women’s Health publishes on contraceptive access

Drs. Michael Smith, Nathan Hale, and Amal Khoury, faculty in the East Tennessee State University College of Public Health’s Center for Applied Research and Evaluation in Women’s Health have published an article in Perspectives on Sexual and Reproductive Health. The article, Ranges of pregnancy preferences and contraceptive use: Results from a population-based survey in the southeast United States, investigates the relationship between the full range of prospective pregnancy preferences, and contraceptive use using a psychometrically evaluated measure of pregnancy preferences.

Dr. Corinne Rocca of the University of California San Francisco (UCSF) School of Medicine is lead author of the article.

Understanding how pregnancy intentions shape contraceptive behavior is essential for investigating contraceptive decision-making and assessing the degree to which individuals enact their reproductive preferences. Substantial research has found that pregnancy intentions, as reported in response to survey items, are a primary factor shaping contraceptive use, but that contraceptive behavior often does not align with pregnancy intentions, even in contexts in which contraception is relatively accessible.

CARE Women’s Health collaborated with UCSF to generate evidence utilizing a novel prospective measure of pregnancy preferences.  They investigated associations between prospective pregnancy preferences, measured with a valid instrument, the Desire to Avoid Pregnancy (DAP) scale, and contraceptive use in a representative sample of 2601 pregnancy-capable self-identified women, aged 18–44 years, in Alabama and South Carolina (2017–2018).

They investigated how probability of modern contraceptive use, and use of different contraceptive method types, changed with increasing preference to avoid pregnancy.  Results show that pregnancy preferences are associated with contraceptive use at the population level.  Analysis identified reasons for contraceptive nonuse among subgroups of women with different pregnancy preferences in the U.S. southeast.  

The authors found provision of appropriate contraceptive care to those not explicitly desiring pregnancy must differentiate between ranges of feelings about pregnancy (including ambivalence about becoming pregnant) , perceived drawbacks to contraceptive use (such as concerns about side effects), and legitimate psychological and interpersonal benefits of nonuse to promote autonomy in contraceptive decision-making.