A Path Analysis Predicting Contraceptive Use Among Youth Formerly in Foster Care: Intention or Unmet Need?

Background and Purpose: Correct and consistent use of contraception is vital to reproductive and sexual health. While disparities, such as STIs and teen pregnancy, are well documented among youth in foster care (YFC), few studies explore predictors of contraceptive use among this group. A direct influence of contraceptive use is pregnancy/parenting desire. Given that YFC are highly marginalized, barriers, such as poor sexual health education and disruptions in care, may prevent their access to contraception.

This study used path modeling to explore the cross-sectional relationship between pregnancy attitudes/intentions and contraceptive use among YFC, after controlling for potential confounding variables including demographic factors, maltreatment exposure, and high school graduation. We hypothesized that a high level of unmet contraceptive need would exist and that pregnancy desire would have little influence on contraceptive use.

Methods: A representative sample of children in out-of-home care who were enrolled in the Fostering Healthy Futures study between the ages of 9-11, were re-interviewed as young adults. This study came from a 5^th wave of interviews with 168 participants aged 18-22 (M=19.6, SD=.97). Half (50.6%) of the participants identified as female, 53.6% as Latino/Hispanic, 46.4% as White, 29.8% as Black, and 28.0% as American Indian (non-exclusive categories). Maltreatment experiences were indexed as a mean of the frequency of 52 self-reported maltreatment items (α= .86). Education was a dichotomous variable indicating if the participant had a high school diploma/equivalent or not. Pregnancy attitudes/intentions were measured through two items asking how the respondent would feel if they became pregnant (got someone pregnant), and if they wanted to become pregnant (father a child) in the next year. Contraceptive use was measured by asking participants how frequently they used protection for the purpose of pregnancy prevention over the past year. Using path analyses, age, gender, race/ethnicity, maltreatment and education were regressed on the two measures of pregnancy attitudes/intentions, and then all variables were regressed on past year contraceptive use.

Results: Although almost all (86.7%) participants reported that they did not currently want a pregnancy (91.9% of females, 81.6% of males), only half (54.2%) of respondents reported that they “always used protection for the purpose of pregnancy prevention.” The overall path model accounted for 42% of variance in predicting continuous contraceptive use (p<.001). Pregnancy attitudes/intentions were not associated with contraceptive use, and race variables were the only significant control variables predicting consistent contraceptive use. Namely, regardless of pregnancy attitudes/intentions, Black and Latino participants reported less contraceptive use, while American Indian participants reported greater use.

Conclusions and Implications: These results suggest a high level of unmet contraceptive need among YFC, as participants’ desire for pregnancy was not associated with use of contraception. While some YFC may desire pregnancy, poor access to sexual education and services may also be a strong driver of low contraceptive use. Efforts are needed to better understand barriers to contraception for YFC and to provide access for young adults who do not wish to become parents in the near future.