Predictors of Reproductive Autonomy Among a University Population

Background and Purpose:  Reproductive autonomy is necessary for women’s overall wellbeing, and is defined as the ability to decide and control issues of contraceptive use, pregnancy, and birth. Although unintended pregnancy is declining in the United States, the rate remains uncomfortably high with an estimated 45% of pregnancies as unintended in 2011, particularly among women aged 19 to 25. Barriers to consistent contraceptive use persist, limiting a woman’s ability to exercise reproductive autonomy.  A woman’s partner, and the expected roles within a partnership, may have a significant impact on reproductive autonomy. A woman may face intimidation or coercion around the use of contraceptive methods.  However, little research has examined reproductive autonomy among university populations. The purpose of the present study is to examine rates and predictors of reproductive autonomy among a university sample.

Methods:Questionnaires were administered to undergraduate students who self-identified as being in an intimate relationship within the last six months. The Reproductive Autonomy Scale measured communication, decision-making, and freedom from coercion around reproductive matters in relationships.  The Gender Beliefs Scale measured healthy and unhealthy gender beliefs. The sample consists of 461 female (n = 304) and male (n = 157) university students from the Southeast United States. The sample has a mean age of 20.19 years (SD = 3.32). Independent t-tests and multivariate analysis were conducted to analyze the data.  Three multiple regressions identified predictors from each of the models on one’s ability to attain reproductive autonomy.   

Results: Participants reported rates of reproductive autonomy on all three of the measurement subscales (communication 85%, decision making 38%, and freedom from coercion 21%). Nearly 21% reported using no birth control, 19% use condoms only, 17% use oral birth-control, and 18% use both condoms and oral birth-control. Significant predictors of achieving reproductive autonomy are shorter travel time to a health care provider, being a woman, holding healthy gender beliefs, lower rates of religious activity, not identifying as heterosexual, and the use of birth control.  Participants who reported using a form of birth control were significantly more likely to have good communication around reproductive health issues than participants who did not use a form of contraception.

Implications:  Multiple factors have a significant impact on achieving reproductive autonomy.  The present study highlights areas for social work interventions and advocacy.  Education efforts should focus on increasing ways for young adults to effectively communicate about the use of contraception within relationships and to promote healthy gender beliefs.  Few respondents reported being free from coercion around reproductive matters. Social work practitioners should expand screening tools to include coercive behaviors, such as the presence of intimidation, isolation, and threats.  Sex education programs should also include information and skill building to address coercive behaviors within an intimate relationship. Social work advocacy efforts should address continuing barriers to health care and effective contraceptive use.