Predictors of Contraceptive Use Among Young Women

Background and Purpose: Approximately 77% of pregnancies among women aged 18-19 are considered unintended (as opposed to 40% for all women of reproductive age). At this age, women are likely to want to avoid pregnancy and face greater consequences if they do become pregnant. However, contraceptive use and pregnancy intention do not always align. Wanting to avoid pregnancy is not the only, or even most important, influence on contraceptive use. Research in this area suggests that contraceptive decision making is complex, involving individual preferences and characteristics, social influences, and larger structural barriers. However, few studies examine these influences simultaneously. In order to increase contraceptive use and prevent unintended pregnancies, it is imperative to holistically understand the predictors of contraceptive use.  This study adds to the literature by focusing on young women(18-19) and examining factors that predict contraceptive use at multiple levels. 

Methods: This study uses baseline and supplemental surveys from the Relationship Dynamic and Social Life (RDSL) dataset, a representative sample of 1,003 women aged 18-22 in Genesee County, Michigan. The analytic sample includes women who reported being sexually active and having never been pregnant (N=695).  

Measures: They key outcome variable was reported current use of contraception (y/n). Key predictors included variables in four categories (1) Individual attitudes and preferences (e.g. attitudes towards sex, desire to avoid pregnancy) (2) Social and relational influences (e.g how partner feels about pregnancy, friends’ attitudes around sex and birth control) (3) Perceived barriers and structural influences (e.g. do you believe contraception is too costly to obtain?) and (4) Demographic predictors of contraceptive use (e.g. education, employment status, and race). Logistic regression was used to examine which variables were predictive of contraceptive use. 

Results: 94.2% of women in this sample reported not wanting to get pregnant in the next month. However, only 70.4 % of these sexually active young women reported currently using any form of contraception. Interestingly, across the four categories of predictors, there were few significant predictors of contraceptive use. Friends’ acceptance of sex and contraception and partner’s desire to avoid pregnancy were associated with a greater likelihood of using contraception, but these were not statistically significant predictors (at p<.05). White women and employed women were also more likely to use contraception, but these differences did not reach statistical significance.  Women who reported feeling guilty after sex were significantly less likely to use contraception (OR= .344, 95 CI =.179-.664). Finally, women with a high school degree were also significantly more likely to report using contraception (OR=2.04, 95 CI= 1.17- 3.56).

Conclusions and Implications: Findings indicate that while removing structural barriers and improving access is important to increasing contraceptive use, this alone is not sufficient as individual attitudes towards sex, such as guilt,  are a driving predictor. These findings suggest that sex-positive messaging should be integrated in interventions around unintended pregnancy and STI prevention. Additionally, the differences by education suggest that we should continue to address larger patterns of social inequality that may be contributing to the gap in use of contraception.