Reproductive Autonomy Among a Young Adult Population: Implications for Policy and Practice

Background and Purpose:  To date in 2017, over 1,000 state level provisions have been introduced addressing reproductive and sexual health services in the United States.  While some proposed legislation protects access to contraception, the majority of the bills would decrease access to the full spectrum of reproductive health services and comprehensive sexual health education.  This continues the trend of restrictive reproductive health policies passed at the state levels, and highlights the need for social work attention.  The ability to control reproductive choices is essential to one’s overall well-being.  Reproductive autonomy is measured by the ability to decide and control contraceptive use and pregnancy intention. This exploratory study examines rates of reproductive autonomy among a sexually active young adult population and identifies areas for social work policy and practice intervention.       

Methods:  The Reproductive Autonomy Scale (measuring decision-making, communication, and freedom from coercion) was administered to university students in the Southeast United States who reported being in an intimate relationship within the past 6 months. Demographic data were also collected from the 468 participants (311 female, 157 male). The sample has a mean age of 20.19 years (SD = 3.32). Male participants reported their primary method of birth control as condoms (32.7%), none (22.4%), and condoms & oral birth control (12.9%) compared with females who reported oral birth control (23.5%), none (19.9%), and condoms & oral birth control (19.6%). Approximately 51.6% of males and 47.9% of females do not currently want to conceive. An additional 43% of men and 48.9% of women would like to conceive in the future. Frequencies, descriptives and univariate comparisons of means were used to analyze the data. Comparison of means identified sex differences regarding reproductive autonomy and contraceptive use.

Results: Female participants of the current study revealed different rates of reproductive autonomy (freedom from coercion 20%, communication 41%, and decision making 67%) than their male peers (freedom from coercion 42%, communication 27%, and decision making 39%). Means differences between men and women show that females are significantly more likely to make decisions regarding reproduction and to use a method of birth control than males. Further analysis revealed that men are significantly less likely to experience coercion around reproductive matters than females. Men and women did not differ on either their likelihood of communicating around reproductive topics or currently wanting a child in their relationships.   

Implications:  Social workers should continue advocacy efforts around increasing access to reproductive health services and information.  Approximately 20% of participants reported using no method of contraception despite not wanting to currently conceive.  Prevention efforts should therefore target contraceptive knowledge and ease of access, and policies protecting health care coverage of contraceptives should be supported and promoted.  Coercive reproductive tactics used within an intimate relationship must be addressed and content aimed at reducing and preventing coercion should be incorporated into comprehensive sex education.  Healthy communication around reproductive health should be incorporated into social work practices.