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Appalachia is a historically marginalized geographic region of the eastern United States encompassing 13 states. Although this area has regional strengths, the challenges confronted by this region include disparities in access to health care. This study examines decision-making associated with seeking or not seeking birth control, in a sample of women residing in Appalachia, to better understand factors influencing contraceptive decision-making.
Methods:
Women ages 18-49 (N=634) residing in Appalachia were recruited for this study using targeted advertisements via the Facebook social media platform. Respondents completed a secure, electronic questionnaire that included questions about factors influencing their birth control (contraceptive) decision-making. Multinomial logistic regressions were conducted to predict decision-making factors from demographic variables.
Results:
Respondents were asked to select important factors in their decision to use birth control. When asked to select the single most important factor, the following had the highest frequencies: effectiveness at preventing pregnancy (43.9%), safety (16.3%), and ease of use (11.9%). A multinomial regression was conducted to ascertain the effects of demographic variables on the most important factor. The model was statistically significant, χ2 (20) = 91.190, p < 0.001. Three predictor variables were statistically significant: age, education, and income. Results showed that as education increased, women were less likely to report ease of use as their most important consideration over effectiveness (OR .526, CI [.393, .705]).
Similarly, women were also asked about important factors in their decision to not use birth control. When asked for the single most important factor, the highest frequencies were: either trying to become pregnant or don’t mind getting pregnant (29.6%), other reasons (23.3%), and thinking they are physically unable to get pregnant (16.3%). Another multinomial regression was conducted, and the model was statistically significant, χ2 (20)= 96.634, p < 0.001. Of the four predictor variables, only two were statistically significant: age and income. Results showed that as income increased, women were more likely (OR 2.377, CI [1.506, 3.751]) to choose thinking they are not physically able to get pregnant as the most important factor over not expecting to have sex.
Conclusion and Implications:
Findings indicate that respondents seek to prioritize contraceptive effectiveness, safety, and ease of use and that contraceptive effectiveness is more likely to be prioritized over ease of use as levels of education increase. This suggests that access to effective, safe, and easy to use options may be appealing to Appalachian residents and that contraceptive options should be accessible in the region. The belief that one is unable to get pregnant suggests this may be a prevailing myth for contraceptive decision-making in the region that needs to be addressed. Findings also indicate that contraceptive side effects were a consideration in both the decision to use and not use birth control. It is recommended that culturally sensitive, medically accurate education about contraceptive options, safety, physical capacity for pregnancy, and side effects be provided using a community health navigator model that emphasizes familiarity with regional cultural norms.