The unintended pregnancy rate in the United States remains high, and there are large race and education differences in unintended pregnancy and fertility. These differences make it important to study race and education differences in contraceptive behavior. Using nationally representative data from the 2002 National Survey of Family Growth, this study examines the effects of race and education on the likelihood that women have ever used particular types of hormonal contraception and have ever discontinued hormonal contraception because of dissatisfaction. The results show that blacks and Latinas were more likely to have used injectable contraceptives ("the shot") and less likely to have used oral contraceptives ("the pill") than were white women. Women with less education were more likely than college-educated women to have used the shot but there were no significant education differences in use of the pill. Among women who had ever used hormonal birth control, those with less than a college degree were more likely than college-educated women to discontinue the birth control because of dissatisfaction. However, net of education, this study found no significant racial/ethnic differences in discontinuation. The most commonly stated reason for discontinuation because of dissatisfaction was side effects.
Most women of reproductive age use highly effective contraception and all available methods are associated with side effects. Whether a woman will experience side effects is uncertain, however, which can pose challenges for clinicians who discuss the methods with patients. In this study, we analyze 102 contraceptive counseling visits to understand how clinicians discursively construct knowledge in the context of uncertainty. We find that while some present the uncertainty of side effects in a straightforward, patient-accessible way, others negotiate their predictions by: 1) differentially constructing uncertainty, suggesting that positive side effects are likely and negative side effects are unlikely and, 2) contesting uncertainty, presenting the risk of serious side effects as controllable. In the end, these strategies deemphasize consideration of negative side effects in women’s contraceptive decision-making. Our results demonstrate the importance of elucidating the translation, instantiation, and construction of medical uncertainty—both in theory and in practice.
Qualitative interviews with young women attending community colleges were used to address why women who do not desire pregnancy vary in how consistently they use contraception. Based on our analysis of the women's sexual histories, we argue that five factors are key to promoting or discouraging consistent use of contraception: efficacy (women's ability to put an intention to contracept into practice), the actions and attitudes of male partners, being in a long‐term relationship, whether women experience side effects, and misinformation or erroneous reasoning about pregnancy risk. Variations in how these factors combine at different times in women's lives explain much about their patterns of contraceptive consistency.
Almost half of pregnancies in the United States are unintended, despite the availability of highly effective forms of birth control. Women often cite side effects as a reason for stopping hormonal birth control, and most research on the topic comes from a medical perspective. In this study, I analyze hormonal contraceptive side effects from a social perspective that highlights the link between cultural messages about gender and women's contraceptive behavior. Drawing on data from interviews with 88 women, I argue that the gendered emphasis on women's appearance and emotionality shapes women's perceptions about the seriousness of hormonal contraceptive side effects, like weight gain and emotional volatility, and their propensity to stop use as a result. Contrary to understandings of side effects as a purely medical aspect of use, the gender analysis elucidates the ways that particular side effects are imbued with social meaning that can undermine women's goals to prevent pregnancy.
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