Assessing contraceptive use as a continuum: outcomes of a qualitative assessment of the contraceptive journey

Abstract

Background Contraceptive use is often a multi-decade experience for people who can become pregnant, yet few studies have assessed how this ongoing process impacts contraceptive decision-making in the context of the reproductive life course. Methods We conducted in-depth interviews assessing the contraceptive journeys of 33 reproductive-aged people who had previously received no-cost contraception through a contraceptive initiative in Utah. We coded these interviews using modified grounded theory. Results A person’s contraceptive journey occurred in four phases: identification of need, method initiation, method use, and method discontinuation. Within these phases, there were five main areas of decisional influence: physiological factors, values, experiences, circumstances, and relationships. Participant stories demonstrated the ongoing and complex process of navigating contraception across these ever-changing aspects. Individuals stressed the lack of any “right” method of contraception in decision-making and advised healthcare providers to approach contraceptive conversations and provision from positions of method neutrality and whole-person perspectives. Conclusions Contraception is a unique health intervention that requires ongoing decision-making without a particular “right” answer. As such, change over time is normal, more method options are needed, and contraceptive counseling should account for a person’s contraceptive journey.

(Dis)continuation of the oral contraceptive pill: A focus group approach in the Netherlands

“…The main themes that were identified were effects, side effects, towards alternatives, interpersonal communication with peers, interpersonal communication with the general practitioner, online information seeking and feeling responsible. There are similarities between the results and those of Simmons et al (2023) [ 13 ]. Simmons et al (2023) assessed the contraceptive journey of participants using interviews and did not specifically focus on OCP use, but mainly on a person's contraceptive journey, and the four phases thereof.…”

“…Although aforementioned pros and cons of OCP use have been examined, most studies focus on contraception decisions in general, rather than specifically on OCP decision-making. For instance, in the study of Simmons et al [ 13 ], semi-structured interviews were used to develop a theory of how contraceptive decision-making occurs over time, identifying different phases in a person's contraceptive journey and five main areas of decisional influence within these phases. According to Sato et al [ 14 ], both discontinuation rates and reasons of discontinuation seems to vary by the type of contraception method, highlighting the relevance of specifically investigating OCP use.…”

YouTube and the implementation and discontinuation of the oral contraceptive pill: A mixed-method content analysis

“…A German study on the knowledge and perceptions about OCPs among young women showed that 64.5% (n = 1480) of those who used OCPs at some point discontinued the method [29]. Simmons et al examined the cessation of contraceptive methods as part of a person's Contraceptive Journey [42]. They defined key factors contributing to this decision: physiological factors, values, experiences, circumstances, and relationships (e.g.…”

“…The discontinuation of OCPs deprives the body of an external source of artificial progesterone and estrogen, resulting in a change in the hormone levels in the body [43,44]. Current medical research on OCP discontinuation is limited to fertility restoration [45,46], fecundability [44], cycle characteristics [45,47], and reasons for discontinuation [29,42,48].…”

Estimates of use of preferred contraceptive method in the United States: a population-based study

“…Focusing on use of certain methods in quality and access metrics neglects that users may want to switch or stop using methods, since method discontinuation and switching are inherently part of the dynamic journey of contraceptive use. 13 , 14 , 15 In a 2022 nationally representative survey of adult U.S. women, 25% of contraceptive users indicated a preference for a different method. 16 The most recent National Survey of Family Growth asked respondents what method they would use if cost was not a worry; in 2015–17, 22% of U.S. women who had “heterosexual intercourse” in the last three months and were not pregnant or trying to become pregnant would use a different method, with the highest level of unsatisfied preferences among Black and Latinx women and low-income women.…”