Patients’ Contraceptive Choices Evolve Over Time and Life Needs
Women’s preferences in contraceptive methods can change with time and circumstances in their lives, new research shows.
- Postpartum women who desire future fertility were more concerned about side effects and their partner’s opinion of their contraceptive choices.
- Values and preferences are influenced by the contraceptive method’s effectiveness, access, convenience, side effects, societal norms, and other issues.
- Long-acting reversible contraceptive methods may become more commonly used as people’s values and preferences change and these contraceptives grow in popularity.
“One and done” is not how most women choose a contraceptive. At one point in their lives, women may select a hormonal contraceptive pill, but might opt for a long-acting reversible contraceptive (LARC) at another point.
A majority of women seeking abortion services in the United States expressed a preference for LARC during contraceptive counseling before their abortion procedure, according to an analysis.1
After analyzing 12 studies of contraceptive preferences among postpartum women, researchers found that women who desired future fertility were concerned about contraceptive side effects and their partner’s disapproval. This affected their contraceptive preferences. Postpartum women who were satisfied with their family size were less concerned about these potential barriers.
“No contraceptive method had all the features users deemed important,” says Anita Dam, MSPH, lead author and program analyst with the United States Agency for International Development (USAID) in Washington, DC. Dam works in the global health bureau on family planning. Her study was completed before she began to work with USAID and does not necessarily reflect the views of USAID.
“This systematic review is part of a set of reviews on values and preferences related to contraception globally,” Dam explains. “It started off with 423 articles. Twenty-three studies from 10 countries met the inclusion criteria for this review specifically.”
One of Dam and colleagues’ signature findings was that many studies emphasize values and practices around LARC, including the convenience of accessing LARC and concerns about side effects.
“In general, out of 23 studies, a lot of them talked about LARC,” Dam says. “These included studies that were looking at values and preferences of LARC.”
LARC was viewed as convenient for women who had just given birth and for women who had sought abortion services and could have LARC inserted at the clinic after the procedure.
The authors found enthusiasm for immediate post-delivery and post-abortion LARC.
The main themes of values and preferences were influenced by method effectiveness, access, availability, convenience, cost, side effects, previous experience, partner approval, and societal norms.
“Similarities and differences were evident across subgroups, especially concerning contraceptive benefits and side effects,” Dam says.
Dam and colleagues also found values and preferences around contraceptive methods are dynamic over the course of a woman’s life. These preferences can be influenced by various factors, including:
- Planned and unplanned pregnancies;
- Change in relationship status;
- Change in health status;
- Availability of new methods;
- Evolving societal norms and structures;
- Availability of contraceptive counseling.
“For example, women satisfied with their respective family size tended to prefer long-acting or permanent methods,” Dam explains.
By contrast, women desiring children in the future considered contraceptive use within the timeline of their planned future fertility and tended to prefer barrier and short-acting methods, or, sometimes, long-acting methods.
In multiple studies, women said they chose a method because it caused fewer side effects than another method, but no method was perceived as causing zero side effects.
“The following side effects came up throughout the 23 studies, but did not show clear patterns across the subgroups analyzed in this paper: disruption of the menstrual cycle, mood-related side effects, sexual side effects, and physical side effects.”
Investigators did not analyze the studies to see which method checked off the most values and preferences, but they did see a skew toward studies discussing the values and preferences of LARC.
“Many of the studies discussed the dichotomy between appreciating the convenience of immediate LARC placement and having concerns about the method, like side effects,” Dam explains. “This emphasis reflects the global trend of increased uptake of LARC in the past decade. This increased user accessibility and uptake of LARC was a part of the greater global commitment to ensure broad access to a wider choice of methods.”
This commitment includes donors and manufacturers ensuring lower commodity costs and higher availability as well as revised expert guidance on a wider client eligibility to receive LARC.
Reproductive health providers should keep in mind that even as individual patients’ values and preferences for contraceptives change over the course of their lifetimes, these values and preferences can change as a society changes and contraceptive science evolves.
“As method availability changes and LARCs may become more commonly used, values and preferences may continue to change,” Dam says. “Individuals must have access to a full range of safe and effective modern contraceptive options, allowing people to make decisions based on evolving contraceptive preferences over time.”
Robert A. Hatcher, MD, MPH, chairman of the Contraceptive Technology Update editorial board, adds “Women’s decisions will be influenced most dramatically in states where abortions become very, very difficult to obtain. Contraceptive effectiveness has always been important, but will become even more important if abortion is virtually unavailable for a woman.”
- Dam A, Yeh PT, Burke AE, Kennedy CE. Contraceptive values and preferences of pregnant women, postpartum women, women seeking emergency contraceptives, and women seeking abortion services: A systematic review. Contraception 2021 Nov 3;S0010-7824(21)00439-X. doi: 10.1016/j.contraception.2021.10.007. [Online ahead of print].
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