The Role of Pregnancy Intention in the Choice of Contraception Among U.S. Women of Reproductive Age: 2017-2019 National Survey of Family Growth

Purpose: Contraceptive use is an important aspect of women’s reproductive health. Long-acting reversible contraceptives (LARCs) such as the intrauterine device and hormonal implant, are known to be highly-effective methods to prevent an unintended pregnancy. Pregnancy intention may contribute to contraception use, and women who do not intend to get pregnant may opt for effective contraception methods. However, pregnancy intention is a behavioral factor that is subject to change based on circumstances. This study describes contraception use by pregnancy intention among a nationally representative sample of U.S. women aged 15-49 years.

Methods: The study sample included women aged 15-49 years from the 2017-2019 National Survey of Family Growth (n=3025). The dependent variable was current contraception method at the time of interview, operationalized into four categories: LARCs (reference category), pill/ring/patch/injectable, barrier methods, and no contraception. Pregnancy intention (in the future or after a current pregnancy) was operationalized as intending, not intending, and don’t know/refused. The relationship between pregnancy intention and current contraception method was examined using weighted, multinomial logistic regression analyses, adjusting for race, age group, and type of current health insurance coverage.

Results: The mean age of the women was 29.6 years (SD=8.4 years), and women identified as White (67.6%), Black (24.2%), and Other (8.2%). Less than a third (29.6%) of the women had a bachelor’s degree or higher, and a majority (58.4%) of women had private insurance. Overall, 22.1% were currently using LARCs and 15.7% were using no contraception. Compared to women intending to get pregnant, women not intending to get pregnant had lower odds of using pill/ring/patch/injectable (aOR=0.57; 95%CI=0.41, 0.80), barrier methods (aOR=0.54; 95%CI=0.40, 0.73), and no contraception (aOR=0.40; 95%CI=0.25, 0.64) versus LARCs. Women aged 20-29 years had lower odds of using pill/ring/patch/injectable (aOR=0.41; 95%CI=0.25, 0.67) and no contraception (aOR=0.43; 95%CI=0.24, 0.79) versus LARCs, compared with women aged 15-19 years. Older women within the age group 40-49 had higher odds of using barrier methods (aOR=1.98; 95%CI=1.05, 3.73) and significantly lower odds of using pill/ring/patch/injectable (aOR=0.32; 95%CI=0.18, 0.57) versus LARCs, compared with women aged 15-19 years. Compared to women with private insurance, women with public insurance (Medicaid/Children’s Health Insurance Program) had lower odds of using pill/ring/patch/injectable (aOR=0.50; 95%CI=0.35, 0.72) versus LARCs.

Conclusions: Overall, women not intending to get pregnant were less likely to use pill/ring/patch/injectable and barrier methods compared to LARCs. As such, women who desire to prevent unintended pregnancy may opt for LARCs. Findings also show that a proportion of women not intending to get pregnant were not using any method of contraception, which highlights the need to examine reasons for no contraceptive use among this group of women. Given that pregnancy intention can be dynamic, preconception care should be accessible to women to support them in making informed decisions about their reproductive health. Moreover, there is need to examine factors that impact decision-making on contraception methods while accounting for pregnancy intention.