Women's perceived barriers to effective contraceptive use in a managed care population

Despite widespread availability of reproductive healthcare services and contraceptive methods, unintended pregnancy remains a major public health problem in the U.S. among all women of reproductive age. Women aged 18-24 years who reported to a managed care clinic for a pregnancy test and did not desire to be pregnant or were unsure of their pregnancy intention completed a reproductive health assessment questionnaire and answered open-ended questions. The open-ended questions addressed their perceived barriers and concerns related to contraceptive use. Data were analyzed using qualitative and quantitative techniques. The most frequently identified barriers to effective contraceptive use were forgetting (reported by 35% of participants) and concern about side effects (31%). Unmarried or cohabiting women identified forgetting as a barrier more frequently than other women. Reporting side effects as a concern was associated with having more education, while having no barriers or concerns was associated with having less education. Thirty-six percent of women who identified partner issues (disagreement about pregnancy desirability, concerns about fidelity) had used no method of contraception in the previous 30 days, and none of the women who reported partner issues used contraceptives effectively. All women, including those of relatively high socioeconomic status and good access to reproductive methods and healthcare, need careful assessment of barriers and concerns related to effective contraceptive use. This study shows that these women do report significant barriers and concerns that put them at risk for unintended pregnancy.