Birth control use and reasons for discontinuation in incarcerated women

BACKGROUND: Unintended pregnancy is an important public health issue, and incarcerated women are at especially high risk upon release. We assessed the contraceptive choices among a sample of incarcerated women to identify factors associated with contraceptive method discontinuation and nonuse. METHODS: Women from Rhode Island's only jail were invited to participate in a study about family planning and STDs. Women age 18-35 were eligible if they were sexually active with men prior to incarceration, were not planning a pregnancy and were not using permanent or long acting reversible contraception (LARC). RESULTS: Of 219 women surveyed, 86.3% had used at least one birth control method (BCM). The most common method was the oral contraceptive pill (OCP: 73.5%), followed by Depo-Provera (52.2%), the patch (20.5%) and spermicide (9.6%). Only 8.7% had ever used a LARC. Reasons for discontinuation included forgetting (70/161 OCPs; 14/115 Depo; 4/45 patch), side effects (56/161 OCPs; 61/115 Depo; 21/45 patch) and unintended pregnancy (15/161 OCPs; 3/115 Depo; 5/45 patch). Only 1.8% of users attributed discontinuation to cost. CONCLUSIONS: Preventing unintended pregnancy, especially in the high-risk incarcerated population, is an important public health issue. In our sample, most women had used at least one BCM in the past. There were high rates of discontinuation due to side effects. Despite high rates of uninsurance and low socioeconomic status in the sample population, cost was not commonly cited as a reason for discontinuation. Possible side effects and reminders for consistent use should be explored when discussing contraceptive methods in this population.