Do policies on access to contraceptives in the U.S. reflect individual preferences and right to self-determination?

In a recent study published in The Lancet Regional Health – Americas, researchers surveyed a nationally representative population of non-sterile individuals in the United States (U.S.) between the ages of 15 and 44 years who had been assigned as female at birth to understand the preferred contraceptive method, differences in these preferences based on sociodemographic factors, and the reasons for not using contraceptives.

Study: Estimates of use of preferred contraceptive method in the United States: a population-based study. Image Credit: Bigc Studio/Shutterstock.com

Background

Sexual and reproductive health equity ensures that all individuals can manage their fertility in a dignified, desired, and acceptable manner, have access to the resources that allow them to be sexually and reproductively healthy, and have self-determination when deciding if, how, and when to get pregnant.

Furthermore, the recent overturning of the landmark legal right to abortion in the U.S. has made equity in reproductive and sexual health even more important.

Contraceptive access is often impeded due to misinformation and misconceptions about contraception, as well as deliberate attempts to restrict access to some contraceptives by claiming that they act as abortifacients.

Although the use of contraceptives is based on individual preferences, programs and policies about contraceptives have promoted the use of specific methods, mostly those with high effectiveness rates and long-lasting effects such as intra-uterine devices and long-acting reversible contraceptives, consequently undermining the individual’s right to self-determination.

About the study

In the present study, the researchers aimed to promote a person-centered approach to improving access to contraceptives by understanding the use of contraceptives of choice across a representative population of prospective and current contraceptive users across the U.S. and determining how various aspects of a healthcare access system that is person-centered can influence the use of contraceptives of choice.

The current methods of tracking access to contraceptives in the U.S. depend largely on the data available from clinical reports on the proportion of fertile and at-risk women who have been provided with either the most or moderately effective contraceptives.

Information on the individual’s choice or request for a contraceptive is not included in these reports. Furthermore, these reports also do not have data from individuals who use contraceptives for reasons, not including the prevention of pregnancies or from individuals who prefer vasectomies as a method of preventing pregnancies.

Therefore, current metrics assessing contraceptive access neglect person-centeredness by not considering self-determination when providing access to contraceptive methods.

Furthermore, aspects such as efficiency are also overlooked since contraceptive access is provided based on assumptions about who needs them and what kind of contraceptives they need, which could result in wasted resources.

The nationally representative survey conducted in this study included biologically female, non-sterile individuals between the ages of 15 and 44 years and was administered in Spanish and English.

The use of the preferred method of contraception was the primary interest measure. Additionally, the reasons for not using contraceptives, as well as differences in contraceptive use based on various sociodemographic characteristics, were also analyzed.

The association between preferred use of contraception and four key features of person-centered healthcare access — two pertaining to self-efficacy and two based on past contraceptive care quality — were also statistically analyzed.

Results

The results showed that close to one-fourth of prospective or current contraceptive users, which correlates to approximately 8.1 million individuals in the U.S., reported a preference for a method of contraception different from the one they were currently using or had access to.

Vasectomy and oral contraceptives were the most preferred methods. Furthermore, the reasons provided by those who did not use the preferred method of contraception included side effects, reasons related to sex, lack of knowledge or logistics, concerns about safety, and cost.

The regression analysis also indicated that key features of person-centered access to healthcare played a major role in the use of preferred methods of contraception.

Patients who believed that they had adequate information to decide which contraceptive method to use and could obtain the preferred method of contraception with relative ease were more likely to use the contraception method they preferred.

Two factors that decreased the odds of using a preferred method of contraception were low-quality care in the form of inadequate person-centered counseling on contraceptive use and various types of discrimination in aspects of family planning.

Conclusions

Overall, the findings suggested that over 25% of the non-sterile population of the U.S. do not use their contraceptive methods of choice, and a significant portion of the non-usage is due to concerns about safety, side effects, lack of knowledge or logistical access, and reasons related to sex.

A person-centered approach to improve access to information and counseling about contraceptives and address aspects of discrimination related to family planning and preferences for specific methods of contraception are essential to improve access to preferred methods of contraception.