(32) Contraceptive decision-making of adolescents and young adults

Background: With the changing political landscape, there is significant uncertainty regarding the future of reproductive autonomy. The purpose of this study is to better understand the factors adolescents and young adults (AYA) consider when choosing methods for contraception and/or menstrual management. This is especially pertinent considering the upcoming ballot issue on reproductive rights in Ohio.

Methods: This is an IRB-approved survey study of female patients age 11-26 years who desired to start a new hormonal suppression or contraception (hereafter known as “method”) from 5/2023-9/2023. Informed consent was obtained. Data collected include demographics, insurance, zip code, previous contraception, and decision-making factors. The child opportunity index (COI) and median annual income were determined based on zip code from published statistics and used as markers of socioeconomic status (SES). Descriptive statistics and Fisher’s exact test data are reported.

Results: A total of 20 respondents completed the survey. The majority (57%) were non-Hispanic white with a mean age of 16.2 years. 50% lived in areas of low COI, with a median annual income of $36,020, and 43% had Medicare insurance. Prior to the visit, 50% had previously used at least one type of birth control, including 50% of these who had used long-acting reversible contraceptives (LARC). Patients most commonly chose to initiate combined oral contraceptives (40%); 25% opted for LARC placement. SES did not affect previous use of contraception and whether LARC was the new method (p=0.19 and 0.37, respectively). The most common reasons cited for choosing a method included dysmenorrhea (55%), heavy bleeding (45%), irregular periods (40%), and contraception (35%). The most frequent reasons given for choosing a specific method were: ease of use (selected as one of the top 3 reasons by 35%), desire for more predictable periods (35%), desire for menstrual suppression (30%), and ease of self-initiation/discontinuation (30%). Only 15% selected concern for future access to contraception as one of their top reasons. When asked if recent changes in politics had affected the decision, 10/19 reported no effect, 4/19 little to moderate effect, and 6/19 a large effect. One patient declined to answer. Whether or not a respondent felt recent politics had an impact on decision-making did not affect their choice of method (p=0.58).

Conclusions: Recent concerns regarding reproductive rights have not significantly impacted AYA decision-making. AYA were more concerned with ease of use and self-control of each method, rather than future access. AYA consider may factors when choosing a contraceptive method and public policy may play a role.