When Selecting Contraception, Both Attitude and Intention toward Pregnancy Matter, New Study Finds

May 2, 2019

Woman in white coat holds up pack of birth control pills

WASHINGTON, DC (November 1, 2018) — As the U.S. rate of unintended pregnancy has remained high, researchers have increasingly recognized that simply asking women whether they intend to become pregnant fails to capture feelings toward pregnancy that are often complex and multifaceted. The Editor’s Choice study in the November/December issue of  Women’s Health Issues, “Associations between Pregnancy Intention, Attitudes, and Contraceptive Use among Women Veterans in the ECUUN Study,” explored the relationship between pregnancy attitude, as well as intention, and contraceptive use in a large, diverse population with low-cost access to a range of contraceptive options. The authors found that “pregnancy intention and attitude were associated, but not perfectly aligned,” and an attitude that pregnancy would be “the worst thing” was associated with use of highly effective contraception.

Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based in the Department of Health Policy and Management at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.

Tierney Wolgemuth of the University of Pittsburgh School of Medicine and her colleagues used data from the Examining Contraceptive Use and Unmet Need among Women Veterans (ECUUN) Study, which included a national sample of women veterans aged 18-44 years who received primary care from the Veterans Affairs Healthcare System. Interviewers asked women both about their plans to get pregnant (now, in the next year, or later in the future) and how they would feel if they became pregnant in the next year (a seven-point scale from “it would be the worst thing” to “it would be the best thing”). Out of 858 women who were sexually active and neither pregnant nor trying to become pregnant, 84% were using contraception, and both pregnancy intention and attitude were associated with method effectiveness.

In exploratory analyses, the authors found racial differences in bivariate associations: For White women, both intention and attitude were associated with method effectiveness; for Hispanic women, only attitude was associated; and for Black women, neither attitude nor intention was significantly associated with the effectiveness of the contraceptive method they used. 

Traditional contraceptive counseling has typically focused on women’s pregnancy intentions and plans, Wolgemuth and her colleagues note, but a wider focus may enable providers to better assist their patients. “Understanding the factors that are most salient to women's contraceptive use is critical to best supporting women in their contraceptive decision making,” they comment.  

“This study is a strong contribution to the growing body of research that is expanding our understanding of how women make decisions about contraception,” said Amita Vyas, Editor-in-Chief of Women's Health Issues and Associate Professor of Prevention and Community Health at Milken Institute SPH. “This improved understanding can help providers offer patient-centered care and assist all clients in achieving their reproductive goals.”

Associations between Pregnancy Intention, Attitudes, and Contraceptive Use among Women Veterans in the ECUUN Study” has been published in the November/December issue of Women’s Health Issues.