Consistent and Inconsistent Contraception Among Young Women: Insights from Qualitative Interviews

Unintended pregnancies account for almost one half of all U.S. pregnancies and more than 70% of pregnancies outside of mar- riage (National Campaign to Prevent Teen and Unplanned Pregnancy [NCPTUP], 2012, Table A-3). Unintended pregnancies are especially common among unmarried women between age 18 and 25 with low income who are not college graduates (Boonstra, Gold, Richards, & Finer, 2006; Finer & Henshaw, 2006; Finer & Zolna, 2011;NCPTUP,2012).Womenwho haveunin- tended pregnancies typically have their children early, sometimes interrupting schooling (Hoff- man, Foster, & Furstenberg, 1993; Klepinger, Lundberg, & Plotnick, 1999). Children born of unintended pregnancies have worse educational, emotional, and health outcomes than those who were intended, even adjusting for their parents' disadvantage(Gipson,Koenig,H Finer & Henshaw, 2006). We do not fully understand why women who do not desire a pregnancy vary in how consistently they use contraception; this study uses data from qualitative interviews with 51 young women to shed light on this issue. The rich narrative data from women's life histories reveal much about contexts that encourage or discourage contraceptive consistency.CONSISTENT AND INCONSISTENT USE OF CONTRACEPTION:PAST RESEARCHPast research shows that more than 99% of women have used some contraceptive method (Mosher & Jones, 2010), and, of sexually active women not intending a pregnancy, only 8% used no contraception the previous year (Frost, Singh, & Finer, 2007). Some studies have focused on which women use more effective methods, gauging failure rates of methods by the percentage of women who, given typical use (which may be imperfect and inconsistent), get pregnant using the method for a year. Oral and injectable contraceptives have low failure rates at 7% and 9%, respectively, whereas condoms and withdrawal have higher rates of 17% and 18%, respectively (Jones, Fennell, Higgins, & Blanchard, 2009; Kost, Singh, Vaughan, Trussell, & Bankole, 2008, p. 18). A more basic issue than what method is used is whether women are consistent. Frost et al. (2007) surveyed sexually active women not wanting a pregnancy and found 8% using no method over the last year, and another 15% with a gap of nonuse lasting at least a month (the average gap was 5 months).Because inconsistent contraception puts women at risk for unintended pregnancy, and our goal was to illuminate what promotes con- sistency, we reviewed studies about predictors of consistent use. Some research sheds light on this indirectly by ascertaining what factors pre- dict pregnancy among women using a method at least some of the time. These factors may indicate which women are inconsistent in their use, although they could also reflect choosing a riskiermethodorincorrectuse.Kostet al.(2008) found that Hispanic and Black women and womeninpovertyaremorelikelytogetpregnant when they say they have been using a method at least sometimes. This was also true if they limited analysis to those using just condoms; but among pill users, there were no differences in pregnancy rates by race or income. Approaching determinants of inconsistency more directly, Frost et al. (2007) found that, among women not intending a pregnancy and using some method, the lower women's education, the more likely they were to have a gap in their use during the previous year. When researchers interview women after a birth and ask whether their conceptions were intended or unintended, much higher proportions are found to be unintended for Blacks than Whites (with Hispanics inter- mediate), and for women with less education or lower income (Finer & Zolna, 2011; Musick, England, Edgington, & Kangas, 2009). Overall, past research shows that, compared to more advantaged women, disadvantaged women are more inconsistent with contraception, even when they do not want a pregnancy, and that they have more unintended pregnancies. …