Associations Between Low-Income Women’s Relationship Characteristics and Their Contraceptive Use

The proportion of pregnancies in the United States that are unintended is 49%, and among low-income women, this proportion is even higher—62% among those with incomes below the federal poverty level.1 Couples' contraceptive use and method choice strongly affect the likelihood that they will experience an unintended pregnancy. Couples who do not use any contraceptive account for more than half of unintended pregnancies,2 and those relying on relatively ineffective methods are much more likely to experience a contraceptive use failure than are those using highly effective ones.3,4 Therefore, among women at risk of an unintended pregnancy, increasing the use of contraceptives in general, and of highly effective methods in particular, could significantly reduce the rate of such pregnancies. Because women experience the risk of unintended pregnancy in the context of a sexual relationship, it is reasonable to expect that the characteristics of that relationship influence their contraceptive use. However, little is known about these potential influences. Recent studies exploring the factors affecting contraceptive use have focused on women's individual characteristics.5–8 Research examining the effects of relationship characteristics on contraceptive use was conducted more than two decades ago and was limited to relatively small samples of college students.9–12 Furthermore, with one exception,13 not only have previous studies of contraceptive use not considered relationship factors, they have focused on the determinants of whether any method is used, rather than on which methods are used. Some research related to HIV or STD prevention (rather than pregnancy prevention) has examined the association between relationship characteristics (e.g., duration, marital status and women's power in the relationship) and the use of condoms or dual methods.14,15 However, except for some studies that controlled for whether women wanted to have a child, most of this research has not accounted for women's pregnancy prevention considerations, and has not investigated the use of other contraceptive methods. Given the varied effectiveness of contraceptive methods3,4 and the importance of condoms for the prevention of STDs, in the present study we investigated how relationship characteristics are related to women's use of all types of contraceptives—condoms, withdrawal, female methods and dual methods—as well as to contraceptive nonuse. We also addressed another problem in previous studies of contraceptive use, which have generally included both women who desire a pregnancy and those who do not, and simply controlled for this factor. The potential determinants of contraceptive use, however, likely depend on whether a woman wants to get pregnant, and controlling for this cannot account for these interactions. Thus, we limited our analysis to women who were at risk of an unintended pregnancy—that is, sexually active, nonsterilized women who did not want to become pregnant or were ambivalent about getting pregnant. By excluding those who wished to become pregnant, we could assess associations between relationship characteristics and contraceptive use among women needing contraceptives. A fuller and clearer identification of relationship characteristics associated with contraceptive nonuse and use of less effective methods can help family planning providers identify women who may need additional support in their contraceptive practice.