Women who obtain services from publicly funded family planning clinics in the United States, particularly those who are young, unmarried or childless, consider their use of contraceptives essential and beneficial for a variety of reasons.1 In a survey of clinic clients in 13 states, at least half of women reported that their use of a method to avoid pregnancy was very important for reasons related to their finances, life control and stability, education and career goals, or readiness for children. On average, adolescents chose nine "very important" reasons for using contraceptives, while women overall chose seven. Women who were younger than 30 or were unmarried and not living with a partner had elevated odds of citing financial strain (odds ratios, 1.6–2.6), instability in their lives (2.7–4.7) or worry about achieving their goals as a very important reason (1.6–4.7).
Because most previous research has examined women's reasons for not using contraceptives, the investigators note, it provides little insight into why women do use methods and what benefits they expect. To explore this side of the issue, the researchers surveyed women attending publicly funded family planning clinics, who are typically young and disadvantaged. The 22 clinics that participated in the study, which was conducted from October 2011 to January 2012, had either participated in a nationally representative survey or been recommended by Title X program administrators.
Women visiting the clinic were eligible for the survey unless they were obtaining prenatal or abortion care. The final sample of 2,094 women completed a questionnaire that asked them about their social, demographic and health care–related characteristics, including what services they were obtaining at the current visit. The questionnaire also listed 17 reasons for using contraceptives to avoid pregnancy, which women rated as "very important," "somewhat important," "not so important" or "not applicable." Analyses focused on 14 of these reasons, which the researchers divided into substantively related groups.
One‐quarter of respondents were younger than 20, half were in their 20s and one‐quarter were 30 or older. Fifty‐one percent were white, 23% were Hispanic and 21% were black; the rest belonged to other racial groups. Most were childless (58%), were not married or cohabiting (63%), and had an income below the federal poverty level (61%).
On average, women overall rated seven reasons for using contraceptives very important; adolescents gave nine reasons this rating. The types of reasons that the largest proportions of women cited as very important had to do with financial constraints (69%), feeling that they were not ready for a child (63%), wanting to have better control over their life (60%), and wanting to avoid pregnancy until they had greater life stability (60%) or had completed education or career goals (57%). Other frequent responses pertained to women's lack of a partner (49%) and need to care for the children they already had (45%).
The researchers conducted a series of multivariate regression analyses to assess the likelihood that women of various social and demographic characteristics considered each type of reason for using contraceptives very important. In the financial constraints model, adolescents and women in their 20s had higher odds than did older women of reporting that using birth control was very important for this reason (odds ratios, 1.6–2.6). Unmarried, noncohabiting women were more likely than those who were married to report this reason (1.6), and compared with women whose education level was high school or below, those with some postsecondary education had higher odds (1.4). The odds were also elevated among women with no children (1.7).
In the life control model, only two characteristics were significant. Black women had a higher likelihood than white women of rating this reason very important, and being unmarried without a live‐in partner was associated with choosing this reason (odds ratio, 1.5 for each). (Race and ethnicity was significant only in this model; women's poverty level was not significant in any model.)
The odds of choosing life instability as a very important reason for contraceptive use were elevated among women younger than 30 (odds ratios, 2.9–4.7), childless women (4.1) and those with some postsecondary schooling (1.6). Women living with a partner and those with no husband or live‐in partner had greater odds than did married women of rating this reason very important (1.8–2.7).
These patterns also held for the model examining interruption of goals. The odds of rating this reason very important were elevated among adolescents and women in their 20s (odds ratios, 1.8–4.5), childless women (2.4), cohabiting women (1.5), those who were neither married nor cohabiting (2.6) and those who had had some education beyond high school (1.9).
Among childless women, those younger than 30 were more likely than older women to regard unreadiness for a child as a very important reason to practice birth control (odds ratios, 2.5–4.9), and women without a husband or live‐in partner had higher odds of choosing this reason than did married women (2.0). A model including only unmarried women revealed that the likelihood of choosing lack of a partner as a very important reason to use a method was elevated among those younger than 20 (1.6), childless women (2.1) and those who were not living with a partner (3.9). Mothers’ odds of reporting that birth control use was very important to help them better care for their children were elevated among those who were neither married nor cohabiting (2.6); the odds were reduced among those who had at least a bachelor's degree (0.4).
The researchers note that while their sample was not nationally representative, the respondents were similar to female clients of Title X–funded family planning clinics nationwide. They recommend that further work focus on the relationship between changes in reasons for using birth control and changes in method choice and use over a woman's lifetime. The findings, they conclude, have "implications for the personal costs of unintended pregnancy and the need for access to and use of contraceptive services."—S. Ramashwar