Women may use multiple contraceptive methods more often and in more complex ways than previously assumed, according to "The complexity of multiple contraceptive method use and the anxiety that informs it: implications for theory and practice," by Guttmacher Institute researcher Lori Frohwirth and colleagues published in the Archives of Sexual Behavior. This qualitative study explores specific ways in which women combine methods, and the anxiety about being able to prevent pregnancy that may motivate these practices.

The authors analyzed 2013 data from 52 interviews with unmarried, sexually active women aged 18–30 with demographic characteristics associated with the highest rates of unintended pregnancy and abortion in the United States. The interviews attempted to capture the full story of each woman’s contraceptive use over the previous year, including which forms of contraception were used, how consistently and correctly each method was used, and exactly how methods may have been used together.

The overwhelming majority of respondents (48 of 52) had used more than one form of contraception in the previous year. Half of respondents backed up inconsistent use of their chosen contraceptive with a secondary method, and some also chose to back up their backup with a third method. More than half of the women interviewed (30) took an approach the authors referred to as "buttressing," wherein women used multiple methods together rather than a single method alone for a perceived higher level of protection from pregnancy. Additionally, many respondents described contraceptive strategies that included both the mechanisms of backing up and buttressing over the course of a year.

"Our research suggests that women layer multiple contraceptive methods for a variety of reasons. One consistent theme of our interviews was that women felt vulnerable to unintended pregnancy, and using more methods made them feel safer," commented Frohwirth. "Research on contraceptive use often focuses on ‘inconsistent users,’ ‘nonusers’ or ‘risk-takers’, but this work shows the depth of some women’s concern about unintended pregnancy and the complexity of their efforts to prevent it."

The authors recommend that health care professionals providing contraceptive counseling and other reproductive health services be aware that their patients may be using multiple methods of contraception. Contraceptive counseling can help a woman choose the method or method mix that she can use most effectively to prevent pregnancy, given her individual circumstances and needs. Counseling can also address women’s concerns about the effectiveness of their contraceptive method(s) of choice. Further research should acknowledge multiple method use to better reflect women’s actual contraceptive practices.

"The complexity of multiple contraceptive method use and the anxiety that informs it: implications for theory and practice," by Lori Frohwirth et al. of the Guttmacher Institute, is currently available online and will appear in a forthcoming issue of Archives of Sexual Behavior.