‘I feel like a person has a right to use a product to protect themselves…’: a qualitative study of the risk–benefit calculus on women’s contraceptive use and choice
Sofía L. Carbone A , Melissa Guillen B , Jaime J. Ramirez B , Sara E. Vargas B C , Connie Fei Lu C , Melissa L. Getz B , Yaa Frimpong C , Kelley A. Smith B , Claire Stout B , Iris Tong C D , Melanie Hill D , Robert E. Berry E , Abigail Harrison A and Kate M. Guthrie![https://orcid.org/0000-0002-5528-1212](/media/client/orcid_16x16.png)
A Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
B Center for Behavioral and Preventive Medicine, Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA.
C The Warren Alpert Medical School at Brown University, 222 Richmond Street, Providence, RI 02903, USA.
D Women’s Medicine Collaborative, Lifespan, 146 West River Street, Providence, RI 02904, USA.
E Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA.
F Corresponding author. Email: kate_guthrie@brown.edu
Sexual Health 17(3) 262-269 https://doi.org/10.1071/SH19197
Submitted: 7 November 2019 Accepted: 12 March 2020 Published: 26 June 2020
Abstract
Background: Reducing pregnancy risk requires a multidimensional approach to sexual and reproductive health product development. The purpose of this analysis is to identify, compare, and contrast women’s pre-use beliefs and attitudes about three different forms of contraceptives: intravaginal rings; spermicide in conjunction with condoms; and oral contraceptive pills – and explore how those attitudes and beliefs, along with actual method-use experience, may affect potential choices in contraceptive method moving forward. The relationship of beliefs and attitudes to their risk–benefit calculations when using these methods was also considered.? Methods: Women used one or more contraceptive methods, each for 3–6 months. Qualitative data from individual in-depth interviews completed after each 3-month use period were analysed using a summary matrix framework. Data were extracted and summarised into themes. Each woman’s experiences were compared among the methods she used; comparisons were also made across participants. Results: The data consist of 33 90–120 min in-depth qualitative interviews from 16 women aged 20–34 years, in which they discussed various elements of their method use experience. One prominent theme was identified: the influence of attitudes and beliefs on the risk–benefit calculus. There were six key elements within the theme: pregnancy prevention; dosing and the potential for user error; side-effects; familiarity; disclosure; and sexual partnerships. Conclusions: Women weighed perceived risks and benefits in their decision-making and, ultimately, their contraception choices. Understanding women’s beliefs and attitudes that contribute to a calculation of risk–benefit can inform the development of sexual and reproductive health products.
Additional keywords: contraception attitudes, contraception beliefs, intravaginal rings, oral contraceptive pills, spermicide and condoms.
References
[1] Watnick D, Keller MJ, Stein K, Bauman LJ. Acceptability of a tenofovir disoproxil fumarate vaginal ring for HIV prevention among women in New York City. AIDS Behav 2018; 22 421–36.| Acceptability of a tenofovir disoproxil fumarate vaginal ring for HIV prevention among women in New York City.Crossref | GoogleScholarGoogle Scholar | 29147810PubMed |
[2] Downey MM, Arteaga S, Villaseñor E, Gomez AM. More than a destination: contraceptive decision making as a journey. Womens Health Issues 2017; 27 539–45.
| More than a destination: contraceptive decision making as a journey.Crossref | GoogleScholarGoogle Scholar | 28412049PubMed |
[3] DeMaria AL, Sundstrom B, Faria AA, Moxley Saxon G, Ramos-Ortiz J. Using the theory of planned behavior and self-identity to explore women’s decision-making and intention to switch from combined oral contraceptive pill (COC) to long-acting reversible contraceptive (LARC). BMC Womens Health 2019; 19 82
| Using the theory of planned behavior and self-identity to explore women’s decision-making and intention to switch from combined oral contraceptive pill (COC) to long-acting reversible contraceptive (LARC).Crossref | GoogleScholarGoogle Scholar | 31221144PubMed |
[4] Brown W, Ottney A, Nguyen S. Breaking the barrier: the Health Belief Model and patient perceptions regarding contraception. Contraception 2011; 83 453–8.
| Breaking the barrier: the Health Belief Model and patient perceptions regarding contraception.Crossref | GoogleScholarGoogle Scholar | 21477689PubMed |
[5] Lowe P. Contraception and heterosex: an intimate relationship. Sexualities 2005; 8 75–92.
| Contraception and heterosex: an intimate relationship.Crossref | GoogleScholarGoogle Scholar |
[6] Rosen RK, Van Den Berg JJ, Vargas SE, Senocak N, Shaw JG, Buckheit RW, et al Meaning-making matters in product design: users’ sensory perceptions and experience evaluations of long-acting vaginal gels and intravaginal rings. Contraception 2015; 92 596–601.
| Meaning-making matters in product design: users’ sensory perceptions and experience evaluations of long-acting vaginal gels and intravaginal rings.Crossref | GoogleScholarGoogle Scholar | 26276246PubMed |
[7] Hogue CJ, Hall KS, Kottke M. Hormonal contraceptives improve women’s health and should continue to be covered by health insurance plans. Ann Intern Med 2017; 167 666–7.
| Hormonal contraceptives improve women’s health and should continue to be covered by health insurance plans.Crossref | GoogleScholarGoogle Scholar | 28973123PubMed |
[8] Lu CF, Vargas SE, Guillen M, Ramirez JJ, Carbone SL, Getz ML, et al A qualitative study of the contraceptive effect on women’s sexual experiences: beyond hormonal effects. Obstet Gynecol 2019; 134 91–101.
| A qualitative study of the contraceptive effect on women’s sexual experiences: beyond hormonal effects.Crossref | GoogleScholarGoogle Scholar | 31188319PubMed |
[9] Marshall C, Kandahari N, Raine-Bennett T. Exploring young women’s decisional needs for contraceptive method choice: a qualitative study. Contraception 2018; 97 243–8.
| Exploring young women’s decisional needs for contraceptive method choice: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 29038070PubMed |
[10] Mbopi-Keou FX, Trottier S, Omar RF, Nkele NN, Fokoua S, Mbu ER, et al A randomized, double-blind, placebo-controlled safety and acceptability study of two Invisible Condom® formulations in women from Cameroon. Contraception 2009; 80 484–92.
| A randomized, double-blind, placebo-controlled safety and acceptability study of two Invisible Condom® formulations in women from Cameroon.Crossref | GoogleScholarGoogle Scholar | 19835725PubMed |
[11] Morrow KM, Ruiz MS. Assessing microbicide acceptability: a comprehensive and integrated approach. AIDS Behav 2008; 12 272–83.
| Assessing microbicide acceptability: a comprehensive and integrated approach.Crossref | GoogleScholarGoogle Scholar | 17592763PubMed |
[12] Severy LJ, Tolley E, Woodsong C, Guest G. A framework for examining the sustained acceptability of microbicides. AIDS Behav 2005; 9 121–31.
| A framework for examining the sustained acceptability of microbicides.Crossref | GoogleScholarGoogle Scholar | 15812619PubMed |
[13] Stevens LM. “We have to be mythbusters”: clinician attitudes about the legitimacy of patient concerns and dissatisfaction with contraception. Soc Sci Med 2018; 212 145–52.
| “We have to be mythbusters”: clinician attitudes about the legitimacy of patient concerns and dissatisfaction with contraception.Crossref | GoogleScholarGoogle Scholar | 30031980PubMed |
[14] Sonfield A, Hasstedt K, Kavanaugh ML, Anderson R. The social and economic benefits of women’s ability to determine whether and when to have children. New York: Guttmacher Institute; 2013. Available online at: https://www.guttmacher.org/sites/default/files/report_pdf/social-economic-benefits.pdf [verified 15 May 2020].
[15] Nelson AL, Shabaik S, Xandre P, Kakaiya R, Awaida J, Mellon M, et al Perceptions of health risks associated with pregnancy compared to oral contraceptive use. Contraception 2019; 100 193–5.
| Perceptions of health risks associated with pregnancy compared to oral contraceptive use.Crossref | GoogleScholarGoogle Scholar | 31071308PubMed |
[16] Morrow KM, Underhill K, van den Berg JJ, Vargas S, Rosen RK, Katz DF. User-identified gel characteristics: a qualitative exploration of perceived product efficacy of topical vaginal microbicides. Arch Sex Behav 2014; 43 1459–67.
| User-identified gel characteristics: a qualitative exploration of perceived product efficacy of topical vaginal microbicides.Crossref | GoogleScholarGoogle Scholar | 24452632PubMed |
[17] Dalessandro C, James-Hawkins L, Sennott C. Strategic silence: college men and hegemonic masculinity in contraceptive decision making. Gend Soc 2019; 33 772–94.
| Strategic silence: college men and hegemonic masculinity in contraceptive decision making.Crossref | GoogleScholarGoogle Scholar |
[18] Higgins JA, Smith NK. The sexual acceptability of contraception: reviewing the literature and building a new concept. J Sex Res 2016; 53 417–56.
| The sexual acceptability of contraception: reviewing the literature and building a new concept.Crossref | GoogleScholarGoogle Scholar | 26954608PubMed |
[19] Fennell JL. Men bring condoms, women take pills: men’s and women’s roles in contraceptive decision making. Gend Soc 2011; 25 496–521.
| Men bring condoms, women take pills: men’s and women’s roles in contraceptive decision making.Crossref | GoogleScholarGoogle Scholar |
[20] Kimport K. Talking about male body-based contraceptives: the counseling visit and the feminization of contraception. Soc Sci Med 2018; 201 44–50.
| Talking about male body-based contraceptives: the counseling visit and the feminization of contraception.Crossref | GoogleScholarGoogle Scholar | 29433012PubMed |
[21] Vargas SE, Midoun MM, Guillen M, Getz ML, Underhill K, et al A qualitative systematic review of women’s experiences using contraceptive vaginal rings: implications for new technologies. Perspect Sex Reprod Health 2019; 51 71–80.
| A qualitative systematic review of women’s experiences using contraceptive vaginal rings: implications for new technologies.Crossref | GoogleScholarGoogle Scholar | 31108027PubMed |
[22] Guthrie KM, Rosen RK, Vargas SE, Getz ML, Dawson L, Guillen M, et al User evaluations offer promise for pod-intravaginal ring as a drug delivery platform: a mixed methods study of acceptability and use experiences. PLoS One 2018; 13 e0197269
| User evaluations offer promise for pod-intravaginal ring as a drug delivery platform: a mixed methods study of acceptability and use experiences.Crossref | GoogleScholarGoogle Scholar | 29758049PubMed |
[23] Fischbein RL, Lanese BG, Falletta L, Hamilton K, King JA, Kenne DR. Pregnant or recently pregnant opioid users: contraception decisions, perceptions and preferences. Contracept Reprod Med 2018; 3 4
| Pregnant or recently pregnant opioid users: contraception decisions, perceptions and preferences.Crossref | GoogleScholarGoogle Scholar | 29610676PubMed |
[24] Joint United Nations Programme on HIV and AIDS (UNAIDS). UNFPA, WHO and UNAIDS: position statement on condoms and the prevention of HIV, other sexually transmitted infections and unintended pregnancy. Geneva: UNAIDS; 2015. Available online at: https://www.unaids.org/en/resources/presscentre/featurestories/2015/july/20150702_condoms_prevention [verified 15 May 2020].
[25] Khan F, Mukhtar S, Dickinson IK, Sriprasad S. The story of the condom. Indian J Urol 2013; 29 12–15.
| The story of the condom.Crossref | GoogleScholarGoogle Scholar | 23671357PubMed |
[26] Higgins JA, Hirsch JS. Pleasure, power, and inequality: incorporating sexuality into research on contraceptive use. Am J Public Health 2008; 98 1803–13.
| Pleasure, power, and inequality: incorporating sexuality into research on contraceptive use.Crossref | GoogleScholarGoogle Scholar | 18703457PubMed |
[27] Moseson H, Zazanis N, Goldberg E, Fix L, Durden M, Stoeffler A, et al The imperative for transgender and gender nonbinary inclusion. Obstet Gynecol 2020; 135 1059–68.
| The imperative for transgender and gender nonbinary inclusion.Crossref | GoogleScholarGoogle Scholar | 32282602PubMed |
[28] Higgins JA, Carpenter E, Everett BG, Greene MZ, Haider S, Hendrick CE. Sexual minority women and contraceptive use: complex pathways between sexual orientation and health outcomes. Am J Public Health 2019; 109 1680–6.
| Sexual minority women and contraceptive use: complex pathways between sexual orientation and health outcomes.Crossref | GoogleScholarGoogle Scholar | 31536410PubMed |
[29] Dehlendorf C, Grumbach K, Schmittdiel JA, Steinauer J. Shared decision making in contraceptive counseling. Contraception 2017; 95 452–5.
| Shared decision making in contraceptive counseling.Crossref | GoogleScholarGoogle Scholar | 28069491PubMed |
[30] Teodoro N, Fu A, Ohly NT, Shalev N, Matseoane-Peterssen D, Westhoff CL. Long-acting reversible contraception knowledge, attitudes and use among HIV-infected and -uninfected women and their providers. Contraception 2019; 120 1386–94.
| Long-acting reversible contraception knowledge, attitudes and use among HIV-infected and -uninfected women and their providers.Crossref | GoogleScholarGoogle Scholar |
[31] Berlan ED, Pritt NM, Norris AH. Pediatricians’ attitudes and beliefs about long-acting reversible contraceptives influence counseling. J Pediatr Adolesc Gynecol 2017; 30 47–52.
| Pediatricians’ attitudes and beliefs about long-acting reversible contraceptives influence counseling.Crossref | GoogleScholarGoogle Scholar | 27639750PubMed |
[32] Dewart CM, Serpico J, Steiner MJ, Gallo MF. Electronic interventions for changing knowledge, attitudes or practices regarding contraception: a systematic review. Contraception 2019; 100 10–25.
| Electronic interventions for changing knowledge, attitudes or practices regarding contraception: a systematic review.Crossref | GoogleScholarGoogle Scholar | 30998928PubMed |
[33] Jawad A, Jawad I, Alwan NA. Interventions using social networking sites to promote contraception in women of reproductive age. Cochrane Database Syst Rev 2019; 3 CD012521
| Interventions using social networking sites to promote contraception in women of reproductive age.Crossref | GoogleScholarGoogle Scholar | 30818414PubMed |
[34] Multipurpose Prevention Technologies (MPTs). IMPT for Reproductive Health 2019. Sacramento: Public Health Institute/CAMI Health/IMPT Secretariat; 2019.