Contraceptive congruence: acknowledging pregnancy ambivalence in a novel measure of contraceptive use

BackgroundThe historical view that pregnancy intention is dichotomous (i.e., intending or not intending pregnancy), and the notion that all individuals not intending pregnancy should be using highly effective contraceptive methods, oversimplifies how we view contraceptive decision-making. To better understand this, we studied contraceptive congruence as an alternative, 3-level measure describing methods as very congruent, somewhat congruent, or incongruent with ones individual attitudes about becoming pregnant. MethodsSecondary data analysis included 982 MyNewOptions study participants who were not intending pregnancy within the next year. The cross-sectional survey assessed attitudes about how important it is to avoid pregnancy, how pleased/upset one would be if pregnant, and current contraceptive method use. Participant answers to attitudinal questions and effectiveness of current contraceptive method were used to determine congruence categories. ResultsContraceptive methods included LARC (8%), other prescription methods (50%), non-prescription methods (30%), and no method (12%). Methods for 23% of participants were very congruent, 48% somewhat congruent, and 29% incongruent with attitudes about becoming pregnant. Contraceptive congruence was significantly associated with contraceptive satisfaction in bivariate analysis. Predictors of contraceptive congruence included being married or living with partner, full-time employment, and intending future pregnancy in the next 1-5 years. ConclusionContraceptive congruence is a novel measure that acknowledges pregnancy ambivalence and is associated with higher contraceptive satisfaction scores. Future contraception research should strive for robust, patient-centered measures of contraceptive use that acknowledge the complex attitudes affecting individual contraceptive behavior and satisfaction.