Original research articleYoung women’s consistency of contraceptive use — does depression or stress matter?☆
Introduction
Contraceptive users account for over half of the annual 3.1 million unintended pregnancies in the United States, with 90% attributed to non-, inconsistent or incorrect use of contraceptive methods [1], [2], [3], [4]. Factors contributing to contraceptive misuse leading to unintended pregnancy are complex and include a wide range of demographic, social, reproductive, relationship and attitudinal characteristics [1], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. Young age, low educational attainment, low income, minority race/ethnicity, transient sexual partnerships, greater numbers of sexual partners, ambivalent attitudes towards pregnancy, dynamic life or professional circumstances (e.g. moving to a new home, starting/stopping a job, having a personal crisis), access issues, and method tolerability are a few examples of known predictors of poor contraceptive behavior [9], [10], [11], [12], [13], [14].
What has been studied to a lesser extent is the influence of mental health symptoms on women’s contraceptive use patterns. Depression, anxiety and related psychological stress are common among young women [16], [17] and are known to impact health behaviors including prescription medication adherence [18], [19]. These mental health symptoms have also been linked with potentially risky sexual practices correlated with negative reproductive sequelae including early and unprotected coitarche, higher number of sexual partners, acquistion of sexually transmitted infections, sex while under the influence of alcohol and drugs and intimate partner violence [20], [21], [22], [23], [24].
In contraceptive research, studies that have examined mental health symptoms have largely focused mood symptoms occurring with hormonal contraception [25], [26], [27] or have used cross-sectional or retrospective designs, limited psychological measures, or finite outcomes like oral contraceptive (OC) discontinuation [28], [29], [30], [31], [32]. It is unclear how women’s mental health symptoms may affect their use of contraceptive methods over time and within the context of their daily lives.
We prospectively investigated the influence of depression and stress on young women’s weekly consistency of contraceptive use, overall and by contraceptive method.
Section snippets
Sample and design
We used data from 992 young women participating in a longitudinal cohort study. Young women residing in a racial/ethnically and socioeconomically diverse county in Michigan were identified from state driver’s license and personal identification card registers. Names and contact information were randomly selected from these public records and eligible women (age 18–20 years at time of recruitment and a resident of the county) were contacted by mail or phone and asked to participate. Sampling
Weekly contraceptive use
Characteristics of our sample are described in Table 1. Among the 689 women who were sexually active and not pregnant (n= 8877 weeks), contraceptive nonuse was reported in 10% of study weeks, while 48% of weeks were covered by non-coital methods and 42% by coital methods alone. For contraceptive methods used each week (n= 7999), women reported long-acting methods (injectable 6%, IUD < 1% and implant < 1%), OCs (44%), other hormonal methods including the ring (1%) and patch (1%), condoms (27%),
Discussion
Using a unique longitudinal population-based design with weekly measurement of both sexual activity and contraceptive behavior, our study provides a more nuanced understanding of contraceptive behavior and factors associated with contraceptive misuse among young women [1], [2], [8], [9], [10]. We found that while sexually active young women reported using a contraceptive method in 90% of study weeks, a method was not used with every act of intercourse just over one-quarter of the time.
Conclusion and implications
Our study has shown that young women with elevated depression and stress symptoms appear to be at risk for inconsistent contraceptive use patterns, especially for the most common methods that require greater user effort and diligence. Based upon these findings which suggest that mental health status appears to be an important factor in women’s contraceptive behavior, clinicians should assess and even address women’s psychological and emotional status when helping patients with contraceptive
Acknowledgments/funding source
This work was supported by a NICHD Building Interdisciplinary Careers in Women’s Health K-12 Career Development grant (Hall, #K12HD001438), by a NICHD grant #R01-HDHD050329 (P.I. Barber, University of Michigan), and by a NICHD center grant for Infrastructure for Population Research at Princeton University (Trussell and Hall while she was a postdoctoral research fellow at Princeton University, #R24HD047879).
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Disclosure statement: None of the authors have a conflict of interest.