Knowing what a woman values most highly in a contraceptive can help guide the health care conversation, say researchers from Washington University in St. Louis, who studied nearly 3,000 women enrolled in the Contraceptive CHOICE Project. Safety and effectiveness topped the general wish list; other factors weighed more or less heavily, according to the individual woman.
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Of the 2,590 women who completed the survey, 99.6% had used contraceptives, usually oral contraceptives and condoms. When choosing a method, they considered cost, whether the contraceptive is long lasting, whether it’s hard to remember to take or use it, and whether it protects against sexually transmitted infections. Health care providers’ recommendations also scored high. The women did not rate the influence of partner, family, friends, or religious community highly.
More than 40% ranked adverse effects (AEs) among the 3 most important factors. The majority had experienced ≥ 1 AE with a contraceptive method in the past, and 60% of those women had discontinued a method because of the AE.
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Tailored counseling is “essential” when talking to women about contraceptives, the researchers say, because many attributes are important. Moreover, they cite studies that have found personalized contraceptive counseling can improve adherence and satisfaction. However, it’s also important to educate women more fully, they advise. For instance, they found that women who said avoiding irregular bleeding or having a regular period were important factors were less likely to choose the copper intrauterine device (IUD), even though that device could resolve their concerns.
One potential limitation to their study, the researchers say, is that the respondents were all participants in the CHOICE Project (a prospective cohort study designed to promote the use of long-acting reversible contraception) and might not be representative of other populations of women. Use of IUDs and implants was much higher among the CHOICE participants than that of the nation: 75%, compared with 8.5%.
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Nonetheless, their findings have promise for health care visits, the researchers say. Once providers understand which attributes are most important to the women they care for, they can present contraceptive methods in an appropriate order, making counseling more effective and efficient.