Abstract
Objective:
We examined whether contraceptive method type, satisfaction with use, and confidence in correct use were independently associated with switching intentions, a precursor of switching behaviors.
Study Design:
Data were from a probability-based sample survey carried out in Delaware and Maryland in 2016 and 2017 among women ages 18 to 44. Women’s current contraceptive methods were classified into five categories: coitally-dependent methods (barrier methods, withdrawal, and natural family planning); oral contraceptive pills, patches, and rings; injections; implants; and intrauterine contraception (IUC). Satisfaction, confidence, and switching intentions were dichotomized into being very versus less satisfied, being completely versus less confident, and having very low versus greater switching intentions. We conducted binomial logistic regression to examine whether method type, satisfaction, and confidence were independently associated with having very low switching intentions, adjusting for a range of covariates including sociodemographics, perceived health, religious attendance frequency, sexual, contraceptive, and reproductive experiences, and state of residence (Maryland or Delaware).
Results:
Among 1,077 women using reversible contraception, those using IUC relative to implants, pills, patches, or rings, and coitally-dependent methods were more likely to have very low switching intentions. Among all survey respondents, those who were very satisfied and those who were completely confident in correct use were also more likely to report very low switching intentions.
Conclusions:
Using IUC, being very satisfied, and being very confident in correct use were independently associated with having very low switching intentions.
Implications:
These results suggest that those using IUC have very low intentions to switch for reasons in addition to satisfaction-level with their method. Other aspects of using IUC such as ease of use, perceived barriers to switching, or having very low switching intentions before beginning IUC may be such reasons.
1. Introduction
Contraceptive behaviors are key determinants of unintended pregnancy [1]. Some behaviors include contraceptive discontinuation or switching [1-4]. Discontinuation is stopping use of a method whereas switching involves stopping one method and beginning another method [1-4]. Less research has focused on understanding what factors are associated with precursors of contraceptive behaviors. According to the theory of planned behavior, intention to engage in a behavior is the main precursor to engaging in a behavior [5]. In addition, attitudes such as satisfaction and beliefs regarding personal control as assessed by confidence in one’s ability to perform the behavior are precursors to actual engagement in behavior and they may have an effect entirely through intentions [5]. Thus, intention to switch a contraceptive method is a key determinant of actual switching of a method, and satisfaction with method and confidence in use of a method may affect individual’ switching intentions.
Method satisfaction, confidence in use, and contraceptive behavioral intentions have been found to be associated with contraceptive behaviors [6-9]. However, little to no research has focused on factors influencing contraceptive behavioral intentions, and particularly switching intentions. Contraceptive switching intentions are important because switching a method is frequently accompanied by gaps in contraceptive use [4], and those gaps increase risk of unintended pregnancy. In addition to examining factors associated with switching intentions, it is important to examine what factors are independently associated with satisfaction and confidence in correct use, two likely factors affecting switching intention [5]. Furthermore, being satisfied with one’s method and having confidence one is using one’s method correctly are important for patient-centered principles and recommended strategies for contraceptive counseling practices [10]. Based on prior research showing that method type is associated with satisfaction [6,11-13], the current study examined 1) whether method type was independently associated with contraceptive satisfaction and confidence in correct use and 2) whether method type, satisfaction, and confidence were independently associated with switching intentions, after controlling for sociodemographics, perceived health status, frequency of religious attendance, frequency of sex with a male in the past 3 months, and past contraceptive behaviors and reproductive experiences.
2. Material and Methods
2.1. Sample
We conducted a probability-based sample survey in Maryland and in Delaware to measure the reproductive health experiences of women. The survey was part of a larger evaluation of the Delaware Contraceptive Access Now program, launched in 2015 [14,15], which aimed to increase access to all forms of contraception for all women in the state by increasing free same day access through payment reform and clinical training. The survey was fielded by NORC at the University of Chicago from November 2016 through March 2017, in the early part of the program, through web based surveys and non-response follow-up using mailed questionnaires. NORC’s Institutional Review Board gave human subjects approval for data collection, and for data analysis, University of Maryland’s Institutional Review Board exempted the research since it was secondary data analysis of de-identified data.
Eligible respondents were women ages 18 to 44 residing in households. Briefly, households were randomly selected from an address-based frame built from the United States Postal Service (USPS) computerized delivery sequence (CDS) file and supplemented with age-targeted lists to improve sample efficiency. Census tracts with higher proportions of non-White households were oversampled. A more thorough description of how women were selected and the design of the survey may be found elsewhere [15].
The overall response rate was 23% [16]. Although this was a lower response rate than is often obtained from federal surveys, it was commensurate with other privately fielded probability-based reproductive health surveys [17]. Furthermore, we constructed post-stratified sample weights that corrected for differences in the initial probability of selection and differential non-response. The strata used in the post-stratification raking procedure included age, education-by-income, race/ethnicity, nativity, marital status, children under 18 in household, housing tenure, and employment. After applying these weights, characteristics from the sample matched population characteristics estimated from the American Community Survey, including characteristics not included in the weighting algorithm.
Our final analytical sample was restricted to women 1) who completed the full survey (n=2,933); 2) who were not currently pregnant, not trying to get pregnant, did not report infertility, and reported currently using a reversible contraceptive method (n=1,483); and 3) who had no missing value for any analytic variable (n= 1,077).
2.2. Measures
2.2.1. Outcomes
Satisfaction with method.
Satisfaction with current method was assessed with the question “How satisfied are you with your birth control method?” Response options were very satisfied, somewhat satisfied, neither satisfied nor dissatisfied, somewhat dissatisfied, and very dissatisfied. Women were coded into those who reported being very satisfied versus less satisfied.
Confidence in correct use.
Confidence in correct use was assessed with the question: “How confident are you that you have been using your method of birth control correctly for the past 3 months?” Response options were completely confident, somewhat confident, neither confident nor not confident, somewhat not confident, and not all confident. Women were coded into those who reported being completely confident versus less confident.
Switching intentions.
Switching intentions was measured with the following question: “Switching your current birth control method and using another method of birth control in the next 3 months is:” Response options were very likely, somewhat likely, neither likely nor unlikely, somewhat unlikely, or very unlikely. Women who reported being very unlikely to switch their birth control methods in the next 3 months were coded as very low switching intentions while everyone else was coded as having greater switching intentions.
2.2.2. Main predictor: contraceptive method type
We coded the reversible contraceptive methods into groups based on how methods are used or where methods are administered or placed (i.e., an injection into the arm, insertion into the uterus, or insertion into the arm by a health professional). Coitally-dependent methods included condoms, other barrier methods, withdrawal, and natural family planning. Self-administered hormonal methods included pills, patches, and rings. Depot Medroxyprogesterone Acetate (DMPA) was its own category since it is administered by a health professional into the arm. Intrauterine contraception (IUC) and implants were each in their own categories.
2.2.3. Covariates
We included the covariates of sociodemographic factors (age, race/ethnicity, household income, education, marital status, health insurance), health status, frequency of religious attendance, frequency of sex with a male in the past 3 months, number of different methods ever used, ever had an unintended pregnancy, when a/another child is desired, the importance of avoiding pregnancy, and state of residence (Maryland or Delaware).
2.3. Analysis
We used binomial logistic regression to examine whether method type was independently associated with being very satisfied with method and being very confident in correct use in the past 3 months, adjusting for all the covariates. We also used binomial logistic regression to examine whether method type, satisfaction with method, and confidence in correct use were independently associated with very low versus greater switching intentions in the next three months.
We conducted two sensitivity analyses. First, we reran the model predicting switching intentions separating out copper IUC (the one non-hormonal method) from hormonal IUC (which included 10 women who did not answer what type of IUC they were using). Second, we reran the model to examine the outcome of low switching intentions rather than just very low switching intentions. In that analysis, low switching intentions included those who said very unlikely and somewhat unlikely to switch while greater switching intentions included the other three categories. All analyses took the sample design into account by including weights, stratification, and cluster variables in the svy procedure in Stata.
3. Results
Descriptive information on satisfaction, confidence in correct use, switching likelihood, and contraceptive methods are presented in Table 1. Sixty-one percent were very satisfied with their method, 77.0% reported they were completely confident they were using their method correctly for the past 3 months, and 68.3% were very unlikely to switch in the next 3 months. Twenty-one percent were using IUC (5.4% of the all contraceptive users reported using copper IUC), 3.5% were using an implant, 4.7% were using DMPA, 45.1% were using pills, 0.2% were using patches, 3.1% were using rings, 17.3% were using condoms, and 5.1% were using a coitally-dependent method other than condoms (other barrier method, natural family planning, or withdrawal). Satisfaction and likelihood of switching varied by method type, p-values < 0.001. Those using IUC were more likely to report being very satisfied (75.0%) and very unlikely (88.0%) to switch their method and those using coitally-dependent methods were more likely to report being less satisfied and having greater switching intentions (36.7% very satisfied and 43.2% very unlikely to switch). Bivariate statistics in Table 2 show what covariates were associated with being very satisfied, being very confident in correct use in the past 3 months, and having very low intentions of switching methods in the next 3 months.
Table 1.
Satisfaction, Confidence in Correct Use, and Switching Intentions by Contraceptive Method Type in Delaware and Maryland, 2016-2017 (n = 1,077)
| Method type | ||||||
|---|---|---|---|---|---|---|
| Total % |
IUC (n = 224) |
Implant (n = 40) |
DMPA (n = 52) |
Pills, patches, or rings (n = 514) |
Coitally- dependent methods (n = 246) |
|
| Satisfaction* | ||||||
| Very satisfied | 60.9 | 75.0 | 69.3 | 66.6 | 64.9 | 36.7 |
| Less satisfied | 39.1 | 25.0 | 30.7 | 33.5 | 35.1 | 63.3 |
| Somewhat satisfied | 27.4 | 22.3 | 29.6 | 32.0 | 24.3 | 36.5 |
| Neither satisfied nor dissatisfied | 8.1 | 0.7 | 0.0 | 0.0 | 5.5 | 23.1 |
| Somewhat dissatisfied | 3.0 | 1.9 | 1.1 | 1.5 | 4.7 | 2.2 |
| Very dissatisfied | 0.7 | 0.1 | 0.0 | 0.0 | 0.6 | 1.5 |
| Confidence in Correct Use | ||||||
| Completely confident using correctly | 77.0 | 82.5 | 92.4 | 87.9 | 75.1 | 71.5 |
| less confident using correctly | 23.0 | 17.5 | 7.6 | 12.1 | 25.9 | 28.5 |
| Somewhat confident | 17.5 | 15.4 | 5.4 | 11.2 | 19.5 | 18.2 |
| Neither confident nor not confident | 2.7 | 2.1 | 2.2 | 0.1 | 1.3 | 6.9 |
| Somewhat not confident | 2.3 | 0.0 | 0.0 | 0.0 | 3.5 | 2.9 |
| Not at all confident | 0.5 | 0.0 | 0.0 | 0.8 | 0.7 | 0.5 |
| Switching Intentions* | ||||||
| Very low switching intentions | 68.3 | 88.0 | 58.7 | 78.9 | 70.9 | 43.2 |
| Greater switching intentions | 31.7 | 12.0 | 41.3 | 21.1 | 29.1 | 56.8 |
| Somewhat unlikely | 9.4 | 2.2 | 20.5 | 4.3 | 9.3 | 15.9 |
| Neither likely nor unlikely | 6.1 | 4.5 | 1.8 | 7.1 | 5.7 | 9.1 |
| Somewhat likely | 9.6 | 1.7 | 17.2 | 6.9 | 8.5 | 18.7 |
| Very likely | 6.6 | 3.6 | 1.8 | 2.7 | 5.6 | 13.0 |
Notes. IUC = intrauterine contraception; NA = not applicable
chi-square of dichotomous coding (i.e., very satisfied vs. not very satisfied and very low vs. not very low switching intentions) with method type is significant at p < .001.
Table 2.
Characteristics of women who currently use reversible contraception in Maryland and Delaware by satisfaction, confidence, and switching intentions, 2016-2017 (n = 1,077)
| Total | Satisfaction with method |
Confidence in correct use |
Switching Intentions |
|||||||
|---|---|---|---|---|---|---|---|---|---|---|
| %/mean (SD) |
Very satisfied |
Less satisfied |
p- value |
Completely confident |
Less confident |
p- value |
Very low |
Greater | p- value |
|
| Contraceptive method type | <0.001 | 0.19 | <0.001 | |||||||
| IUC | 21.0 | 25.8 | 13.4 | 22.4 | 16.0 | 27.0 | 7.9 | |||
| Implants | 3.5 | 4.0 | 2.8 | 4.2 | 1.2 | 3.0 | 4.6 | |||
| Injectable (DMPA) | 4.7 | 5.2 | 4.1 | 5.4 | 2.5 | 5.5 | 3.1 | |||
| Pills, patches, and rings | 48.4 | 51.6 | 43.5 | 47.2 | 52.6 | 50.3 | 44.4 | |||
| Coitally-dependent methods | 22.4 | 13.5 | 36.3 | 20.8 | 27.7 | 14.2 | 40.0 | |||
| Age | 0.26 | <0.01 | 0.13 | |||||||
| 18-24 | 26.8 | 28.9 | 23.4 | 24.0 | 36.0 | 27.6 | 24.9 | |||
| 25-34 | 44.7 | 41.5 | 49.8 | 42.9 | 50.8 | 41.5 | 51.7 | |||
| 35-44 | 28.5 | 29.6 | 26.8 | 33.1 | 13.2 | 30.9 | 23.3 | |||
| Race/ethnicity | 0.45 | 0.21 | 0.83 | |||||||
| White | 59.5 | 59.6 | 59.4 | 62.3 | 50.2 | 59.0 | 60.6 | |||
| Black | 21.2 | 20.6 | 22.2 | 19.3 | 27.5 | 20.9 | 21.9 | |||
| Hispanic | 5.8 | 7.2 | 3.6 | 4.9 | 8.9 | 5.6 | 6.3 | |||
| Other | 13.5 | 12.6 | 14.9 | 13.5 | 13.4 | 14.6 | 11.2 | |||
| Education | 0.94 | 0.46 | 0.93 | |||||||
| High school or less | 9.5 | 9.4 | 9.7 | 8.8 | 11.8 | 9.5 | 9.4 | |||
| Some college | 38.1 | 37.5 | 39.0 | 37.1 | 41.6 | 37.5 | 39.4 | |||
| At least college grad | 52.4 | 53.1 | 51.3 | 54.1 | 46.6 | 53.0 | 51.2 | |||
| Household Income | 0.13 | 0.09 | 0.26 | |||||||
| < 25,000 | 12.1 | 11.1 | 13.6 | 10.7 | 16.5 | 10.8 | 14.9 | |||
| 25,000-50,000 | 12.4 | 12.4 | 12.4 | 11.0 | 17.4 | 11.3 | 14.9 | |||
| 50,000-75,000 | 12.0 | 9.5 | 15.9 | 12.7 | 9.9 | 11.5 | 13.1 | |||
| >75,000 | 63.5 | 66.9 | 58.1 | 65.7 | 56.2 | 66.4 | 57.2 | |||
| Marital Status | 0.26 | 0.70 | 0.95 | |||||||
| Married/cohabitating | 65.1 | 61.9 | 70.1 | 65.6 | 63.3 | 65.0 | 65.3 | |||
| Not married nor cohabitating | 34.9 | 38.1 | 29.9 | 34.4 | 34.7 | 35.0 | 34.7 | |||
| Health insurance | 0.92 | 0.02 | 0.70 | |||||||
| Public | 15.2 | 14.9 | 15.6 | 12.6 | 23.7 | 14.5 | 16.7 | |||
| Private | 78.7 | 78.6 | 78.8 | 82.2 | 66.8 | 78.8 | 78.5 | |||
| Uninsured | 6.1 | 6.5 | 5.5 | 5.1 | 9.5 | 6.7 | 4.8 | |||
| Health status | <0.01 | 0.02 | 0.01 | |||||||
| Excellent or very good | 71.4 | 77.4 | 62.0 | 74.2 | 62.0 | 75.7 | 62.1 | |||
| Good | 24.9 | 20.0 | 32.4 | 21.8 | 35.0 | 21.6 | 31.8 | |||
| Fair or poor | 3.7 | 2.6 | 5.6 | 4.0 | 3.0 | 2.6 | 6.1 | |||
| Frequency of religious attendance | 0.22 | 0.79 | 0.52 | |||||||
| Infrequently | 56.1 | 54.2 | 59.1 | 56.5 | 54.9 | 55.1 | 58.4 | |||
| Frequently | 43.9 | 45.8 | 40.9 | 43.5 | 45.1 | 44.9 | 41.6 | |||
| Frequency of sex with male in past 3 months | 0.06 | 0.91 | 0.11 | |||||||
| None | 12.5 | 11.0 | 14.9 | 12.1 | 13.8 | 13.4 | 10.7 | |||
| Moderate | 43.1 | 40.1 | 47.7 | 43.1 | 43.1 | 39.7 | 50.3 | |||
| Frequent | 44.4 | 49.0 | 37.3 | 44.8 | 43.2 | 46.9 | 39.0 | |||
| Number of methods ever used | 2.56 (1.18) | 2.61 (1.21) | 2.47 (1.13) | 0.23 | 2.62 (1.21) | 2.34 (1.07) | 0.08 | 2.63 (1.22) | 2.39 (1.05) | 0.03 |
| Ever had an unintended pregnancy | 0.23 | 0.66 | 0.98 | |||||||
| No | 67.8 | 70.1 | 64.3 | 32.8 | 70.0 | 67.9 | 67.8 | |||
| Yes | 32.2 | 29.9 | 35.7 | 67.2 | 30.0 | 32.1 | 32.3 | |||
| State | 0.29 | 0.11 | 0.97 | |||||||
| DE | 13.0 | 13.8 | 11.8 | 13.8 | 10.3 | 13.0 | 13.0 | |||
| MD | 87.0 | 86.2 | 88.3 | 86.2 | 89.7 | 87.0 | 87.1 | |||
| When want a/another child | 0.79 | 0.01 | 0.88 | |||||||
| Don’t want one | 38.3 | 36.4 | 41.4 | 42.4 | 24.6 | 38.9 | 37.0 | |||
| Want one within 2 years | 17.4 | 17.6 | 16.9 | 16.6 | 20.0 | 16.4 | 19.5 | |||
| Want one in 2 or more years | 31.6 | 32.8 | 29.7 | 30.9 | 33.8 | 32.1 | 30.6 | |||
| Want one but don’t know when | 12.7 | 13.2 | 12.0 | 10.1 | 21.7 | 12.6 | 13.0 | |||
| How important to avoid pregnancy | 0.47 | 1.00 | 0.96 | |||||||
| Not very important to avoid | 31.6 | 32.9 | 29.6 | 68.4 | 68.4 | 68.5 | 68.3 | |||
| Very important to avoid | 68.4 | 67.1 | 70.4 | 31.6 | 31.6 | 31.5 | 31.7 | |||
Notes. Very low switching intentions includes those responding it is very unlikely they switch methods in the next 3 months, while not very low switching intentions is everyone else. IUC is intrauterine contraception. Infrequent religious attendance were those who responded they went once or twice a year or never, while frequent religious attendance were those who responded they went at least 3 times a year. For frequency of sex, none were those who reported no sex with a male in the past three months, moderate were those who reported sex less than once a month, about once a month, or a few times a month with a male, and frequent were those who reported sex about once a week or more.
In adjusted logistic regression analysis predicting satisfaction-level, women using pills, patches, or rings [OR = 0.47, 95% CI: 0.24-0.94] or coitally-dependent methods [OR = 13, 95% CI: 0.06-0.29] were less likely to report being very satisfied with their method relative to women using IUC. However, method type was not associated with confidence in correct use. In our adjusted logistic regression models predicting switching intentions, those using implants [OR = 0.19, 95% CI: 0.04-0.99], pills, patches, or rings [OR = 0.36, 95% CI: 0.16-0.86], and coitally-dependent methods [OR = 0.15, 95% CI: 0.06-0.39] relative to IUC were less likely to report very low switching intentions. In contrast, being very satisfied with one’s method [OR = 6.68, 95% CI: 4.15-10.76] and being very confident in correct use [OR = 1.78, 95% CI: 1.06-2.99] were associated with reporting very low switching intentions.
For our first sensitivity analysis we reran the model examining very low switching intentions separating copper IUC and hormonal IUC. Our reference group was hormonal IUC. We found that using copper IUC [OR = 15.52, 95% CI: 2.61-92.23] was associated with very low switching intentions relative to using hormonal IUC. In contrast, those using coitally-based methods [OR = 0.20, 95% CI: 0.07-0.54] were less likely to report very low switching intentions relative to those using hormonal IUC. Those using implants [OR = 0.26, 95% CI: 0.05-1.41] and patches, rings, or pills [OR = 0.49, 95% CI: 0.20-1.20] were also less likely to report very low switching intentions relative to those using hormonal IUC but no longer at p < 0.05. Those who were very satisfied versus not very satisfied [OR = 6.51, 95% CI: 4.03-10.52] and who were very confident versus not very confident in using their method correctly [OR = 1.82, 95% CI: 1.07-3.10] were more likely to report very low switching intentions.
Our second sensitivity analysis recoded switching intentions so that those who reported being very unlikely and somewhat unlikely to switch were coded as having low switching intentions while the other 3 categories (very likely, somewhat likely, neither likely nor unlikely) were coded as greater or not low switching intentions. Similar to our main analysis, we found that those using coitally-dependent methods [OR = 0.24, 95% CI: 0.07-0.74] were less likely to report low switching intentions and being very satisfied [OR = 6.76, 95% CI: 4.02-11.36] and being very confident in correct use [OR = 2.36, 95% CI: 1.38-4.05] were associated with having low switching intentions. We did not find a significant association between those using implants versus IUC [OR = 0.47, 95% CI: 0.12-1.75] or using pills, patches, or rings versus IUC [OR = 0.45, 95% CI: 0.15-1.30] and having low versus not low switching intentions. However, the associations were all in the same direction as our coding of very low versus not very low switching intentions in the main analysis.
4. Discussion
After controlling for a range of covariates, we found that being very satisfied with one’s method, being completely confident in the correct use, and using IUC were independently associated with having very low switching intentions. These findings support the theory of planned behavior in that satisfaction and confidence in one’s behavior (i.e., believing one is using contraception correctly) both were independently associated with switching intentions[5]. In our study, 75% of women using IUC, 69% using implants, 66% using injectables, 65% using pills, patches, or rings, and 37% using coitally-dependent methods were very satisfied with their method. And in models adjusted for a range of covariates, using IUC was associated with being very satisfied relative to using implants, pills, patches, or rings, and coitally-dependent methods. Other research has found individuals to be more satisfied with IUC relative to pills, patches, or rings or coitally-dependent methods [11-13]. Very high levels of satisfaction of IUC may be due to ease of use [13] or due to fewer user behaviors required of such methods compared to coitally-dependent methods.
Our results suggest that even though most IUC users reported being very satisfied with this method, and being very satisfied was associated with having very low switching intentions, this high-level of satisfaction did not fully account for the association between method type and switching intentions. Indeed, being very satisfied and using IUC were both independently associated with switching intentions, and had similar large magnitudes of association. That is, those using IUC had very low switching intentions relative to those using implants, pills, patches, or rings, and coitally-dependent methods, controlling for satisfaction with method.
There are a variety of reasons why IUC use might be associated with having very low switching intentions, independent of satisfaction and confidence in correct use. The single-item measure of global satisfaction, as we employed here, may miss important features of patient experience that reflect women’s underlying attitudes towards or experiences with contraception – e.g., ease of use, side effects, or concealability from partners. Alternatively, having very low switching intentions among IUC users may reflect perceived barriers to IUC removal. Such barriers might include perceived pressure to continue IUC that is exerted by national and state campaigns to increase IUC use, perceived difficulty in finding a provider to remove IUC, or experience with providers who discourage IUC removal either directly or implicitly [18-22]. Individuals may also expect or have experienced provider biases or pressure not to remove it [23,24]. It is also possible that those using IUC do in fact have very low switching intentions and that is why they choose this long-acting method. Related, women may choose coitally-dependent methods with which they are not satisfied temporarily while they are deciding on another method.
There are some limitations worth mentioning. First, we do not know why those using IUC had very low intentions to switch their methods, even after controlling for global satisfaction. Future research could examine why women using IUC, regardless of global satisfaction, had very low switching intentions. Second, we did not assess actual switching behavior to know whether intentions to switch predicted actual switching behaviors. Third, our results are generalizable to only individuals using contraception in Delaware and Maryland and may not generalize to other places. It was important to examine such factors in these states because the percentage of pregnancies that are unintended are high relative to other states [25]. Fourth, we did not assess knowledge about contraceptive methods, a factor that may be associated with intention to switch methods.
We found that among a representative sample of reproductive-aged women in Delaware and Maryland, those who were using IUC reported being very satisfied with their method relative to women using pills, patches, or rings and coitally-dependent methods. Across all users those who were very satisfied, those who were completely confident in correct use, and those using IUC were more likely to report very low switching intentions than those who were less satisfied, less confident, and using methods other than the IUC.
Table 3.
Adjusted odds ratios (and 95% CIs) from logistic regression models predicting Satisfaction, Confidence, and Switching Intentions in Delaware and Maryland, 2016-2017 (n = 1,077)
| Satisfaction with method (Very satisfied versus less satisfied) |
Confidence using method correctly (Completely confident vs. less confident) |
Switching intentions (Very Low vs. greater switching intentions) |
|
|---|---|---|---|
| Contraceptive method type | |||
| IUC | 1.00 | 1.00 | 1.00 |
| Implants | 0.74 (0.24-2.24) | 3.21 (0.76-13.45) | 0.19* (0.04-0.99) |
| Injectable (DMPA) | 0.68 (0.22-2.07) | 2.69 (0.54-13.29) | 0.48 (0.14-1.72) |
| Pills, patches, and rings | 0.47* (0.24-0.94) | 0.81 (0.36-1.81) | 0.36** (0.16-0.86) |
| Coitally-dependent methods | 0.13** (0.06-0.29) | 0.72 (0.29-1.75) | 0.15** (0.06-0.39) |
| Age | |||
| 18-24 | 1.00 | 1.00 | 1.00 |
| 25-34 | 0.85 (0.47-1.53) | 1.61 (0.75-3.48) | 0.37 (0.60-1.59) |
| 35-44 | 1.51 (0.71-3.20) | 4.24** (1.51-11.94) | 1.21 (0.51-2.88) |
| Race | |||
| White | 1.00 | 1.00 | 1.00 |
| Black | 1.05 (0.59-1.85) | 0.54 (0.26-1.12) | 1.17 (0.55-2.49) |
| Hispanic | 3.15** (1.30-7.62) | 0.49 (0.22-1.09) | 0.77 (0.29-2.02) |
| Other | 1.00 (0.53-1.89) | 0.90 (0.39-2.03) | 1.68 (0.73-3.86) |
| Education | |||
| High school or less | 1.00 | 1.00 | 1.00 |
| Some college | 0.76 (0.31-1.84) | 0.86 (0.35-2.08) | 0.68 (0.30-1.55) |
| At least college grad | 1.01 (0.37-2.73) | 0.66 (0.25-1.73) | 0.65 (0.25-1.70) |
| Household Income | |||
| < 25,000 | 1.00 | 1.00 | 1.00 |
| 25,000-50,000 | 1.74 (0.72-4.20) | 0.71 (0.30-1.71) | 0.88 (0.40-1.90) |
| 50,000-75,000 | 1.09 (0.49-2.46) | 1.40 (0.56-3.49) | 1.66 (0.71-3.87) |
| >75,000 | 1.86 (0.90-3.83) | 1. 17 (0.46-2.93) | 1.57 (0.75-3.32) |
| Marital Status | |||
| Not married nor cohabitating | 1.00 | 1.00 | 1.00 |
| Married/cohabitating | 0.46** (0.27-0.78) | 0.67 (0.35-1.25) | 1.20 (0.67-2.16) |
| Health insurance | |||
| Public | 1.00 | 1.00 | 1.00 |
| Private | 0.77 (0.37-1.61) | 1.86 (0.77-4.53) | 1.12 (0.55-2.29) |
| Uninsured | 0.87 (0.34-2.21) | 1.01 (0.34-2.95) | 2.23 (0.87-5.72) |
| State | |||
| DE | 1.00 | 1.00 | 1.00 |
| MD | 0.71 (0.48-1.07) | 0.71 (0.46-1.11) | 1.12 (0.72-1.75) |
| Frequency of religious attendance | |||
| Infrequently | 1.00 | 1.00 | 1.00 |
| Frequently | 1.40 (0.92-2.12) | 1.01 (0.60-1.69) | 1.02 (0.61-1.70) |
| Frequency of sex with male in past 3 months | |||
| None | 1.00 | 1.00 | 1.00 |
| Moderate | 1.98* (1.06-3.71) | 0.73 (0.34-1.57) | 0.54 (0.25-1.17) |
| Frequent | 2.88** (1.46-5.68) | 0.95 (0.41-2.17) | 0.65 (0.29-1.46) |
| Health status | |||
| Excellent or very good | 1.00 | 1.00 | 1.00 |
| Good | 0.56* (0.34-0.92) | 0.56* (0.31-0.98) | 0.86 (0.51-1.43) |
| Fair or poor | 0.38 (0.13-1.11) | 0.86 (0.30-2.42) | 0.59 (0.24-1.47) |
| Number of methods ever used | 0.93 (0.75-1.16) | 1.13 (0.89-1.43) | 1.02 (0.82-1.29) |
| Ever had an unintended pregnancy | |||
| No | 1.00 | 1.00 | 1.00 |
| Yes | 0.68 (0.42-1.09) | 1.15 (0.62-2.13) | 1.10 (0.64-1.87) |
| When want a/another child | |||
| Never | 1.00 | 1.00 | 1.00 |
| Within 2 years | 1.47 (0.72-3.02) | 0.72 (0.31-1.65) | 1.01 (0.49-2.07) |
| 2 or more years | 1.04 (0.57-1.92) | 0.75 (0.35-1.60) | 1.05 (0.52-2.12) |
| Not sure when | 1.47 (0.76-2.85) | 0.44* (0.20-0.96) | 1.07 (0.50-2.33) |
| Importance of avoiding pregnancy | |||
| Not very important | 1.00 | 1.00 | 1.00 |
| Very important | 0.72 (0.43-1.19) | 0.76 (0.42-1.35) | 0.86 (0.47-1.57) |
| Satisfaction with method | NA | NA | |
| Not very satisfied | 1.00 | ||
| Very satisfied | 6.68** (4.15–10.76) | ||
| Confidence in correct use | NA | NA | |
| Not very confident | 1.00 | ||
| Very confident | 1.78* (1.06-2.99) | ||
Notes.
p < 0.05
p< 0.01. Models adjust for all variables in each column that do not have a “NA” in its cell. Very low switching intentions includes those responding it is very unlikely they switch methods in the next 3 months, while not very low switching intentions is everyone else. IUC is intrauterine contraception. Infrequent religious attendance were those who responded they went once or twice a year or never, while frequent religious attendance were those who responded they went at least 3 times a year. For frequency of sex, none were those who reported no sex with a male in the past three months, moderate were those who reported sex less than once a month, about once a month, or a few times a month with a male, and frequent were those who reported sex about once a week or more.
Acknowledgments
Support
This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, population research infrastructure grant P2C-HD041041, and a research grant from a private philanthropic foundation. Neither organization had any involvement in the analysis and interpretation of the data, nor on the decision to submit the article for publication.
Footnotes
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Declaration of interests
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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