Contraceptive careers: young women's choices, influences and risks

Williamson, Lisa Margaret (2008) Contraceptive careers: young women's choices, influences and risks. PhD thesis, University of Glasgow.

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Background: Reducing rates of unintended pregnancy among young women in the United Kingdom (UK) requires that we understand why young women use particular contraceptive methods, why they stop using them, and why, in turn, they switch to other methods. The majority of studies in this area have been quantitative, and few have taken place in the UK. This study examines the patterns of contraceptive use among young women from the East of Scotland, and uses a qualitative approach to explore if they have contraceptive careers.
Methods: Quantitative analyses of data collected as part of the SHARE (Sexual Health and Relationships) Sex Education Trial were used to explore young women’s contraceptive use, discontinuation, method switching, and patterns of use over time at age 16. In-depth interviews were conducted with 20 young women from this sample to examine their full sexual and contraceptive histories and the contexts within which they occur. Purposive sampling was used to select a heterogeneous sample of young women at age 20 based on sexual experience, area of residence, educational attainment and social background.
Findings: Young women’s contraceptive use is complex and, in the quantitative data, multiple individual patterns of use were apparent. In the qualitative study, three contraceptive career types were apparent: consistent, complex, and chaotic. Consistent contraceptive careers were characterised by uniform and regular use over time; complex by manageable change depending on relationships, partner type, and experiences of method use; and chaotic by frequent method changes and multiple experiences of contraceptive failure, which were further complications in their already, somewhat disordered lives.
All of the young women who were interviewed recognised their need for contraception but their ability to manage use, and therefore their experience of method discontinuation and contraceptive risks, varied depending on career type. All reported that they had changed their contraceptive method at least once, although most had only used condoms or the contraceptive pill. Most change was between these two particular methods. The need for pregnancy prevention underpinned all of the young women’s contraceptive choices, but for each method there were specific push factors, which encouraged use, and pull factors, which discouraged use. Ease of access and social norms around use encouraged condom use but the young women’s personal dislike of the method and their experience of condom failures resulted in change to the pill, particularly once the young women were in relationships with boyfriends. The pill was perceived to be more reliable, and its non-contraceptive benefits, particularly menstrual regulation, set it apart from other available methods and encouraged continued use. Use of alternative methods, such as long acting reversible contraceptives (LARC), was only initiated when the young women experienced major problems or side effects with the pill and change was advocated by a health professional. However, all who used alternatives, discontinued use because they disliked the side effects they experienced. Half had had unprotected sex, and for a few this was an unplanned, unexpected, one-off event, but for most it was a frequent behaviour, which became the norm. Most had used emergency contraception at some point, mainly as a result of contraceptive failure, and it remained a temporary, back-up method rather than a regular contraceptive.
Conclusions: Contraceptive discontinuation and method switching was common among the young women in this study. Assessing their different patterns of use demonstrated that for some, contraceptive use was straightforward, while for others, it remained a constant struggle. A range of contraceptive methods should be made available to young women as one size does not fit all. However, it is important to recognise that pill use can be unproblematic if managed well. Sexual and reproductive health policies and interventions should consider what might really suit each individual young woman, based on her lifestyle and contraceptive experiences.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: contraception, young women, sexual and reproductive health
Subjects: H Social Sciences > HM Sociology
H Social Sciences > H Social Sciences (General)
Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing
Supervisor's Name: Buston, Dr Katie and Sweeting, Dr Helen
Date of Award: 2008
Depositing User: Dr Lisa Margaret Williamson
Unique ID: glathesis:2008-164
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 10 Apr 2008
Last Modified: 10 Dec 2012 13:16

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