Contraceptive Attitudes among Female College Students

Kellie D. Bryant RN, DNPKellie D. Bryant RN, DNP

Associate ProfessorAssociate Professor

SUNY DownstateSUNY Downstate

Problem: Unintended Pregnancy & Contraception

• 60% of pregnancies are unintended60% of pregnancies are unintended

• Leading causes are lack of contraceptive use Leading causes are lack of contraceptive use and contraceptive failure and contraceptive failure

• 53% of unintended pregnancies could have 53% of unintended pregnancies could have been avoided if women used contraception been avoided if women used contraception

Highest Teenage Pregnancy Rate

1.1. US (52.1 births/1000 women 15-19 years) US (52.1 births/1000 women 15-19 years)

2. United Kingdom (30.8 births/1000) second2. United Kingdom (30.8 births/1000) second

Highest teenage births among 28 rich nations.Highest teenage births among 28 rich nations.

Reasons for Lack of Contraceptive Use

• Misconceptions about contraceptivesMisconceptions about contraceptives• Negative attitude about contraception Negative attitude about contraception • Failure to recognize the risk of pregnancyFailure to recognize the risk of pregnancy• Inability to communicate with their partner Inability to communicate with their partner

about contraceptives about contraceptives • Partners disapprove of contraceptionPartners disapprove of contraception• Worried about side effectsWorried about side effects

Barriers to Contraception

• Cost, substandard health care facilities, Cost, substandard health care facilities, childcare issues, and lack of transportation childcare issues, and lack of transportation

• Among Blacks and Hispanics -decreased Among Blacks and Hispanics -decreased income, higher rate of unemployment, income, higher rate of unemployment, decreased level of education, and lack of decreased level of education, and lack of insuranceinsurance

Purpose of Study

• To examine contraceptive attitudes and To examine contraceptive attitudes and demographic characteristics of demographic characteristics of contraceptive users among female college contraceptive users among female college students from three different groups of students from three different groups of contraceptive usecontraceptive use

Three Contraceptive Groups

1.1. ““All the time” = All the time” = Uninterrupted userUninterrupted user

2.2. ““Sometimes” = ISometimes” = Intermittent contraceptive ntermittent contraceptive useruser

3.3. ““Never” = Never” = Contraceptive nonusersContraceptive nonusers

Importance of Proposed Study

• Contraceptive use among college students Contraceptive use among college students has not been well examined has not been well examined

• Lack of research on contraceptive use since Lack of research on contraceptive use since the development of newer forms of the development of newer forms of contraceptivescontraceptives

Importance of Proposed Study

• Identification of women’s attitudes about Identification of women’s attitudes about contraceptives may help health care contraceptives may help health care providers eliminate some of the barriers and providers eliminate some of the barriers and misconceptions regarding contraceptives. misconceptions regarding contraceptives.

• Women ages 18-24 have a high rate of Women ages 18-24 have a high rate of unintended pregnancy rateunintended pregnancy rate

Research Questions and Hypothesizes

Research Questions

1.1. What are the most commonly used What are the most commonly used contraceptive methods among female contraceptive methods among female college students?college students?

2.2. What percentage of female college What percentage of female college students are in the 3 groups of students are in the 3 groups of contraceptive users: uninterrupted, contraceptive users: uninterrupted, intermittent, and nonusers? intermittent, and nonusers?

Research Questions

3.3. What are the most common demographic What are the most common demographic characteristics among the 3 groups characteristics among the 3 groups (uninterrupted contraceptive users, (uninterrupted contraceptive users, intermittent contraceptive users, & intermittent contraceptive users, & contraceptive nonusers?contraceptive nonusers?

4.4. What are the contraceptive attitude scores What are the contraceptive attitude scores of female college students?of female college students?

Research Question

5.5. Do contraceptive attitude scores of female Do contraceptive attitude scores of female college students vary by race, age, marital college students vary by race, age, marital status, and socioeconomic status?status, and socioeconomic status?

6.6. Do contraceptive attitude scores vary Do contraceptive attitude scores vary among uninterrupted contraceptive users, among uninterrupted contraceptive users, intermittent contraceptive users, and intermittent contraceptive users, and contraceptive nonusers?contraceptive nonusers?

Hypothesis

1. Demographic factors associated with 1. Demographic factors associated with uninterrupted contraceptive use are being uninterrupted contraceptive use are being married, 24 years of age or older, from a married, 24 years of age or older, from a higher socioeconomic status, and White. higher socioeconomic status, and White.

Hypothesis

2. Contraceptive attitude scores will be lowest 2. Contraceptive attitude scores will be lowest among females who are Black or Hispanic, among females who are Black or Hispanic, less than 24 years of age, unmarried, and less than 24 years of age, unmarried, and from lower socioeconomic levels.from lower socioeconomic levels.

Hypothesis

3. Contraceptive attitude scores among 3. Contraceptive attitude scores among uninterrupted contraceptive users will be uninterrupted contraceptive users will be higher than among intermittent higher than among intermittent contraceptive users and nonusers. contraceptive users and nonusers.

Methods

Design

• Quantitative, comparative descriptive Quantitative, comparative descriptive design design

• Participants categorized by the frequency Participants categorized by the frequency they use their preferred contraceptive they use their preferred contraceptive method: 1) Uninterrupted, 2) Intermittent, method: 1) Uninterrupted, 2) Intermittent, and 3) non use of contraceptives. and 3) non use of contraceptives.

Setting

• University located in a highly diverse area University located in a highly diverse area of a large metropolitan city on the east of a large metropolitan city on the east coast. coast.

• 47% black, 15% Hispanic, 25% white, and 47% black, 15% Hispanic, 25% white, and 13% Asian 13% Asian

• 72% female 72% female • Average age of an undergraduate student is Average age of an undergraduate student is

24 years 24 years

Sample Criteria

• Inclusion criteria - female college student, Inclusion criteria - female college student, between the ages of 18 to 44, who can read between the ages of 18 to 44, who can read and speak English and has been sexually and speak English and has been sexually active in the past three months active in the past three months

• Exclusion criteria - females older than 44, Exclusion criteria - females older than 44, younger than 18 years of age, and students younger than 18 years of age, and students who do not speak or read English. who do not speak or read English.

Sample

• Convenience, purposive sample N = 120Convenience, purposive sample N = 120

• Mean age = 24.2Mean age = 24.2

Range = 18 to 44 yearsRange = 18 to 44 years

• Racial background : Black (45%), Racial background : Black (45%),

White (19.2%), Hispanic (14.2%), White (19.2%), Hispanic (14.2%),

Asian/Pacific Islander (13.3%). Asian/Pacific Islander (13.3%).

Sample

• Student income: 65.3 % earned Student income: 65.3 % earned <<$19,999$19,999• Marital Status: 12.5% marriedMarital Status: 12.5% married• Religion: 63.4% Christian, 11.7% No Religion: 63.4% Christian, 11.7% No

ReligionReligionClassified into 3 groups of contraceptive Classified into 3 groups of contraceptive

users: 1) Uninterrupted, 2) Intermittent, 3) users: 1) Uninterrupted, 2) Intermittent, 3) Non- userNon- user

Years of College of Participants

Questionnaire

The survey consisted of three questionnairesThe survey consisted of three questionnaires• Contraceptive Attitude ScaleContraceptive Attitude Scale• Contraceptive Use ToolContraceptive Use Tool• Demographic ToolDemographic Tool

• Survey took approximately 11 minutes to Survey took approximately 11 minutes to complete complete

Results

RQ 1 Results: Most commonly used contraceptive methods

• The 5 most preferred methods: male The 5 most preferred methods: male condom (48.2%), pill (22.4%), withdrawal condom (48.2%), pill (22.4%), withdrawal (10.6%), patch (4.7%), and Depo Provera (10.6%), patch (4.7%), and Depo Provera (4.1%).(4.1%).

RQ 2: What % are uninterrupted, intermittent and nonusers

Research Question #3

• What are the most common demographic What are the most common demographic characteristics among uninterrupted characteristics among uninterrupted contraceptive users, intermittent contraceptive users, intermittent contraceptive users, and contraceptive contraceptive users, and contraceptive nonusers?nonusers?

RQ# 3 Results

• The findings from this study failed to find a The findings from this study failed to find a relationship between contraceptive use and relationship between contraceptive use and race, age, socioeconomic level, years of race, age, socioeconomic level, years of education, or religion education, or religion

• May be due to the homogenous sample of May be due to the homogenous sample of students at the University.students at the University.

Research Question #4

• What are the contraceptive attitude scores What are the contraceptive attitude scores of female college students?of female college students?

RQ#4: Results

• The contraceptive attitude scores for the The contraceptive attitude scores for the participants in the study were homogenous. participants in the study were homogenous.

• Most participants had a positive attitude. Most participants had a positive attitude.

• The mean score for the group was 4.1008 The mean score for the group was 4.1008 out of 5 with a SD of 0.498.out of 5 with a SD of 0.498.

Research Question #5

• Do contraceptive attitude scores of female Do contraceptive attitude scores of female college students vary by race, age, marital college students vary by race, age, marital status, and socioeconomic status?status, and socioeconomic status?

RQ # 5 Results

• Contraceptive attitude scores did not vary Contraceptive attitude scores did not vary by age, race, marital status, and by age, race, marital status, and socioeconomic statussocioeconomic status

Research Question #6

• Do contraceptive attitude scores vary Do contraceptive attitude scores vary among uninterrupted contraceptive users, among uninterrupted contraceptive users, intermittent contraceptive users, and intermittent contraceptive users, and contraceptive nonusers?contraceptive nonusers?

Results among 3 Contraceptive Groups

• Uninterrupted users scored 0.27 points Uninterrupted users scored 0.27 points higher on the contraceptive attitude scale higher on the contraceptive attitude scale than intermittent users.than intermittent users.

• Uninterrupted users scored 0.45 points Uninterrupted users scored 0.45 points higher than nonusers.higher than nonusers.

Contraceptive Attitude Scale

• Students with higher contraceptive attitude Students with higher contraceptive attitude scores were more likely to be consistent scores were more likely to be consistent contraceptive users. contraceptive users.

Additional Findings

• Blacks were more likely to use condoms. Blacks were more likely to use condoms. • Older women less likely to use birth control.Older women less likely to use birth control.• Whites more likely to use withdrawal method. Whites more likely to use withdrawal method. • Younger students more likely to use condoms.Younger students more likely to use condoms.• Students with more years of college were more Students with more years of college were more

likely to use birth controllikely to use birth control..

Top 5 Reasons for Not using Birth Control

• Worried about side effects Worried about side effects

• Health concerns Health concerns

• Opposed to birth control Opposed to birth control

• Partner opposed Partner opposed

• Want children Want children

Woman 35 and Older

• Women 35 & older were less likely to use Women 35 & older were less likely to use birth control birth control

• May be due to older woman believing they May be due to older woman believing they have a small chance of becoming pregnant have a small chance of becoming pregnant

• May be due to increased fear of side effects May be due to increased fear of side effects due to advanced age and the misconception due to advanced age and the misconception that hormonal methods may negatively that hormonal methods may negatively affect their health. affect their health.

Younger Woman and Condoms

• Increased condom use was among younger Increased condom use was among younger woman.woman.

• May be contributed to younger woman May be contributed to younger woman being less likely to be married or in a long being less likely to be married or in a long term monogamous relationship. term monogamous relationship.

• Younger woman to be more likely to use Younger woman to be more likely to use condoms due to concerns about protection condoms due to concerns about protection against sexually transmitted infections. against sexually transmitted infections.

Evidence Based Practice

What Works???

• Better contraceptive services;Better contraceptive services;

• New methods that are more effective and New methods that are more effective and easier to use;easier to use;

• Methods with noncontraceptive benefitsMethods with noncontraceptive benefits

• Making methods available without the need Making methods available without the need to see a doctorto see a doctor

• Improved education -Improved education -

Evidence Practice to Decrease Unintended Pregnancies

• Women considering birth control should Women considering birth control should receive detailed information - both verbal receive detailed information - both verbal and written and written

Information to Discuss with Clients

• Contraceptive efficacy Contraceptive efficacy

• Duration of use Duration of use

• Risks and possible side effects Risks and possible side effects

• Non-contraceptive benefits Non-contraceptive benefits

• The procedure for initiation and The procedure for initiation and removal/discontinuation removal/discontinuation

• When to seek help while using the methodWhen to seek help while using the method

Evidence Based Practice

• Adequate time during consultations to Adequate time during consultations to address contraceptive and broader health address contraceptive and broader health issues . issues .

• Contraceptive and sexual health services in Contraceptive and sexual health services in schools to promote and provide the schools to promote and provide the planning, delivery, and evaluation of sex planning, delivery, and evaluation of sex and relationship education. and relationship education.

Evidence Based Practice

• IUD’s , IUS, and implants are more cost IUD’s , IUS, and implants are more cost effective than the injectable contraceptives effective than the injectable contraceptives

• Increasing the use of these methods will Increasing the use of these methods will reduce the number of unintended reduce the number of unintended pregnanciespregnancies

In Reality…

• No single intervention will make a No single intervention will make a measurable difference. measurable difference.

• Providers should concentrate on Providers should concentrate on encouraging correct and consistent use. encouraging correct and consistent use.

• Frequent follow-up appointments are Frequent follow-up appointments are required . required .

The End

Questions and AnswerQuestions and Answer