MCH Student:

Amy Gilbert

Date of Defense:

May 2008

Abstract:

Introduction: About half of pregnancies in the U.S. are unintended. The proportion is higher among women who are poor, less educated, or of color. In Minnesota there is a large unmet need for contraceptive services, especially publicly supported services. Unintended pregnancy is associated with lower educational attainment and lower income for women, with increased infant mortality, with poorer health and educational outcomes for children, with social and economic costs, and with depletion of environmental resources. Causal factors include user- and method-related barriers, problems with family planning services, and political factors. It is now recognized that hormonal contraception can be provided safely without requiring a pelvic exam. Currently available services are not meeting women’s needs, but the nature of the mismatch is not clear.

Methods: Using a qualitative approach, a series of focus groups was conducted at community sites. Women from populations at high risk of unintended pregnancy discussed their experiences with contraceptive methods, and providers, and considered the idea of receiving birth control methods at community sites without a pelvic exam.

Findings: A key finding is that many women do not expect to plan whether to become pregnant; rather they wait to see if it happens. Many women expressed fear about the risks of contraceptive methods, and sometimes felt pushed into accepting a method they did not trust. Although they disliked pelvic exams, many felt they are necessary for sage prescription of birth control methods. There was guarded support for the idea of providing contraception at community sites without a pelvic exam. Women liked the ease of access, but some worried that important medical conditions would be missed.

Conclusion: With education about birth control methods and a non-pressured approach, providing contraception at community sites could offer a valuable approach to reducing unintended pregnancy.