Contraceptive risk events among family planning specialists: a cross sectional study

Abstract

Proponents of abortion restriction cite advancements in contraceptive technology as a reason against the need for abortion care today, most recently through oral arguments in the Supreme Court of the United States case, Dobbs v. Jackson Women’s Health. However, consistent and correct use of contraception requires reproductive health literacy. Our objectives were to quantify contraceptive risk events and assess contraceptive history and preferences among a population well-equipped to evade contraceptive risks, family planning specialists following initiation of their medical training. “Risk events” are defined as reported episodes of contraceptive failure, emergency contraception use and/or unprotected or underprotected intercourse. This was a cross-sectional study among current members of a professional organization of family planning specialists. Inclusion criteria included: status as a current or retired clinician, consensual penile-vaginal intercourse and personal or partner capacity to become pregnant since the start of medical training. Descriptive statistics were performed. This study was IRB exempt. Among 229 respondents, 157 (69%) reported experiencing a contraceptive risk event since training. Twenty-nine (13%) respondents reported an occurrence within the last year. By category, 47% (108/229; 3 reported unknown) reported under- or unprotected intercourse, 35% (81/229) reported emergency contraception use, and 52% of participants (117/227; 2 unknown) reported known or suspected contraceptive failure. The mean number of contraceptive methods used was 3.7 (SD 1.7) out of the 13 methods listed. Almost all (97%) participants reported at least one method was not an acceptable option, with a mean of 5.6 (SD 2.7) of the 13 listed methods. The majority of family planning specialists have experienced contraceptive risk events during times of active pregnancy prevention since their medical training. Contraceptive method change is common and most respondents were limited in the number of methods that were personally acceptable to them. Dialogue idealizing the role of contraception in minimizing or eliminating abortion need is simplistic and inaccurately represents the lived realities of pregnancy-capable individuals and their partners, including among those with exceptional contraceptive literacy and access. Since Dobbs v. Jackson, the landmark Supreme Court of the United States case overturning the right to abortion, it is very important to better understand current birth control use and the risk of unintended pregnancy. While birth control helps people to avoid unintended pregnancy, current methods are not perfect. This study examined the limitations of current birth control, even when used by expert clinicians with special knowledge and access. We provided an online survey to doctors and advanced practice clinicians who specialize in birth control. We measured risk of unintended pregnancy by asking about experiences with birth control failure, emergency contraceptive use (such as plan B), and unprotected sex since the start of medical training. We also asked about reasons for changing or avoiding certain birth control methods. Among 229 expert clinicians, we found that nearly 70% had experienced a risk of unintended pregnancy since beginning their medical training. Birth control method change was common, and many reported that several options were unacceptable. Participants shared that they found methods difficult, unreliable, unpleasant, or had health conditions that limited the number of safe options available. Our findings suggest that, even among experts, everyone remains at risk of unintended pregnancy. The study highlights the need for improved birth control options as well as access to safe and legal abortion.