UNDERSTANDING CHANGES IN CONTRACEPTIVE INTENTION, KNOWLEDGE, AND ATTITUDES IN THE CONTEXT OF THE DELCAN INITIATIVE TO REDUCE UNINTENDED PREGNANCY

Abstract

Unintended pregnancies are consistently linked to a higher risk of negative health, social, and economic outcomes for both mother and child. A Delaware public health initiative sought to expand statewide access to all contraceptive methods, particularly IUDs and implants (also known as long-acting reversible contraception (LARC)), due to their high effectiveness, upfront costs, and provision barriers. This study examined changes in self-reported planned contraceptive use, knowledge, and attitudes prior to and following a visit with a medical provider to better understand the provider role in contraceptive outcomes. A diverse group of women (N=474) were recruited at primary care and women’s health Title-X-funded clinics in Delaware. Pre-visit contraceptive use or plan was assessed with two measures: current method use and a composite of current method use and planned method use. Incorporating women’s contraceptive plans in the pre-visit measure resulted in fewer participants being categorized as switching to LARC (2.3%) after a provider visit, compared to the measure that only accounted for current contraceptive use (8.2%). The strongest predictor of changing to a method of higher effectiveness was pre-visit contraceptive choice. On average, women’s knowledge increased; participants with lower pre-visit knowledge were more likely to improve in knowledge post-visit (p<0.001). On average, positive attitudes about LARC decreased, although some individual items changed in the positive direction while others changed in the negative direction. Those with more versus less positive attitudes before the clinic visit had larger decreases in positive attitudes (p<0.001). The full rollout of the DelCAN initiative was associated with an increase in LARC knowledge, while its association with change in LARC attitudes and effectiveness level of planned method use was mixed. These findings suggest that measuring contraceptive plans as opposed to only current method use before a visit is important when applying a pre-post visit design to evaluations of contraceptive use or plans; broadening the conceptualization and measurement of pre-visit contraceptive use or plans could better capture the sources of change that may manifest in post-visit. Additionally, clinic visits may serve as effective education events, particularly for women with lower contraceptive knowledge, and they may provide a more realistic understanding of different contraceptive methods’ advantages and disadvantages. It is possible that the lack of increase in positive contraceptive attitudes may be attributable to the negativity bias following changes in knowledge and personal experience, but more research is needed to replicate and understand the phenomenon.