Consistency, complexity or chaos: a qualitative study of young women’s
patterns of contraceptive use
L. Williamson, K. Buston, H. Sweeting
MRC Social and Public Health Sciences Unit, University of Glasgow, UK
Objectives: Research has identified linear patterns of contraceptive
use in young women, progressing from non-use to condom use to oral contraceptive
use, but more recent studies have found more variable patterns, with young women
making many changes to their contraceptive use and giving diverse explanations
for this. The aim of this qualitative study is to investigate young women’s
patterns of contraceptive use during their early years of sexual activity and
develop a typology of contraceptive careers.
Design & Methods: A qualitative study using in-depth interviews
with 20-year-old young women from the East Coast of Scotland. Purposive
sampling, based on sex experience, area of residence, father’s social class,
and educational attainment was used to recruit a wide range of young women. The
interview schedule included questions on contraceptive and relationship history,
reasons for use and non-use of contraceptives, the influence of partners,
parents, friends, and others, and the use of sexual and reproductive health
services. Interviews were transcribed verbatim and analysed using framework
analysis.
Results: Young women were able to spontaneously name various
contraceptive methods including condoms, oral and injectable contraceptives, and
the IUD. Condoms were the predominant contraceptive method used, with all
participants reporting use of these at some time; all but one reported oral
contraceptive use. Most had used emergency contraception and half reported
episodes of unprotected (in contraceptive terms) sex. All of the young women had
changed their contraceptive method at least once. Changes occurred within and
between relationships, as a result of contraceptive crises (condom breakages,
experience of side effects), and for non-contraceptive reasons (management of
irregular menstruation, PMS, acne). Each young woman had her own specific
experience of contraceptive use, but overall three patterns were apparent:
consistent, complex and chaotic. Consistent contraceptive patterns were
characterised by uniform and regular use over time, regardless of relationship
changes or experience of contraceptive crises. Complex patterns were
characterised by change and variability, with method use depending on
relationships, partner type, non-contraceptive reasons and contraceptive crises.
These young women incorporated change in a manageable way. Chaotic patterns were
characterised by frequent method changes within and between relationships and
multiple contraceptive crises. For these young women the experience of frequent
method change was a further complication in somewhat disordered lives, leaving
them further exposed to contraceptive crises.
Conclusions: Young women experienced contraceptive method change and
they did not share a homogenous contraceptive pattern. Consistent, complex and
chaotic patterns were evident. To help young women control their fertility,
health care professionals must understand the influences that may be important
in young women’s lives and appreciate the dynamic nature of their reproductive
health needs.
