The Role of Reproductive Autonomy in Adolescent Contraceptive Choice and Acceptance of Long-acting Reversible Contraception.

STUDY

OBJECTIVE

To examine the association between reproductive autonomy and adolescent receptivity toward long-acting reversible contraceptive (LARC) methods.

DESIGN

A survey to assess sexual history and contraceptive practices/knowledge/attitudes was administered. Reproductive autonomy was measured with an adapted validated scale.

SETTING

Adolescent medicine clinic in an urban academic medical center in the Midwestern United States.

PARTICIPANTS

Girls ages 14-21 years who presented for well or contraceptive visits.

INTERVENTIONS AND MAIN OUTCOME MEASURES: Primary outcome was a favorable rating toward the question "How much do you like the idea of LARC for yourself?" The primary independent variable was the reproductive autonomy decision-making subscale score (higher score indicating increased autonomy).

RESULTS

Eighty-nine participants with a mean age of 16 years completed surveys. Almost all (92%) identified as African American. At study enrollment 56.2% were using Depo-Provera (Pfizer), 15.7% oral contraceptives, 3.4% implants, and 24.7% no method. Only 13.5% of participants liked the idea of LARC for themselves. The mean score on the decision-making subscale was 9 (range, 4-12). In bivariable analysis, age was associated with decision-making subscale score, but was not retained as a confounder in multivariable analysis. The odds of liking LARC decreased by 30% with each unit increase in the autonomy decision-making subscale score (odds ratio, 0.70; 95% confidence interval, 0.52-0.94; P = .02).

CONCLUSION

Our findings suggest that adolescents with higher reproductive autonomy, measured according to their score on the decision-making subscale, were less likely to favor LARC. Further research should explore participants' perceptions of autonomy and the relational dynamics between adolescents and their parents/partners in contraceptive choice.