Hormonal contraceptive method choice among young, low-income women: how important is the provider?

OBJECTIVES

Several new methods are available, but we know little about successful integration of contraceptive technologies into services. We investigated provider factors associated with the initiation of new hormonal methods among women at high risk of unintended pregnancy.

METHODS

This cohort study enrolled 1387 women aged 15-24 starting hormonal contraception (vaginal ring, transdermal patch, oral contraceptive, or injectable) at four family planning clinics in low-income communities. We measured provider factors associated with method choice, using multinomial logistic regression.

RESULTS

Ring and patch initiators were more likely than women starting oral contraceptives to report that they chose their method due to provider counseling (p<0.001). Contraceptive knowledge in general was low, but initiation of a new method, the ring, was associated with higher knowledge about all methods after seeing the provider (p<0.001). Method initiated varied with provider site (p<0.001). These associations remained significant, controlling for demographics and factors describing the provider-patient relationship, including trust in provider and continuity of care.

CONCLUSION

Women's reports of provider counseling and of their own contraceptive knowledge after the visit was significantly associated with hormonal method initiated.

PRACTICE IMPLICATIONS: More extensive counseling and patient education should be expected for successful integration of new hormonal methods into clinical practice.