Original research article“I don't know enough to feel comfortable using them:” Women's knowledge of and perceived barriers to long-acting reversible contraceptives on a college campus☆,☆☆
Introduction
Leading health organizations have recognized long-acting reversible contraception (LARC) as a strategic priority to reduce rates of unintended pregnancy among young women in the United States and worldwide [1], [2], [3], [4]. Intrauterine devices (IUDs) and implants are highly efficacious, safe and cost-effective, and have higher satisfaction and continuation rates compared to other contraceptive methods [1], [2], [3], [4], [5], [6], [7], [8]. Nonetheless, use of LARC remains low in the United States. An estimated 6.4% and 0.8% of sexually active women use IUDs and implants, respectively [9]. Estimates are lower for adolescents and young adult women [10] and are similar for specific groups who are historically believed to have greater access to and knowledge of contraception, such as women in higher education programs [11]. In the most recent American College Health Association's National College Health Assessment (NCHA), 6.6% of sexually active females reported IUD use at last intercourse and 2.7% reported implant use [11].
College settings are an underutilized resource for improving young women's use of highly effective contraception. Women 18–24 years of age experience the highest rates of unintended pregnancy in the United States and comprise over half of the 18 million students attending US colleges; thus, campuses offer a unique opportunity to reach large, diverse numbers of women and reduce unintended pregnancy among this high-risk group [12], [13]. The NCHA, the most comprehensive, recurring survey of college students' health, collects little information on family planning outcomes or contraception method awareness, experiences and barriers to use [11]. An increasing body of research on IUDs, and to a lesser extent implants, from other contexts suggests that lack of knowledge and misconceptions are prevalent among young women generally, although these results have often been based on studies with clinical settings, small sample sizes, limited measurement approaches and inadequate attention to multiple dimensions of knowledge (e.g., mechanisms of action, efficacy, risks, benefits, use) [14], [15], [16], [17], [18], [19], [20], [21], [22], [23]. Furthermore, research to date has not adequately considered young women's perspectives on the diverse factors operating across levels of their environment which influence LARC knowledge, attitudes and uptake, especially in college contexts and among this high-risk age demographic.
We sought to describe knowledge, perceptions and experiences regarding IUDs and implants among a sample of college women and identify women's perceptions of individual-, health systems- and community-level barriers to LARC use on campuses.
Section snippets
Study design and sample
This study was part of a larger multiphase, mixed-method project aimed at identifying and addressing multi-level barriers to LARC in college settings. We conducted an Internet-based survey of undergraduate females at a large mid-western US university in fall of 2013. All full-time enrolled female undergraduate students who were English speaking and aged ≥ 18 years (n = 13,693) were eligible and e-mailed a series of invitations to participate in a “survey on reproductive health” through the Office
Sample characteristics
Characteristics of the sample (n = 1982) are presented in Table 1. The mean age was 19 years, and women were dispersed evenly across years in their undergraduate programs. The majority were white (75%), insured (90%), employed (67%); had mothers with at least some college education (91%); and identified as heterosexual (87%). Significant proportions resided on campus (43%), were not in a relationship (46%), were not religiously affiliated (34%) and never attended religious services (36%). Most
Discussion
Among this large sample of undergraduate women, knowledge of IUDs and implants was exceedingly low, estimated by both self-report and our formal LARC knowledge scale. In fact, women's perceived knowledge was much lower than their measured knowledge and the most salient individual-level perceived barrier precluding IUD and implant use was “not knowing enough.” Moreover, misperceptions about side effects, pain, serious health problems and method eligibility were other common barriers. These
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Awareness, knowledge, and misconceptions of adolescents and young people regarding long-acting reversible contraceptives: a systematic review and meta-analysis
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2020, Journal of Pediatric and Adolescent GynecologyThe effects of CenteringPregnancy group prenatal care on postpartum visit attendance and contraception use
2020, ContraceptionCitation Excerpt :While women in group prenatal care were less likely to choose permanent contraception, they were more likely to choose LARC methods. This may reflect the impact that facilitated group discussion of family planning options has on improving women’s knowledge of and comfort with choosing LARC methods of contraception [33,34]. The relatively small differences and low rates in contraception outcomes suggest the limitations of prenatal care to support postpartum contraception choice.
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Disclosures: V.K.D. served as an expert witness for Bayer Pharmaceuticals in 2014.
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Acknowledgements/Funding: This work was supported by NICHD Grant Nos. K12HD001438 (K.S.H.), T32HD007339 (E.E.), and R24HD041028 (K.S.H. and E.E.); the Society of Family Planning No. SFPRF7-T5 (A.C. and K.S.H.); and Robert Wood Johnson Foundation Clinical Scholars Program (M.M.), and received support from the Department of Obstetrics and Gynecology and Program on Women's Health Care Effectiveness Research at the University of Michigan (Director V.K.D.).