The process of contraceptive decision-making in women: using a feminist grounded theory approach

Abstract

Half of pregnancies in the United States that occur annually are unintended. Half of these pregnancies occur among women using contraceptives; half are electively terminated. Reducing contraceptive discontinuation and failure could have a significant impact on abortion rates and the toll that unintended pregnancies have on women. The purpose of this study is to develop a theory of contraceptive decision-making in women to contribute to knowledge development, which may make a difference in women's lives as they negotiate contraceptive use. A feminist, grounded theory design was chosen using the data collection method of open-ended interviews. Sixteen women were interviewed from August, 2002, through January, 2003 on the island of Kauai using a semi-structured interview guide. The data, which included interviews, field notes and memos, were coded using open, axial, and selective coding methods and analyzed using constant comparative analysis until saturation occurred. The core category that describes the process of contraceptive decision-making in women is "finding the best fit". Women choose a method or methods to prevent pregnancy based on their knowledge, experience, and evaluation of what would be the best fit within the context of their current life situation. Categories of "finding the best fit" are "becoming aware", "weighing what's best for me", and "navigating a course". Women become aware of options and/or resources for preventing pregnancy. In "weighing what's best for me", a woman evaluates one or more methods for preventing pregnancy in order to choose one that is most suitable within the context of her current life circumstances. In "navigating a course", women contend with access to and use of one or more birth control methods. It is recommended that providers should conduct a thorough contraceptive history, identify a woman's perceptions of methods, and identify personal and clinical practice biases. Providers should offer a variety of educational materials and explore ways to link with community, educational, and political agencies to offer programs for and increase access to birth control. Further knowledge development about becoming aware, having support, women's perceptions of methods is recommended as well as to repeat this study in different populations.