Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan;99(1):22-26.
doi: 10.1016/j.contraception.2018.08.014. Epub 2018 Aug 17.

Beyond intent: exploring the association of contraceptive choice with questions about Pregnancy Attitudes, Timing and How important is pregnancy prevention (PATH) questions

Claudia Geist  1 , Abigail Ra Aiken  2 , Jessica N Sanders  3 , Bethany G Everett  3 , Kyl Myers  3 , Patty Cason  4 , Rebecca G Simmons  3 , David K Turok  3
Affiliations

Beyond intent: exploring the association of contraceptive choice with questions about Pregnancy Attitudes, Timing and How important is pregnancy prevention (PATH) questions

Claudia Geist et al. Contraception. 2019 Jan.

Erratum in

Abstract

Objectives: To explore women's responses to PATH questions (Pregnancy Attitudes, Timing and How important is pregnancy prevention) about hypothetical pregnancies and associations with contraceptive method selection among individuals who present as new contraceptive clients and desire to prevent pregnancy for at least 1 year.

Study design: The HER Salt Lake Contraceptive Initiative provided no-cost contraception to new contraceptive clients for 1 year at family planning health centers in Salt Lake County. Those who wanted to avoid pregnancy for at least 1 year and completed the enrollment survey are included in the current study. We used Poisson regression to explore the association between survey-adapted PATH questions and contraceptive method selection.

Results: Based on an analytic sample of 3121 individuals, we found pregnancy timing and happiness about hypothetical pregnancies to be associated with method selection. Clients who report plans to wait more than 5 years [prevalence rate (PR) 1.14; 95% confidence interval (CI) 1.05-1.24], those who never wanted to become pregnant (PR 1.16; 95% CI 1.07-1.26) or those who were uncertain (PR=1.19; 95% CI 1.09-1.30) were all more likely to select IUDs and implants than women who reported wanting to become pregnant within 5 years. Greater happiness was associated with lower chance of choosing an IUD or implant (PR 0.98; 95% CI 0.96-0.999). Expressed importance of pregnancy prevention was not significantly associated with any specific contraceptive choice.

Conclusions: Pregnancy intentions and happiness about a hypothetical pregnancy were independently associated with selection of IUDs and implants.

Implications: Pregnancy attitudes, plans and emotions inform clients' contraceptive needs and behaviors. Client-centered contraceptive care may benefit from a more nuanced PATH approach rather than relying on a single time-oriented question about pregnancy intention.

Keywords: Contraceptive method choice; Cost barrier; Emotions about pregnancy; LARC; PATH questions; Pregnancy intentions.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest:

The University of Utah Department of Obstetrics and Gynecology Program in Family Planning receives research funding from Bayer Women’s Health Care, Merck & Co. Inc., Teva Pharmaceuticals, Bioceptive, Contramed, and Medicines 360. PC originally developed the PATH questions and serves on an advisory Board for Teva, ContraMed, and Cooper Surgical and as speaker/trainer for Teva, ContraMed, and Merck. The other authors have no conflicts of interest to report.

Figures

Figure 1
Figure 1
: Predicted probability of LARC choice by pregnancy intention and emotions towards pregnancy based on Poisson Regression Models (Table 3) for participants who enrolled in the survey arm of the HER Salt Lake Contraceptive Initiative and responded to key attitude, sociodemographic, and behavior measures. Note: N=3130. Based on results from multivariable Poisson regressions that adjusted for race, education, parity, insurance status, sexual identity, enrollment period, and clinic location. All controls held at sample means
See this image and copyright information in PMC

Comment in

  • A PATH to action perhaps?
    Nelson AL. Nelson AL. Contraception. 2019 Mar;99(3):194. doi: 10.1016/j.contraception.2018.09.008. Epub 2018 Oct 13. Contraception. 2019. PMID: 30326215 No abstract available.
  • Response to the letter to the editor.
    Geist C, Cason P, Simmons RG, Sanders JN, Everett BG, Aiken AR, Myers K, Turok DK. Geist C, et al. Contraception. 2019 Mar;99(3):194-195. doi: 10.1016/j.contraception.2018.10.003. Epub 2018 Oct 16. Contraception. 2019. PMID: 30339779 No abstract available.

References

    1. Bachrach CA, Newcomer S. Intended pregnancies and unintended pregnancies: Distinct categories or opposite ends of a continuum? Fam Plann Perspect. 1999;31:251–2. - PubMed
    1. Jones RK. Change and consistency in US women’s pregnancy attitudes and associations with contraceptive use. Contraception. 2017;95:485–90. - PMC - PubMed
    1. Aiken AR, Borrero S, Callegari LS, Dehlendorf C. Rethinking the pregnancy planning paradigm: unintended conceptions or unrepresentative concepts? Perspect Sex Reprod Health. 2016;48:147. - PMC - PubMed
    1. Bellanca HK, Hunter MS. ONE KEY QUESTION : Preventive reproductive health is part of high quality primary care. Contraception. 2013;88:3–6. - PubMed
    1. Callegari LS, Aiken AR, Dehlendorf C, Cason P, Borrero S. Addressing potential pitfalls of reproductive life planning with patient-centered counseling. Am J Obstet Gynecol. 2017;216:129–34. - PubMed

Publication types