Beyond safety and efficacy: sexuality-related priorities and their associations with contraceptive method selection

Jenny A Higgins; Kelsey Q Wright; David K Turok; Jessica N Sanders

doi:10.1016/j.conx.2020.100038

Beyond safety and efficacy: sexuality-related priorities and their associations with contraceptive method selection

Contracept X. 2020 Aug 19:2:100038. doi: 10.1016/j.conx.2020.100038. eCollection 2020.

Authors

Jenny A Higgins^{1

2

3

4}, Kelsey Q Wright^{1

2}, David K Turok⁵, Jessica N Sanders⁵

Affiliations

¹ Center for Demography and Ecology, 4412 Social Sciences, 1180 Observatory Drive, Madison, WI 53706, USA.
² Collaborative for Reproductive Equity, 4440 Social Sciences, 1180 Observatory Drive, Madison, WI 53706.
³ Department of Obstetrics and Gynecology, 1010 Mound St., Madison, WI 53715.
⁴ Department of Gender and Women's Studies, 3321 Sterling Hall, Madison, WI 53706.
⁵ Department of Obstetrics and Gynecology, 50 North Medical Drive, Salt Lake City, UT 84132.

Abstract

Objectives: Sexuality-related preferences have been understudied in contraceptive selection and uptake. Investigators endeavored to assess contraceptive preferences among patients selecting new methods at family planning clinics and to evaluate the degree to which two sexuality-related preferences are (a) valued and (b) associated with method selection.

Study design: Data were derived from the HER Salt Lake Contraceptive Initiative, a longitudinal cohort nested in a quasi-experimental, observational study enrolling 18-45-year-old patients at four family planning health centers in Salt Lake County. At the time of selecting the new method of their choice, participants reported the importance of nine factors in contraceptive method selection, including two sexuality-related preferences: a method's lack of impact on libido and its lack of sexual interruption. Analyses involved multinomial logistic regression with method selected as the outcome, sexuality-related factors as the main explanatory variables, and a range of controls and covariates.

Results: Among 2188 individuals seeking new contraceptive methods, the factors most frequently cited as quite or extremely important were safety (98%), effectiveness (94%), not interrupting sex (81%), not impacting libido (81%) and lack of side effects (80%). Less frequently cited factors included partner acceptability (46%), lack of hormones (39%), friend recommendation (29%) and alignment with religious beliefs (11%). Multivariate models documented no significant associations between sexual-related priorities and method selection.

Conclusions: Many contraceptive seekers rank sexual-related priorities alongside safety and efficacy as very important, but a range of methods align with people's sexual priorities.

Implications: Since patients endorse the importance of sexual-related contraceptive factors (impact on libido, impact on sexual interruption) alongside safety and efficacy, contraceptive research, counseling and care should attend to people's sexuality.

Keywords: Contraceptive preferences; Patient decision making; Sexual-related priorities; Women's sexuality.

Abstract

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