Consistency, complexity or chaos: a qualitative study of young women’s patterns of contraceptive use

Consistency, complexity or chaos: a qualitative study of young women’s

patterns of contraceptive use

L. Williamson, K. Buston, H. Sweeting

MRC Social and Public Health Sciences Unit, University of Glasgow, UK

Objectives: Research has identified linear patterns of contraceptive

use in young women, progressing from non-use to condom use to oral contraceptive

use, but more recent studies have found more variable patterns, with young women

making many changes to their contraceptive use and giving diverse explanations

for this. The aim of this qualitative study is to investigate young women’s

patterns of contraceptive use during their early years of sexual activity and

develop a typology of contraceptive careers.

Design & Methods: A qualitative study using in-depth interviews

with 20-year-old young women from the East Coast of Scotland. Purposive

sampling, based on sex experience, area of residence, father’s social class,

and educational attainment was used to recruit a wide range of young women. The

interview schedule included questions on contraceptive and relationship history,

reasons for use and non-use of contraceptives, the influence of partners,

parents, friends, and others, and the use of sexual and reproductive health

services. Interviews were transcribed verbatim and analysed using framework


Results: Young women were able to spontaneously name various

contraceptive methods including condoms, oral and injectable contraceptives, and

the IUD. Condoms were the predominant contraceptive method used, with all

participants reporting use of these at some time; all but one reported oral

contraceptive use. Most had used emergency contraception and half reported

episodes of unprotected (in contraceptive terms) sex. All of the young women had

changed their contraceptive method at least once. Changes occurred within and

between relationships, as a result of contraceptive crises (condom breakages,

experience of side effects), and for non-contraceptive reasons (management of

irregular menstruation, PMS, acne). Each young woman had her own specific

experience of contraceptive use, but overall three patterns were apparent:

consistent, complex and chaotic. Consistent contraceptive patterns were

characterised by uniform and regular use over time, regardless of relationship

changes or experience of contraceptive crises. Complex patterns were

characterised by change and variability, with method use depending on

relationships, partner type, non-contraceptive reasons and contraceptive crises.

These young women incorporated change in a manageable way. Chaotic patterns were

characterised by frequent method changes within and between relationships and

multiple contraceptive crises. For these young women the experience of frequent

method change was a further complication in somewhat disordered lives, leaving

them further exposed to contraceptive crises.

Conclusions: Young women experienced contraceptive method change and

they did not share a homogenous contraceptive pattern. Consistent, complex and

chaotic patterns were evident. To help young women control their fertility,

health care professionals must understand the influences that may be important

in young women’s lives and appreciate the dynamic nature of their reproductive

health needs.

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