It’s a plan: How do women make decisions about contraception?

Community-based research targets factors that could impact rates of unintended pregnancy.

Originally posted via WCHRI here

With an unintended pregnancy rate of nearly 50 per cent in Canada, Emma Bedard set out to better understand women’s decision-making processes when considering contraception methods. Some women making decisions about contraception know exactly what they want, while others are not sure and are looking at options. 

Long-acting reversible contraception (LARC) methods are the most effective reversible contraception, yet only five per cent of sexually-active women who don’t want a pregnancy use them. 

As a practicing pharmacist, and a master’s student, Bedard is using her clinical knowledge and growing research skills to partner with Alberta Health Services’ Birth Control Centre to explore women’s experiences of accessing LARC. She hopes the results from this study will contribute to our understanding of women’s needs and provide insight into future practice changes for health-care providers — like pharmacists — advising about contraception.

LARC includes intrauterine devices (IUDs), either copper-containing or hormonal (progestin), and a progestin-only subdermal implant that has been used worldwide for years but only approved in Canada in 2020. While there are studies showing that fewer unintended pregnancies result if more people use long-acting methods of contraception, people often opt for methods that require them to remember to take it or are less effective. There is also existing evidence about what women like or dislike about different contraceptive methods. Bedard, however, is going deeper with her qualitative research.

“We’re talking to women about their decision-making process,” she says, explaining her collaborative community-based approach. “I feel like health care is still very top-down where it’s providers and researchers creating the questions to ask, rather than going to people and talking about it.”

The line of enquiry her research team is using has revealed questions such as, Where do women go for research or evidence? Do they go to social media? Do they talk to friends and family? Do they talk to health-care providers? What do they consider important when deciding? How do they balance the pros and cons?

Bedard is finishing her interviews with women and sifting through masses of data to code it for analysis. “If you consider all the data like pieces of a puzzle, I’m putting them together, trying to see where things fit. What sort of story is it creating? That’s where I am in the research process, but I don’t have this big picture yet.”

She has already put together some interesting pieces, however:

  • Something triggers a need for women to think about birth control or about a long-acting method, specifically. Some women may have never used contraception before or are using a different method and want something more effective. 
  • Some people make up their mind about using LARC after attending the clinic and others are still unsure. 
  • People rely heavily on those that are close to them. They’ll talk to a health-care provider, and get that information, but they still want to know about other people’s experiences. They’ll go to TikTok, Reddit or Quora — or do a Google search to try and get stories.

Health-care providers at the Birth Control Centre are being asked to contribute their perspectives and one of the physicians is part of the research team. “We are really interested in having them work with us to provide insight and context during our data analysis,” says Bedard.

Once that analysis is complete, Bedard would love to find a way to share it so people who are trying to make this decision can access the results. She also hopes that the information can be used to help health-care providers talk to women considering LARC or help shape future contraception programs in the community. Bedard intends to work full time as a pharmacist while staying involved in research. “I work now with an inner city population, trying to build up as much of a women’s health practice as I can, but I don’t think I’m ever going to really stop doing research.”

Emma Bedard is supervised by Nese Yuksel in the Faculty of Pharmacy & Pharmaceutical Sciences. Her research is funded by the Alberta Women’s Health Foundation through the Women and Children’s Health Research Institute.

1. This study specifically recruited individuals over the age of 18 years, who self identified as women and have female reproductive anatomy. Contraceptive needs can apply to any individual who was assigned female at birth.