Body image and pregnancy risk: A mixed methods study on contraception in first-year college women
Awarded 2016
Complex Family Planning Fellowship Research
Elham Altaf, MD
The University of Chicago

Background: Negative body image contributes to negative health behaviors, particularly eating disorders. In sexual health, women with negative body image are less likely to use a condom than women with positive body image. However, there is little research on how body image influences use of the various birth control methods available to young women.
Methods: Focus group discussions and then surveys were conducted with students from six universities in Chicago. Focus groups identified themes related to body image and contraception. Survey domains included: body image scales and reasons contraception was used or avoided.
Results: There were 23 participants in six focus groups and a total of 1456 women were surveyed. Women with high scores on scales of negative body image, compared to women with low scores, were more likely to have sex without birth control (33% v. 21%) due to fear of side effects (49% v. 23), fear of their partner’s reaction (49% vs 22%) and embarrassment (43% vs 9%).
Most women indicated that side effects that alter weight (78%), change skin (79%) were important to their birth control decisions. While 85% said pregnancy prevention was “extremely important,” 79% identified some kind of method they would avoid because of fear of weight or appearance changes. Women in the focus groups expressed that “people don’t talk about” body image issues and, in the survey study, most women (79%) never discuss the issue with a doctor.
Conclusions: Young women worry about birth control side effects that can alter their appearance. Negative body image is associated with having sex without birth control and avoidance of specific methods for fear of appearance-related side effects. Few women report having ever discussed body image with their doctor. So, for college women, body image is an important factor when making contraceptive decisions. Contraceptive counseling should address body image and weight gain.