Prevalence of shared negative contraception experiences and their impact on counseling about LARC
Awarded 2013
Trainee Grants
Benjamin Brown, MD
University of Chicago

Objectives: To explore the prevalence of negative experiences with long-acting reversible contraception (LARC), shared by a friend or family member, and to assess the influence of these stories on decision-making. Methods: We performed a sub-study within a randomized controlled trial evaluating a contraceptive counseling intervention for women presenting for induced abortion (n=60). We surveyed participants at baseline and one and three months post-abortion. A blinded researcher conducted semi-structured qualitative interviews with a subset of participants (n=9) at three months. Transcripts were coded and analyzed for salient themes using Atlas.ti. Results: Sixteen respondents (26.7%) had heard negative LARC stories (NLS): 13 about the intrauterine device (IUD), 3 about the implant. Of those with NLS, 25% (4/16) received a LARC method post-abortion, compared with 56.8% (25/44) of those without NLS (p=0.04). Moreover, 31.3% (5/16) of those with NLS started no method, compared with 15.9% (7/44) of those without NLS (p=0.27). Interviews substantiated NLS as strong deterrents to use. Friends and family were viewed as more trustworthy than partners and providers. Respondents disliked perceived coercion by providers toward use of specific methods and underscored the importance of counselors validating negative experiences and offering information about side effects; validation of NLS was perceived to moderate their impact. Conclusion: NLS are common, valued in decision-making, and associated with decreased use of LARC. NLS were also associated with nonuse of contraception in general, which, although not statistically-significant in this exploratory study, is worthy of further research. Counseling which validates negative experiences may moderate their impact.