Contraceptive congruence: acknowledging pregnancy ambivalence in a novel measure of contraceptive use

Background The historical view that pregnancy intention is dichotomous (i.e., intending or not intending pregnancy), and the notion that all individuals not intending pregnancy should be using highly effective contraceptive methods, oversimplifies how we view contraceptive decision-making. To better understand this, we studied contraceptive congruence as an alternative, 3-level measure describing methods as very congruent, somewhat congruent, or incongruent with one’s individual attitudes about becoming pregnant. Methods Secondary data analysis included 982 MyNewOptions study participants who were not intending pregnancy within the next year. The cross-sectional survey assessed attitudes about how important it is to avoid pregnancy, how pleased/upset one would be if pregnant, and current contraceptive method use. Participant answers to attitudinal questions and effectiveness of current contraceptive method were used to determine congruence categories. Results Contraceptive methods included LARC (8%), other prescription methods (50%), non-prescription methods (30%), and no method (12%). Methods for 23% of participants were very congruent, 48% somewhat congruent, and 29% incongruent with attitudes about becoming pregnant. Contraceptive congruence was significantly associated with contraceptive satisfaction in bivariate analysis. Predictors of contraceptive congruence included being married or living with partner, full-time employment, and intending future pregnancy in the next 1-5 years. Conclusion Contraceptive congruence is a novel measure that acknowledges pregnancy ambivalence and is associated with higher contraceptive satisfaction scores. Future contraception research should strive for robust, patient-centered measures of contraceptive use that acknowledge the complex attitudes affecting individual contraceptive behavior and satisfaction. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT02100124 ### Funding Statement This work was supported by the Patient-Centered Outcomes Research Institute (PCORI) Program Award (CD-1304-6117). All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of PCORI, its Board of Governors or its Methodology Committee. Study data were collected and managed using REDCap electronic data capture tools hosted at the Penn State Milton S. Hershey Medical Center and College of Medicine. REDCap is supported by the Penn State Clinical & Translational Science Institute, Pennsylvania State University CTSI, NIH/NCATS Grant Number UL1 TR000127. The contents are solely the responsibility of the authors and do not necessarily represent the official views of NIH/NCATS. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The MyNewOptions study was approved by the Pennsylvania State University Institutional Review Board, which gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as [ClinicalTrials.gov][1]. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors [1]: http://ClinicalTrials.gov