The Relationship between Personal Characteristics and Contraceptive Choices and Use over 5 Years

Background. Unintended pregnancies have been identified as "among the most essential health status indicators in the field of reproductive health” (Finer & Zolna, 2011, p. 478).  According to the Guttmacher Institute, of the 213 million worldwide pregnancies in 2012, a full 40% were unintended (Sedgh, Singh, & Hussain, 2014).  Pregnancy outcomes for these women and adolescents result in abortion 50% of the time, while 13% experience a miscarriage, and 38% having an unplanned childbirth.  There are numerous studies that associate unintended pregnancies with negative outcomes for the mother and child, including health, economic, social and psychological ones. The World Health Organization (WHO) has set worldwide goals to address health disparities, one of which addresses improvement in maternal health (2014).  One component of that goal is to address the gap between desire for contraception and its access.  This gap varied between regions and countries.  For example, in Eastern Asia, the gap is only 4%, while it is 16% in Western Asia.  In contrast, the rate in Oceana is 24.6% and Sub-Saharan Africa has a 25.1% rate of unmet family planning needs.  Females between 15-49 years who are at high risk for unintended pregnancies generally have low-income and low educational attainment.  In some countries, such as the United States, that risk is also higher in minority racial and some ethnic groups.  Identifying characteristics for non-use, non-continuation of birth control and inconsistent or non-use of contraception in this growing population is postulated to better address the unintended pregnancy rate. Contraceptive choices have changed during this time and it is not known if contraceptive use has reflected this change. Purpose. The purpose of this research project is to evaluate characteristics of adolescents and women at high-risk for unintended pregnancies by 1) comparing the contraceptive choice and use for the years 2009 and 2014, and 2) exploring relationships among contraceptive choice and use with selected characteristics of clients seeking family planning services. Methods. A retrospective chart audit is being conducted on 300 randomly-selected records, half of which are from the year 2009 and the remaining from 2014. The characteristics derived from the chart audits were derived from the literature and from seven of the goals of Healthy People, 2020 (DHHS, 2010). Once data collection is completed, the data will be analyzed using descriptive statistics to answer research question #1, while race/ethnicity and age will be evaluated via t-test and ANOVA. Differences between the years 2009 and 2014 will be investigated with t-tests and Chi-square. To address question #2, gender will be analyzed by nonparametric statistics such as Chi-square, Mann-Whitney U test, and Pearson’s product moment correlation according to the level of data obtained and the examination of the assumptions underlying the tests. Also, logistic regression will be used to explore relationships among variables.  Results.  The results will influence the development of tailored interventions for adolescents and women at high risk for unintended pregnancy.  Dissemination includes the development of a client-education application (app), which is already underway.