1. Complex combinations of these scenarios were also evident
Lesley Hoggart, Senior Lecturer, The Open University
Victoria Newton, Research Associate, The Open University
“I didn’t think it would happen to me”. Young women’s accounts of pre- and post- abortion contraceptive use
Objectives: The overall aim of a multi-method study was to explore the behavioural, social and service related factors that are associated with one or more unintended and unwanted pregnancy amongst young women (under 25 years). This poster focuses on the qualitative strand of the study.
Methods: a longitudinal investigation using in-depth qualitative interviews with 36 young women who have had one or more abortion. The study is funded by, and was undertaken in collaboration with, Marie Stopes International.
KEY ISSUE: There was a diverse range of situational and behavioural scenarios in which women experienced an unintended pregnancy.
Experience
“I thought I couldn’t get pregnant. Obviously, because it had been so long [not using contraception], I thought that maybe I couldn’t get pregnant[...] and that’s why it was such a shock.”
Unaware of Unprotected Sex
“I could have just missed it. But I was quite good because, at that age, I was really scared not to miss it. I was at the point where you don’t forget because it’s your main priority. But I’ve no idea what happened there.”
Fertility Misperceptions
Contraceptive failure
Unimaginable Pregnancy
Unpredictable Pregnancy
I thought I couldn’t get pregnant
I don’t know why I got pregnant
Aware but did not Realise Risk
“think we’d slept together about 1am/2am in the morning and by the afternoon I was in the [Sexual Health] Centre having the pill [EHC] I’m not quite sure why it didn’t work but.”
Medical Issues
“Basically after the surgery that I had in December [for an ectopic pregnancy] , I didn’t have a period at all. So I’ve been told I’m not ovulating. So I don’t really see how I fell pregnant.”
Complex combinations of these scenarios were also evident
Predictable but not Predicted
Pregnancy
Emergency Contraception
For women who were aware they were at risk of an unintended pregnancy, most did not seek emergency contraception. These women recounted finding it difficult to access EHC, or worried about having to pay for it. For the few women who did access EHC, there was very little evidence of advice regarding the emergency IUD being given by their provider.
Some women were not aware of their pregnancy risk therefore did not access EC.
Some did access EHC but still became pregnant.
Post-abortion contraceptive use
Participants recalled being given advice regarding contraception at MSI.
Some struggled to find a method of contraception that suited them.
Some young women who had opted for a medical termination had more difficulty in establishing their post abortion contraceptive regime. This was for a number of reasons. For some, contraception was not at the forefront of their mind when they left the clinic. They had not yet completed their abortion. Others waited for their body to ‘return to normal’. This is supported by the quantitative strand of the study.
The research did note some movement from the Pill and condoms to LARC. However, many women remained committed to their pre-abortion contraception.
I hoped it wouldn’t happen to me
Unpredictable Sex
“I’m at uni, like I don’t see him that much, and so like, because I’ve been on the pill, it’s sort of… That urgency of taking it, it sounds really ridiculous, but it hasn’t sort of seemed to be so urgent, because I’m not having sex all the time .”
Erratic or non-use of contraception
Inaccessible Services
“whereas I always wanted to get it [the pill] before but just going to like a clinic or something just seemed really weird, like I wouldn’t be comfortable doing it. ”
Unanticipated Sex
“We got back together, had sex, didn’t use anything, like the one time that we didn’t use anything, so I did the morning-after pill. And then, got pregnant ”
Unacceptable Contraceptives
“I don’t think that I’ve found something that I’m totally happy with, in terms of contraception.”
Conclusions
It is a complex picture. In support of the quantitative branch of the study, it is not possible to identify a particular ‘type’ of young woman who is most ‘at risk’ of unintended pregnancy.
It is important to acknowledge that unintended pregnancy will be experienced by many women for a wide variety of reasons and hetero-sexually active women will need access to abortion as a normal part of their reproductive healthcare.
What can providers do to help young women improve their reproductive control?
Contraceptive counselling at provider level is clearly important and needs to be retained and – preferably – extended/given extra time.
Women who are not ready to make a contraceptive decision at the abortion provider should be sign-posted to good quality local services.
An advance supply of EHC would enable women to have it to hand should the need arise. It should be provided together with information about when it may not work (in relation to ovulation and the length of time after sex) and information about the emergency IUD.
General awareness about the IUD as a method of emergency contraception needs to be raised. Providers should discuss the emergency IUD with women seeking EHC, especially for those who are close to the EHC time limit or who may have recently ovulated.