How young Australian women explain their use of condoms, withdrawal and fertility awareness: a qualitative analysis of free-text comments from the CUPID study

Abstract

Rates of oral contraceptive pill use have declined over the past decade in Australia. While some women use highly effective methods, others rely on less effective methods such as condoms, withdrawal and fertility awareness. We aimed to understand motivations for relying on these methods among young women in Australia. Women aged 18–23 years who reported using less effective methods and participated in the Contraceptive Use, Pregnancy Intention and Decisions (CUPID) study formed the sample for this analysis. Using thematic analysis, we analysed 140 free-text comments. Findings suggest that less effective methods were used when they were assessed as being best suited to current reproductive needs. These methods were perceived as offering benefits that hormonal and more invasive methods did not, and participants were largely satisfied with them. By contrast, some less effective method use was driven by a lack of choice or alternative options, previous bad experiences with hormonal methods, a lack of appropriate information about alternatives and difficulty accessing other methods. It is therefore essential to move beyond ‘LARC-first’ contraceptive counselling approaches to ensure young women are provided with accurate information regarding all contraceptive options available (including how to negotiate their use) and how to use them to their greatest efficacy.

Keywords:

• contraception
• women
• Australia
• less effective methods

Acknowledgements

The authors wish to thank the women who participated in the CUPID study.

Disclosure statement

The research was funded by an ARC Linkage Grant that involved some cash and in-kind support from Family Planning NSW and Bayer Australia Ltd. Dr Melissa Harris and Dr Britta Wigginton were previously employed through the Linkage Project Grant. Professor Deborah Loxton and Professor Jayne Lucke were Investigators on the grant.

Data availability

Please contact the corresponding author to discuss data availability.

Notes

1 In this paper, woman refers to a person with a uterus, fallopian tubes and ovaries, and man refers to a person with a penis and testicles; however, we recognise that people who identify as men can also have female reproductive organs and vice versa. Given our focus on contraceptive use as pregnancy prevention, our study reports on cisgender women who have sex with cisgender men.

Additional information

Funding

The research on which this paper is based was supported by an Australian Research Council (ARC) Linkage Project (LP100200349). We are grateful to the ARC for their support. Melissa L. Harris was funded by the ARC Discovery Early Career Researcher Award (DE190101134). The views expressed herein are those of the authors and are not necessarily those of the Australian Government or the Australian Research Council.