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Contraceptive Congruence: A Novel Measure of Contraceptive Use that Acknowledges Pregnancy Ambivalence [A06]

INTRODUCTION: Aligned with the bias that highly effective long acting reversible contraception (LARC) should be first-line for all women not intending pregnancy, historic measures emphasized contraceptive effectiveness. We propose an alternative measure, contraceptive congruence, which acknowledges pregnancy ambivalence by describing whether a method is aligned with individual attitudes about getting pregnant, specifically how important it is to avoid pregnancy and how pleased/upset she would be if pregnant. METHODS: Among 984 women not intending pregnancy in the next year, contraceptive congruence was defined as a three-level variable describing whether a woman’s current contraceptive method was very congruent, somewhat congruent, or incongruent with her pregnancy attitudes. If a woman was ambivalent about pregnancy, she was very congruent at a lower tier of contraceptive efficacy than someone very upset and importantly avoiding pregnancy. Patient-level variables were examined using chi-square analysis for associations with contraceptive congruence. RESULTS: Contraceptive methods included LARCs (8%), hormonal methods (50%), barrier methods (30%), or no method (12%). Methods for 43% of women were very congruent, 39% somewhat congruent, and 18% incongruent with attitudes about becoming pregnant. Therefore, many women were using methods that were aligned with their pregnancy attitudes. Predictors of contraceptive congruence included age, marriage, non-Hispanic white ethnicity, full-time employment, and higher income. CONCLUSION: By including individual attitudes about getting pregnant, contraceptive congruence acknowledges pregnancy ambivalence, which is missing when categorizing contraceptive methods by strictly effectiveness alone. Future research and clinical care that acknowledge pregnancy ambivalence will more closely align with actual complex attitudes that affect individual contraceptive behavior.