The power dynamics in a relationship and pressure to have sex may be associated with a woman's decision to use emergency contraception.1 In a clinic-based survey of women aged 15-30 years, the likelihood of emergency contraception use was elevated if the male partner dominated decision-making, if a woman had felt pressured for sex or if the male partner had a strong desire to avoid pregnancy. Other factors, such as communication within, satisfaction with and commitment to the relationship, were not associated with emergency contraception use, although previous research suggests that such factors are associated with the use of other types of contraception. Because factors associated with the use of emergency contraception may not be evident to the clinician, the findings highlight the importance of including emergency contraception in routine counseling of all women, the researchers conclude.
The study was conducted in a San Francisco Bay area Planned Parenthood clinic, community family planning clinic and university health center between 1995 and 1998. Sexually active women aged 15-30 who were not pregnant or trying to get pregnant were eligible for the study. Data on the women's background characteristics, their sexual risk factors, and characteristics of their male partner and relationship were collected through surveys and medical histories. Only women who responded to a question about whether they had used emergency contraception were included in the analyses. Information was collected for the main partner or, for women who had only casual partners, the most recent partner.
The 497 women in the sample had a mean age of 21. Fifty percent were white, 25% Hispanic, 11% Asian, 5% black and 9% other races or ethnicities. Women predominantly were unmarried (92%) and had a main partner (90%). Nearly nine in 10 had used some method of contraception at last sex, and seven in 10 said they never had unprotected sex. Most women had not been pregnant or had a sexually transmitted disease; two-thirds drank or used drugs. Seventy percent reported that they and their partner shared decision-making, but a similar proportion (65% of those with a main partner) said that they had been pressured to have sex. The majority said that a pregnancy would make them or their partner very unhappy (78% and 61%, respectively).
Seventy-nine percent of women were aware of emergency contraception, and 14% had used it. Results of bivariate analyses suggested that the prevalence of use was elevated among women who used substances, those who had felt pressured to have sex, those with partners who had a strong desire to avoid pregnancy and those with partners who dominated decision-making (although this difference was of borderline significance). There were no significant differences according to women's demographic characteristics or other relationship factors, such as commitment, satisfaction and communication.
The results of a multivariate logistic regression analysis generally reflected the bivariate results. Women who reported substance use were more likely to use emergency contraception than were those who did not (odds ratio, 2.3). And the odds of emergency contraception use were elevated among women with partners who had a strong desire to avoid pregnancy (4.2), those in a relationship in which the male partner dominated decision-making (4.2) and those who had felt pressured to have sex (2.7). Age also became significant: The older a woman was, the greater her odds of using the method (1.1).
The researchers note that the study was limited because of its cross-sectional design and because emergency contraception was measured in terms of ever-use. Emergency contraception use may be associated with the selection of partners with a strong desire to avoid pregnancy. Furthermore, women may have used emergency contraception with another partner. Nevertheless, the study suggests that relationship factors associated with the use of emergency contraception differ from those associated with the use of other types of contraception, the researchers conclude. Factors associated with emergency contraception use "do not typically appear on medical histories; it is therefore important to reach all women with [emergency contraception] information and supplies."
—T. Tamkins
REFERENCE
1. Harper CC et al., Sexual partners and use of emergency contraception, American Journal of Obstetrics and Gynecology, 2003, 189(4):1093-1099.