دانلود رایگان مقاله انگلیسی ترس از بارداری و تغییر در استفاده از پیشگیری از بارداری - الزویر 2018

abstract

Article history: Received 15 December 2017 Received in revised form 17 July 2018 Accepted 21 July 2018 Available online xxxx Objective: We examined whether the experience of a “pregnancy scare” is related to subsequent changes in contraceptive use that increase the risk of unintended pregnancy. Methods: We used data from the Relationship Dynamics and Social Life (RDSL) study, which interviewed a random, population-based sample of 1003 young women weekly for 2.5 years. We used multivariate regression models to predict the effect of experiencing a pregnancy scare on change in contraceptive use. Results: We found pregnancy scares are associated with changes in contraceptive use that increase the risk of pregnancy. Experiencing a pregnancy scare is related to discontinued contraceptive use, change from consistent to inconsistent use of contraception, and change from a more effective to a less effective method of contraception. We also found pregnancy scares are associated with continued inconsistent use of contraception. Conclusions: Our findings suggest that the experience of a pregnancy scare does not serve as a “wake-up call” to start using contraception, to start using it consistently, or to switch to a more effective method to reduce the risk of unintended pregnancy. Instead, contraceptive use after a pregnancy scare typically remains the same or worsens. Implications: Clinicians should be aware that young women who have experienced pregnancy scares may be at increased risk of unintended pregnancy, relative to young women who did not experience a pregnancy scare.

4. Discussion

Pregnancy scares are associated with changes in contraceptive use that increase the risk of unintended pregnancy. These results suggest that a pregnancy scare is not a “wake-up call” to start using contraception, to increase contraceptive consistency, or to switch to a more effective method. Furthermore, these changes in contraceptive use occurred in the very short-term – the week after the pregnancy scare, when memory of the scare is still likely strong – as well as in the longerterm – at least 4 weeks after the pregnancy scare. Thus, contraceptive users who experienced pregnancy scares experienced increased unintended pregnancy risk, relative to young women who did not experience a pregnancy scare. The effect of experiencing a pregnancy scare on subsequent change in contraceptive use among contraceptive nonusers is less clear. More research is needed to better understand how pregnancy scares affect women who are not using contraception. It is also important to note that most women continued the same contraceptive behavior between interviews with an intervening pregnancy scare and between adjacent interviews without an intervening pregnancy scare. That is, most of the time respondents continued using or not using contraception, they continued using contraception consistently or inconsistently, and they continued using the same contraceptive method, whether they experienced a pregnancy scare or not. It is beyond the scope of the current study to explore why contraceptive use after a pregnancy scare worsens, but future research should examine whether pregnancy desire, attitudes toward contraception, or perceptions of infertility change after this experience. It is possible that pregnancy scares normalize the experience of pregnancy, and may even increase desire for pregnancy. It is also possible that pregnancy scares decrease confidence in contraception or increase selfperceptions of subfecundity, which in turn affects contraceptive behavior. Adolescents who perceive themselves as unable to conceive use contraceptives less frequently than other adolescents [9].