Measuring Nuance in Individual Contraceptive Need: A Case Study from a Cohort in Malawi

Abstract

Contraceptive counseling protocols tend to focus narrowly on pregnancy intentions, which may overlook other factors that contribute to whether an individual wants or needs contraception. In this report, we demonstrate the potential of two measures of individual contraceptive need that could be assessed as part of contraceptive counseling: (1) a composite score constructed from pregnancy intentions, sexual frequency, and perceived fecundity and (2) a direct measure of contraceptive need (“do you feel it is necessary for you to be using contraception right now?”) We compare the two measures using data from Umoyo wa Thanzi, a cohort study in Central Malawi (N = 906; 2017–2018). More frequent sex, perceptions of being more fecund, and a stronger desire to avoid pregnancy were associated with directly reporting contraceptive need (p < 0.001). Women who directly reported contraceptive need had a higher average composite score than women who directly reported they had no need (mean = 7.4 vs. 6.3; p < 0.01), but nearly all participants had scores indicating some risk of unintended pregnancy. Contraceptive counseling protocols should consider assessing women's direct report of contraceptive need, along with risk factors for unintended pregnancy, such as sexual frequency, perceived fecundity, and desire to avoid pregnancy, to better counsel clients.

Introduction to the Special Issue: Indicators in Sexual and Reproductive Health and Rights

“…Mallinson and colleagues (2023) argue that standard approaches to assessing fertility intentions are inadequate for studying change during times of crisis such as those related to the COVID‐19 pandemic and suggest alternative approaches. Bornstein and colleagues (2023) argue that need for contraception is assessed directly rather than through questions that assess the desire to delay or avoid a pregnancy. And Canning and Karra (2023) examine the use of contraceptives by women who say they currently want to become pregnant.…”