The Role of Reproductive Autonomy in Adolescent Contraceptive Choice and Acceptance of Long-acting Reversible Contraception

Study objective: To examine the association between reproductive autonomy and adolescent receptivity toward long-acting reversible contraceptive (LARC) methods.

Design: A survey to assess sexual history and contraceptive practices/knowledge/attitudes was administered. Reproductive autonomy was measured with an adapted validated scale.

Setting: Adolescent medicine clinic in an urban academic medical center in the Midwestern United States.

Participants: Girls ages 14-21 years who presented for well or contraceptive visits.

Interventions and main outcome measures: Primary outcome was a favorable rating toward the question "How much do you like the idea of LARC for yourself?" The primary independent variable was the reproductive autonomy decision-making subscale score (higher score indicating increased autonomy).

Results: Eighty-nine participants with a mean age of 16 years completed surveys. Almost all (92%) identified as African American. At study enrollment 56.2% were using Depo-Provera (Pfizer), 15.7% oral contraceptives, 3.4% implants, and 24.7% no method. Only 13.5% of participants liked the idea of LARC for themselves. The mean score on the decision-making subscale was 9 (range, 4-12). In bivariable analysis, age was associated with decision-making subscale score, but was not retained as a confounder in multivariable analysis. The odds of liking LARC decreased by 30% with each unit increase in the autonomy decision-making subscale score (odds ratio, 0.70; 95% confidence interval, 0.52-0.94; P = .02).

Conclusion: Our findings suggest that adolescents with higher reproductive autonomy, measured according to their score on the decision-making subscale, were less likely to favor LARC. Further research should explore participants' perceptions of autonomy and the relational dynamics between adolescents and their parents/partners in contraceptive choice.