Contraceptive Decision-Making and Use Among Latina Adolescents Aged 18-19 in the United States

Contraceptives offer individuals who do not want to become pregnant one form of reproductive autonomy. They are safe and effective when used correctly, and in the case of long-acting reversible contraception (LARC), are associated with very low failure rates, user independence, and convenience. For adolescents, who are beginning to engage in sexual activity, and are also likely to want to prevent pregnancy, contraceptives provide a mechanism to do so. In the United States, where the adolescent birth rate is still significantly higher than other industrialized nations, there is particular interest by policymakers and reproductive health program developers to better understand how, when, and why adolescents use contraceptives. However, U.S. history is fraught with coercive, racist, and discriminatory practices and policies targeted at marginalized groups, and this has long-lasting ramifications on individuals’ contraceptive use perceptions and behaviors. Nationally representative, cross-sectional survey data, from sources such as the National Survey of Family Growth and the Youth Risk Behavior Surveillance System, provide an initial assessment of U.S. adolescent contraceptive use. Data from these surveys indicate that U.S. Hispanic adolescents are less likely to use effective contraception than their non-Hispanic white counterparts. Furthermore, they experience disproportionately higher rates of unintended pregnancy. However, beyond these data, very little is known about U.S. Latina adolescent contraceptive use patterns and decision-making. This dissertation aims to address this gap by: 1) investigating Latina adolescents’ consistency in non-barrier contraceptive method use and factors associated with method non-use, switching, and consistency; 2) assessing whether Latina adolescents using different types of non-barrier contraceptive methods, specifically LARC (implants and intrauterine devices), are more likely to engage in condomless sex and less likely to use dual methods of protection (combined use of non-barrier contraception and condoms); and 3) explore the influential factors that may interact in the Latina adolescent’s decision-making process around contraception use. Previous research has indicated that U.S. Latinas of any age are less likely to use contraception, may have different method preferences, and may be inclined to earlier discontinuation, but we are unaware of any longitudinal investigation of Latina adolescent contraceptive use. Our research fills this gap by exploring the temporal dynamics of and factors associated with Latina adolescent contraceptive use over a nine-month period within a cohort of individuals who were trying to avoid pregnancy. We found that those using intrauterine devices (IUD) were most likely to be consistently using the same method nine months later than users of other non-barrier methods, and factors associated with this included being older, having never been pregnant, having higher contraceptive knowledge, and having a greater perceived risk of pregnancy. This suggests that the IUD may offer greater contraceptive stability for Latina adolescents who do not want to become pregnant. While non-barrier contraception may offer protection from unintended pregnancy, contemporary literature among women of any reproductive age and predominantly non-Latina white adolescents has reported that users of specific contraceptive methods, notably LARC, appear less likely to use dual protection (combined use of non-barrier contraception and condoms) than those using short-acting hormonal methods. However, there is also some conflicting research indicating that LARC use may not lead to diminished perceptions of STI risk or actual condom use. Alongside this, there has been a recent notable rise in sexually transmitted infections (STIs) among U.S. adolescents, with Latina adolescents experiencing STI rates up to three times greater than their non-Latina white counterparts. The higher STI rates, mixed findings on this topic, and data indicating that Latina adolescents use contraceptives and condoms differently than their counterparts in other racial and ethnic groups, highlight important questions to ask about Latinas’ use of dual protection. Our research found that Latina adolescents using any type of non-barrier contraception had higher rates of recent condomless sex than non-users, and that among those using non-barrier contraception, LARC or injection users had significantly lower rates of dual protection use. Taken together, this suggests that Latina adolescents using non-barrier contraception, particularly LARC, may be at greater risk for STIs (although, this needs to be investigated in future research) and emphasizes the importance of including information on dual protection in contraceptive counseling and reproductive health interventions. Qualitative research methods provide us with an opportunity to gain deeper insight and a more nuanced understanding of factors that may influence Latina adolescents’ contraceptive choices. We leveraged interview data collected from 37 Latina adolescents to explore how interpersonal- and individual-level factors may interact in the contraceptive decision-making process. Our analysis sheds light on the interconnected roles that future ambitions, partner influence, pregnancy intentions, method consistency, fear, and expected familial responses to pregnancy play in this process. The collective findings in this dissertation offer enhanced knowledge on how, when, and why U.S. Latina adolescents use non-barrier contraception, which can be pragmatically applied in patient-centered contraceptive counseling and reproductive health programs. This work aims to motivate recognition of the potentially differential contraceptive use behaviors and priorities of U.S. Latina adolescents and highlight the need for reproductive justice-informed approaches that are more responsive and attentive to their individual needs and desires.