Substance use disorder: contraceptive options counseling

What’s New in Contraception?

Contraceptive Technology Conference!

Biologic sexism of STIs

Excess breast cancer deaths after COVID-19

Contraception for patients with medical conditions

Pelvic Floor Dysfunction

Treating vulvodynia

Puzzling Over the Hurt Down-Under

Serious Mental Illness and Contraception

New 13-Cycle Vaginal Contraceptive System

The Future of Family Planning in Post-COVID America

New ASCCP Guidelines: Implications for FP

On the alert: mood disorders during 2020 stressors

Sex in the Time of COVID-19

Challenges old and new during the pandemic

Reproductive health in the time of Covid-19

Talking about toys

Missed Pills: The Problem That Hasn’t Gone Away

Find the “yes! . . . and” rather than “no” or “but”

Digital Family Planning: the Future is Now

Irregular Bleeding Due to Contraceptives

When she’s low on libido…

Ouch! Best approaches to menstrual pain

Contraceptive efficacy: understanding how user and method characteristics play their part

Strategizing treatment for chronic heavy menstrual bleeding


Untangling the literature on obesity and contraception

High tech apps for no-tech FABM

Menstrual exacerbation of other medical conditions

From Princeton University: Thomas James Trussell (1949-2018)

The Short and Long of IUD Use Duration

Selecting a Method When Guidance Isn’t Clear-cut

Healthcare in the Time of Digital Expansion

The Scoop on Two New FDA-Approved Contraceptive Methods

Pregnancy of unknown location—meeting the challenge

Big “yes” (with caveats) to CHCs during perimenopause

The role of IUDs (LNG IUDs, too!) in emergency contraception

Combined pills’ effect on mood disorders

Abortion in the U.S.: safe, declining, and under threat

Hope for ovarian cancer screening test

Breast cancer still a small risk with some hormonal contraceptives

New treatment modality for BV

Record rate of HPV-related throat cancer

Viruses in semen potentially transmissible

Don’t Abstain from Your Role in Abstinence

Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

Reassuring news on depression and OC use

PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm


Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception New and Improved

December 2015


Non-use of contraception is associated with about 900,000 unintended births in the United States each year. Why do women choose not to use a contraceptive? Surprisingly, the potential for side effects, a key focus in many providers’ educational messages, was a concern for only 10% of women enrolled in the National Survey of Family Growth who were asked about their nonuse of contraception that led to their unintended pregnancy.[1] More commonly, women mistakenly thought they couldn’t get pregnant, with 41% giving that response. In general, women who think that sex won’t lead to pregnancy either believe that they are not in the fertile phase of their menstrual cycle or they think, mistakenly, that they are infertile. About 24% reported that they hadn’t expected to be having sex. This set of women was more likely to be unmarried and not cohabiting (42%) than were women who were married (12%) or cohabiting (16%).

About 1 in 5 women “didn’t really mind getting pregnant.” That’s called ambivalence, and it turns out that our understanding of what exactly ambivalence means is ambiguous. Ambivalence is more nuanced and multi-faceted than surveys and research have implied. A recent study of 576 single women ages 18-29 who were sexually active in the previous 12 months examined the permutations of ambivalence so clinicians can better identify strategies for serving those women who are “on the fence” when it comes to having a baby.[2] According to the researchers, ambivalence can take different forms, with a blend of dimensions that are both cognitive (whether one “should” or “should not” do something) or affective (how one “feels” about something). As pertains to family planning behaviors, a woman cognitively considers whether avoiding pregnancy, say with contraceptive use, is either important or unimportant to her. She additionally will affectively feel either upset or pleased were she to find herself pregnant at this point in time.

There are women who cognitively think it is important to avoid a pregnancy—in other words, they “should” take measures to prevent pregnancy, even if they may be pleased if they have an unintended pregnancy. However, no matter how pleased they might feel about getting unexpectedly pregnant, these women generally use contraception. These women would be classified as having positive ambivalence. In fact, these women were just as likely to use consistent and effective contraception as were women who were not ambivalent at all—you know, the ones who think it important to avoid pregnancy because they would be upset about a pregnancy. Using effective contraception consistently requires substantial planning, a cognitively-driven behavior, write the researchers, not spur-of-the-moment decisions.

In contrast, other women say it isn’t important to avoid a pregnancy yet, if pregnant, they would be unhappy about it. These women—with negative ambivalence—are substantially less likely to use effective contraception, whether consistently or at all. Relatively few women expressed negative ambivalence, only about 3%. Yet it is this 3% of women who pose the greatest family planning challenge. They don’t want a baby and would be unhappy with a pregnancy, but they are not taking action to prevent pregnancy. This negative ambivalence is most common among women who are neither working nor in school. Men, analyzed in another arm of the study, were four times more likely to fall into the negative ambivalence category.

The researchers also analyzed women who reported no ambivalence, finding that these women acted in ways that supported their attitudes. Least likely to use contraception are women who think it unimportant to avoid getting pregnant but who would be pleased to be so. And most likely to use contraception are those women who think it important to avoid a pregnancy because they would be upset about it.

Most of the women (77%) in the survey reported that every pregnancy is a “blessing,” even the pregnancies over which the women may be upset…even the women with negative ambivalence. Those who felt that every pregnancy is a blessing expressed the greatest conflicted feelings if they thought it important to avoid a pregnancy because they are not in a position to have one because, for example, their finances or relationships were not secure. Among the women surveyed, 37% women with incomes three or more times the poverty level said they “didn’t mind getting pregnant” compared to 16% living at poverty levels. Just over half of college graduates said the same, compared to the 18-19% at lower educational levels. Married women were less likely to mind (29%) compared with single women (7%). Least likely to think every pregnancy is a blessing were women who would be upset over pregnancy and so thought it important to avoid pregnancy.

Another recent study explored the concept of unintended pregnancy and consequently babies as a “gift.” The researchers conducted indepth qualitative interviews with 28 women who did not desire a pregnancy but were at risk for one. Nearly all women had positive feelings toward babies themselves, even if they were to have a baby when they didn’t really want one. Their negative feelings arose from considering the experiences associated with having a baby, such as changing diapers and dealing with crying, and about effects a baby would have on their lives such as losing freedom and facing increased financial needs.[3] The researchers suggested that messages need to address both the positive and the negative emotions women may have about unintended pregnancy.

—Deborah Kowal, MA, PA, managing editor and co-author of Contraceptive Technology

[1] Mosher W, Jones J, Abma J. Nonuse of contraception among women at risk of unintended pregnancy in the United States. Contraception 2015; 92:170-6.

[2] Yoo SH, Guzzo KB, Hayford Sr. understanding the complexity of ambivalence toward pregnancy: does it predict inconsistent use of contraception. Biodemo Soc Biol 2014:60:49-66.

[3] Askelson NM, Losch ME, Thomas LJ, Reynolds JC. “Baby? Baby not?”: Exploring women’s narratives about ambivalence towards an unintended pregnancy. Women & Health 2015;55:842-58.