The purpose of this Grounded Theory study was to explore the reasons for the seemingly underuse of emergency contraceptive pills (ECP) in older adolescent and young adults. Knowledge, attitudes, experiences, partner influence, and couple dynamics as they relate to decision making about ECP use were explored. Observations and interviews were conducted with 22 sexually involved, heterosexual couples with members ranging from 18 to 25 years of age. Basic knowledge of ECP was a requirement but prior use was not. Both individual and couple interviews were conducted with each dyad.
Participants revealed several meanings that ECP use held for them based on moral principles, personal responsibility, and the safety and efficacy of ECP. Each of these categories represented a continuum of value judgments. Despite the relatively high educational level of the participants, these ascribed meanings were often based on incomplete or erroneous information. The majority of couples favored ECP use though often in limited circumstances only; within couple concordance on this issue was high. Couple dynamics and decision making about ECP use revealed issues of trust and power, with female participants expressing feelings of control and their partners expressing vulnerability. Theses emotions stemmed from the reality that females could make the final decision about ECP use. Perceived and actual contraceptive responsibility sometimes varied both with individuals and within couples.
Implications for practice include more comprehensive health education regarding contraception in general, including ECP, with a concerted effort to including young men in the process. Clinicians need to be aware of popular misconceptions about ECP so that they might provide accurate information. Those practicing with young adult populations also need to be aware that contraceptive decision making does not occur in isolation, but rather often includes a young woman's partner, and therefore, realize the salience of couple dynamics in their approach. Additionally, the results of this study may provide a basis for future theory development regarding ECP decision making in young adult couples.