UC Berkeley

BACKGROUND: Previous research has found self-efficacy is associated with reproductive health behaviors and outcomes. However, few studies have quantitatively examined the relationship between barriers accessing contraception and self-efficacy. In addition, existing population-level metrics of contraceptive access tend to focus on method availability, uptake, and use, rather than peoples self-defined needs and preferences. This study uses person-centered metrics to assess the relationship between experiencing a recent challenge or delay obtaining desired contraception and two measures of contraceptive self-efficacy. METHODS: In 2022, we fielded a nationally representative survey in English and Spanish using NORCs AmeriSpeak panel, surveying non-sterile 15- to 44-year-olds assigned female sex at birth in the U.S. We describe common challenges and delays obtaining contraception and present the distribution of experiencing a challenge or delay obtaining contraception by key sociodemographic and reproductive health characteristics. We also conduct logistic regression analyses to investigate associations between experiencing a challenge/delay and two measures of contraceptive self-efficacy: confidence in obtaining a desired method when wanted and perceived ease of switching methods when wanted. RESULTS: Among the analytic sample of respondents who had ever used or tried to obtain a contraceptive product, device, or procedure (unweighted n = 2,771), about 14% experienced a challenge/delay obtaining desired contraception in the past year. The most common reasons for challenges or delays were related to logistics (transportation, childcare, scheduling; 38.2%) and cost/insurance coverage (35.8%). Among those who experienced a challenge/delay obtaining desired contraception (unweighted n = 301), higher proportions were younger, identified as non-heterosexual, had lower educational attainment, and could afford smaller emergency expenses compared to the subgroup that did not experience a challenge/delay. Experiencing a challenge/delay was associated with decreased odds of feeling very or somewhat confident in obtaining a desired method (aOR 0.14; 95% CI 0.07, 0.25) and decreased odds of feeling it would be very or somewhat easy to switch contraceptive methods (aOR 0.48; 95% CI 0.33, 0.71). CONCLUSIONS: Eliminating barriers to contraceptive care is crucial to achieving person-centered access. Our research suggests that experiencing a challenge/delay has implications not only for recent contraceptive access but also influences self-efficacy, potentially inhibiting future ability to obtain and use desired contraception.