Factors Influencing Contraceptive Use in Women Seeking First-Trimester Abortion Care: An Austrian Cross-Sectional Survey.

BACKGROUND: Coined the Contraceptive Paradox, unwanted pregnancies and abortions remain stable in most West-European countries despite the wide availability of highly effective contraception. Demographic and contextual reasons for ineffective (or no) contraceptive use in couples with no desire for a child have been described, yet data on women's concerns are scarce. OBJECTIVE: This study evaluates a broad range of individual factors potentially determining insufficient/less or ineffective contraceptive use. METHODS: N = 399 women post abortion in Vienna, Austria answered a questionnaire assessing demographics, use of contraception, fertility perception, desire to avoid a pregnancy, influence of family and friends, and attitudes toward hormones, the pharma industry, and naturalness. We used multivariate ordinal logistic regression (OLR), reporting Odds Ratios (OR) to identify factors determining contraceptive use (none vs. moderately effective vs. highly effective contraception). Additionally, decision trees served as a basis for hypothesis generation. RESULTS: Hormone skepticism (OR when compared with no skepticism ranged from 0.07 for very large to 0.20 for low skepticism), a moderate desire to avoid a pregnancy (1.43), older age (0.98), being unemployed (1.93) and being single (OR = 2.63 for unstable relationship and 1.73 for stable relationship when compared with no relationship, respectively), were all associated with using no contraception. Decision trees suggested perceiving oneself and the partner as fertile and knowing that hormone-free contraception was important for friends and family as additional factors. CONCLUSIONS: Our findings may assist clinicians in better understanding women's attitudes and misconceptions. However, further research is needed to address potential dilemmas in women's contraceptive decision-making processes.