Lifetime patterns of contraception and their relationship to unintended pregnancies

BACKGROUND: For the past 30 years many effective methods of contraception have been available, yet unintended pregnancy rates still range from 30% to 50% in many populations. We examined patterns of women's contraceptive use throughout their lives and relate them to unintended pregnancy. METHODS: A total of 396 women aged 18 to 50 years chosen by convenience sampling from a family practice residency office were interviewed in a cross-sectional study about their history of using and changing contraception, and whether they believed they became pregnant while using a method of contraception. We analyzed the data for correlations and significance using chi-square and Student t tests. RESULTS: Most women had used both condoms and oral contraceptive pills, and tried an average of 3.54 methods during a lifetime. Two patterns of women's use of contraception emerged that describe 75% of the women. One third of the women--those who indicated a pattern of following their first method with a less effective method--are significantly more likely to have an unintended pregnancy while using contraception (odds ratio=1.4). The other group (50% of the entire sample) used increasingly effective methods and were less likely to have an unintended pregnancy. CONCLUSIONS: Pregnancy is an inherent natural consequence of sexual intercourse, even when using very effective contraceptive methods. By asking a few questions about a woman's history of contraceptive use, physicians may be able to determine those who are more likely to be at risk for an unintended pregnancy.     

Unintended Pregnancy in a Commercially Insured Population

Objectives: While much attention has been focused on unintended pregnancy in disadvantaged populations, few studies have focused on women in lower risk groups. This study, conducted in a national managed care organization, reports the prevalence of unintended pregnancy resulting in live births and examines associated factors. Methods: Women ages 18–49 who delivered a live infant during a 6-month interval were eligible for the study. Telephone surveys were conducted after delivery. We report the rate of unintended pregnancy resulting in a live birth, and describe its association with sociodemographic and pregnancy-related factors, partner's intention status, and contraceptive use. Results: Of 1173 births, 29% were unintended. Women who reported that the partner did not want the pregnancy were 7.4 times more likely than women whose partner wanted the pregnancy to regard the pregnancy as unintended. Only 40% of the women with an unintended birth used birth control and 64% of those used less effective methods such as condoms and diaphragms. Conclusions: In a population where the majority of women were married, educated, and with incomes over $40,000, almost 1/3 of the births resulted from unintended pregnancies. Future research is needed to help us better understand contradictions in pregnancy intention and contraceptive behavior. Comprehensive efforts are needed to promote consistent and correct use of contraception by women at risk for unintended pregnancy, and to involve male partners in family planning.     

Factors associated with effective contraceptive use among a sample of Latina women

Unintended pregnancy disproportionately affects Latina women. One factor contributing to unintended pregnancy among Latinas is the low rate of contraceptive use. This study examined correlates of effective contraceptive use among a sample of Latina women (n=202) at increased risk for HIV. In addition to traditional intrapersonal variables (i.e., perceived risk of pregnancy, motivation to avoid pregnancy), the present study examined the role of the male partner and relationship factors (i.e., relationship commitment, duration, pregnancy prevention decision-making) on contraceptive use. Participants were recruited from clinics and community locations in East Los Angeles and administered a 60-minute in-person interview. Multivariate logistic regression was used to compare women who consistently used effective contraceptives (36%) to women using no method or an ineffective method. Women in relationships of 1 to 2 years were nearly 3 times more likely to use an effective contraceptive compared to women in relationships of less than 1 year (odds ratio (OR)=2.7, 95% CI 1.1, 6.7). Women were more than twice as likely to use an effective method if they reported a high level of involvement in decision-making about whether to use contraception (OR=2.3, 95% CI 1.1, 4.7) or had discussed contraception with their partner (OR=2.4, 95% CI 1.03, 5.6). This study provides additional information about the importance of male partners and relationship factors in contraceptive use among Latina women. Efforts to prevent unintended pregnancy need to address the role of relationship factors in the sexual risk and protective behaviors of Latinas.     

Measuring pregnancy intention and its relationship with contraceptive use among women undergoing therapeutic abortion

BACKGROUND: Most pregnancies ending in therapeutic abortion are assumed to have been unintended. In the developed world, most arise from inconsistent or incorrect contraceptive use. Ambivalence about pregnancy might be associated with less effective contraceptive use. METHODS: Three hundred sixteen women undergoing abortion in Scotland were interviewed about contraceptive use at the time of conception. A modified measure of pregnancy intendedness was used to determine ambivalence. RESULTS: Pregnancy appeared to be clearly unintended for 92% of women. Sixteen percent were not using contraception and had higher intendedness scores (p<.001) than those using a method. Forty-four percent were using contraception inconsistently or incorrectly, almost always condoms or oral contraception, but method choice was not linked to pregnancy intendedness. DISCUSSION: Women who are ambivalent about the desire for pregnancy are less likely to use contraception. The challenge for reducing abortion rates lies in improving contraceptive use among the much larger group of women who do not intend to get pregnant but use contraception imperfectly.     

Contraceptive failure--results from a study conducted among women with accepted and unaccepted pregnancies in Denmark

Most studies focusing on contraceptive failure in relation to pregnancy have focused on contraceptive failure among women having induced abortions, thereby neglecting those women who, despite contraceptive failure, accept the pregnancy and intend to carry the fetus to term. To get a more complete picture of the problem of contraceptive failure, this study focuses on contraceptive failure among women with diverse pregnancy outcomes.In all, 3520 pregnant women attending Odense University Hospital were included: 373 had induced abortions, 435 had spontaneous abortions, 97 had ectopic pregnancies, and 2614 received antenatal care. The variables studied comprise age, partner relationship, number of births, occupational and economical situation, and contraceptive use.Contraceptive failure, defined as contraceptive use (condom, diaphragm, IUD, oral contraception, or another modern method) at the intercourse where conception most likely occurred, were reported by 315 women, 52% of these women had induced abortions, 10% had spontaneous abortions, 3% had ectopic pregnancies, and 36% received antenatal care. Women aged 15-24 years were more likely to have experienced contraceptive failure in relation to use of condom and oral contraception than women aged 25-34 years. In addition, contraceptive failure was found to be associated with being single, a student, and having given birth twice or more previously. Regarding pregnancy acceptance, being 25-34 years of age was positively associated, whereas being single and a student was negatively associated with pregnancy acceptance.     

Age differences between sexual partners in the United States.

CONTEXT: Researchers have examined the age of partners of young women at first intercourse and of young women who have given birth, but little is known about the age of partners of young women in current sexual relationships or young women who have had an abortion. METHODS: Data from the 1995 National Survey of Family Growth (NSFG) were used to examine age differences between women and their current partner and women's use of contraceptives at last intercourse, by marital status and by the age difference between women and their partner. Data from the NSFG and the 1994-1995 Alan Guttmacher Institute Abortion Patient Survey, with supplemental information from other sources, were used to estimate 1994 pregnancy rates for women by their age and marital status, according to the age difference between the women and their partner. RESULTS: Among all sexually active women aged 15-44, 10% had a partner who was three or more years younger, 52% a partner who was within two years of their age, 20% a partner who was 3-5 years older, and 18% a partner who was six or more years older. In contrast, 64% of sexually active women aged 15-17 had a partner within two years of their age, 29% a partner who was 3-5 years older, and 7% a partner who was six or more years older. Among women younger than 18, the pregnancy rate among those with a partner who was six or more years older was 3.7 times as high as the rate among those whose partner was no more than two years older. Among women younger than 18 who became pregnant, those with a partner who was six or more years older were less likely to have an unintended pregnancy (70%) or to terminate an unintended pregnancy (21%) than were those whose partner was no more than two years older (82% and 49%, respectively). Among women younger than 18 who were at risk of unintended pregnancy, 66% of those who had a partner who was six or more years older had practiced contraception at last sex, compared with 78% of those with a partner within two years of their own age. Young women who were Catholic and those who had first had sex with their partner within a relatively committed relationship were less likely to be involved with a man who was six or more years older than were young women who were Protestants and those who first had sex with their partner when they were dating, friends or had just met. Young women who had ever been forced to have sex were twice as likely as those who had not to have a partner who was 3-5 years older. CONCLUSION: Although the proportion of 15-17-year-old women who have a much older partner is small, these adolescents are of concern because of their low rate of contraceptive use and their relatively high rates of pregnancy and birth. Research is needed to determine why some young women have relationships with an older man, and how their partner's characteristics affect their reproductive behavior.     

Contraceptive use, pregnancy and fertility patterns among single American women in their 20s

Eighty-two percent of never-married American women aged 20-29 have had sexual intercourse; black women are somewhat more likely than white women to have had intercourse. In all, 53 percent of never-married women in this age-group had intercourse at least once in the four weeks preceding the 1983 National Survey of Unmarried Women. Black women are more likely than white women to have done so (62 percent compared with 51 percent). Nearly all of the women who ever had intercourse have used a contraceptive method at some time; 78 percent practiced contraception at the time of their most recent intercourse. A high proportion did not start using birth control until some time after first intercourse, however: On average, the delay between first coitus and first contraceptive use was eight months, and one-fifth of the respondents said that they began using a method only after their first pregnancy. Most of the women who did use a method at the time of first intercourse relied on the condom or withdrawal; in contrast, about two-thirds of white women and three-quarters of black women now rely on the pill, IUD or sterilization. Eighty-six percent of the women who had intercourse in the four weeks before the interview were current users--88 percent of the white women and 77 percent of the black women. Catholic women are no less likely than others to have ever had intercourse, to be currently sexually active or to be using contraceptives. However, Catholic women who receive communion at least once a week are less likely to be sexually active and substantially less likely to use medical contraceptive methods. Women who consider themselves very religious are less likely to be sexually active, but the sexually active among them are about as likely as others to use contraceptives. Better-educated women are much more likely than less-educated women to practice contraception, and women who work outside of the home are more likely than those who do not to use contraceptives. Thirty-three percent of unmarried 20-29-year-olds have had at least one pregnancy (about 40 percent of those who have ever had intercourse). Thirty-two percent of sexually active white women have been pregnant, compared with 70 percent of comparable black women. Furthermore, whereas 14 percent of white 20-29-year-olds have had an out-of-wedlock birth, 62 percent of black women have done so.(ABSTRACT TRUNCATED AT 400 WORDS)     

Young women under 16 years with experience of sexual intercourse: who becomes pregnant?

BACKGROUND: The UK has the highest rate of teenage pregnancies in western Europe. Although there is a large body of literature focusing on predictors of conception among this age group, almost all the work compares those young women who have become pregnant with their peers, regardless of whether or not their peers have experienced sexual intercourse. OBJECTIVE: To compare 16-year-old young women who have become pregnant with their peers who also have experience of sexual intercourse, but who have not conceived. DESIGN: Analysis of data from the baseline and follow-up surveys conducted as part of a trial of sex education. SETTING AND PARTICIPANTS: Female school students aged 14-16 years from the East of Scotland. MAIN RESULTS: Young age of self and partner, and non-use of contraception, all at first intercourse, are most strongly associated with pregnancy. CONCLUSIONS: Those who engage in sexual intercourse at a relatively young age will often have had more opportunity to become pregnant than those whose sexual debut comes later. Similarly, the fact that those who use contraception at first intercourse have been less likely to conceive than those who do not could reflect the overall patterns of contraceptive use: young women who have used contraception at each occasion of intercourse will have had less chance to conceive than those who have not. Having a young partner at first intercourse suggests that, if this pattern continues, the couple may lack the resources needed to prevent a pregnancy due to the immaturity of both partners.     

U.S. women's one-year contraceptive use patterns, 2004

CONTEXT: Unintended pregnancies occur far too often in the United States, and half occur when couples fail to practice contraception. Improved measures of the continuity of women's contraceptive use, nonuse and switching patterns can help identify ways to reduce unintended pregnancy. METHODS: A nationally representative sample of 1,978 adult women at risk of unintended pregnancy was surveyed by telephone in 2004. Respondents provided detailed information about contraceptive use and periods of stopping or switching methods during the past year. A typology of patterns of contraceptive use was created, classifying women into mutually exclusive categories according to their exposure to pregnancy risk. RESULTS: Twenty-three percent of women at risk of unintended pregnancy were exposed to a high risk of pregnancy because of gaps in contraceptive method use in the year prior to the survey--8% were consistent nonusers, and 15% experienced 1-11 months of nonuse while at risk. More than half of women used a method during each of the previous 12 months-38% used the same method or methods all year, and 24% switched methods. Fifteen percent of women had gaps in contraceptive use when they were not at risk. Women reported a variety of reasons for their gaps in contraceptive use, including method-related difficulties and side effects, infrequent sex and being ambivalent about avoiding pregnancy. CONCLUSIONS: Strategies for reducing gaps in contraceptive use include improved counseling to help women both choose the right method and continue method use, especially when they have periods of infrequent sexual activity or are experiencing method-related side effects or problems.     

Unintended pregnancy and postpartum contraceptive use in women with and without chronic medical disease who experienced a live birth

Background

Maternal chronic medical disease and unintended pregnancies increase the risk of maternal and infant morbidity and mortality. Little is known regarding the relationship between chronic medical disease status and pregnancy intendedness or contraceptive use.

Study Design

We compared pregnancy intention and postpartum contraception use in women with and without chronic medical disease who experienced a live birth using data from the Florida Pregnancy Risk Assessment Monitoring System 2004–2005.

Results

Women aged ≥20 years with chronic medical disease were more likely to report that the index pregnancy was unintended (odds ratio [OR]=1.56, 95% confidence interval [CI] 1.28–2.03) and reported similar postpartum contraception nonuse (OR=0.85, 95% CI 0.60–1.19) compared to those without chronic medical disease. Women aged <20 years with chronic medical disease were less likely to report that the index pregnancy was unintended (OR=0.50, 95% CI 0.28–0.88) and reported similar postpartum contraception nonuse (OR=0.99, 95% CI 0.54–1.82) compared to those without chronic medical disease.

Conclusions

In our study population, age and chronic medical disease were associated with different risks of pregnancy intention in the index pregnancy. Women with and without chronic disease in both age groups reported similar postpartum contraception use.     

Factors associated with contraceptive use and nonuse, United States, 2004

CONTEXT: Each year, nearly one in four U.S. women at risk of unintended pregnancy experience one or more months of contraceptive nonuse. Understanding what factors are associated with risky contraceptive use patterns can inform programs and policies designed to reduce levels of unintended pregnancy. METHODS: A nationally representative sample of 1,978 adult women at risk for unintended pregnancy was surveyed over the telephone in 2004. Respondents provided information on contraceptive use over the past 12 months. Multiple logistic regressions were used to identify factors associated with different contraceptive use patterns. RESULTS: Ambivalence about avoiding pregnancy was strongly associated with both contraceptive nonuse and having a gap in use while remaining at risk of unintended pregnancy (odds ratios, 2.4 and 2.0, respectively). Other significant predictors of either of these risky contraceptive behaviors were having less than a college education, being black, being 35-44 years old, having infrequent sexual intercourse, not being in a current relationship, being dissatisfied with one's method and believing that contraceptive service providers were not available to answer method-related questions (1.7-3.8). CONCLUSIONS: Providers could better help women avoid unintended pregnancy by initiating regular assessments of method use difficulties, improving counseling on method choice and pregnancy risk, and identifying and assisting women at higher risk for inconsistent method use because of disadvantage, relationship characteristics or ambivalence about pregnancy prevention. In addition to providers' efforts, broader societal commitment is critical for increasing contraceptive knowledge and expanding access to contraceptive care for all women who are at risk of having an unintended pregnancy.     

The sexual and reproductive behavior of American women, 1982-1988

Comparison of 1988 data from the National Survey of Family Growth with 1982 data reveals that the proportion of U.S. women who have had sexual intercourse rose slightly, from 86 percent to 89 percent. Among teenagers, the proportion sexually active rose from 47 percent to 53 percent; most of the change is attributable to increases occurring among white and nonpoor teenagers, thus narrowing racial and income differences. Among women aged 15-44 in 1988 who have ever had intercourse, 67 percent reported that they had had two or more sexual partners in their lifetime. The proportion was highest among women aged 20-34 (about 70 percent), but 58 percent of sexually active teenage women reported having had two or more sexual partners. About 67 percent of women of reproductive age in 1988 were exposed to the risk of unintended pregnancy, up from 63 percent in 1982. Among these women, 35 percent rely on contraceptive sterilization to prevent pregnancy and 55 percent use reversible methods, while 10 percent use no method. Poor women are much more likely than nonpoor women to be using no method of contraception (15 vs. eight percent); among poor teenagers, this proportion reaches 25 percent. The level of contraceptive use at first intercourse among teenage women improved substantially between 1982 and 1988, however, rising from 48 percent to 65 percent. During 1984-1988, almost four in 10 births and almost six in 10 pregnancies among American women were unintended; most of these were mistimed, but 12 percent of births were unwanted ever.(ABSTRACT TRUNCATED AT 250 WORDS)     

Young adults' contraceptive knowledge, norms and attitudes: associations with risk of unintended pregnancy

CONTEXT: Women aged 18–29 have higher rates of unintended pregnancy than any other age‐group. Information is needed to understand what characteristics are associated with risky contraceptive use practices among this population and to develop new strategies for reducing these women's risk of unintended pregnancy. METHODS: Data related to unintended pregnancy risk were collected from a nationally representative sample of 1,800 unmarried women and men aged 18–29 surveyed by telephone in 2009. Among those at risk of unintended pregnancy, multiple logistic regression was used to assess associations between contraceptive knowledge, norms and attitudes and selected risky contraceptive behaviors. RESULTS: More than half of young men and a quarter of young women received low scores on contraceptive knowledge, and six in 10 underestimated the effectiveness of oral contraceptives. Among women, for each correct response on a contraceptive knowledge scale, the odds of expecting to have unprotected sex in the next three months decreased by 9%, of currently using a hormonal or long‐acting reversible method increased by 17%, and of using no method decreased by 17%. Fear of side effects, norms and attitudes that favor nonmarital pregnancy or undervalue the importance of contraception, pregnancy ambivalence and mistrust of government's role in promoting contraception were also associated with one or more risky contraceptive use behaviors. CONCLUSIONS: Programs to increase young adults’ knowledge about contraceptive methods and use are urgently needed. Given the demonstrated link between method knowledge and contraceptive behaviors, such programs may be useful in addressing risky behavior in this population.     

Contraceptive counseling in managed care: preventing unintended pregnancy in adults.

This study examines contraceptive counseling received by adult women in their managed care plans and the relationship between counseling and women's contraceptive attitudes and practices. Telephone interviews were conducted with a random sample of 898 women ages 18 to 44 enrolled in a commercial health maintenance organization (HMO) or point-of-service (POS) health plan. Counseling received in the past 2 years was measured on three dimensions: exposure through any communication channel; content of information; and personalization of discussion. Multiple logistic regression analysis was used to examine the determinants of counseling and the relationship between counseling and four outcomes: satisfaction with counseling received, self-efficacy for preventing unintended pregnancy, current use of contraception (if at risk of unintended pregnancy), and intent to contracept in the next year (if at risk). Overall, 60.5% of women were at risk of unintended pregnancy; among those at risk, 69% received any counseling in the past 2 years, compared with 38% among those not at risk. Receiving personalized counseling (as opposed to no counseling or only informational counseling) significantly increases the odds of satisfaction with counseling, current contraceptive use, and intent to contracept. Informational counseling alone (without personalization) significantly increases the odds of contraceptive use. Women ages 40-44 were less likely than younger women to receive counseling and to use contraception if at risk of unintended pregnancy. We conclude that receiving contraceptive counseling in managed care is associated with contraceptive attitudes and practices among adults and that there is substantial room for quality improvement in the provision of contraceptive counseling.     

Homeless Women: Who is Really at Risk for Unintended Pregnancy?

Objective To identify correlates of failure to use contraception among homeless women at risk for unintended pregnancy. Study Design A representative sample of 974 homeless women surveyed in Los Angeles County in 1997 included 457 who were at risk for unintended pregnancy. Logistic regression modeling was used to identify important predictors of contraceptive nonuse or rare use in the past year. Results One third of the sample used contraception rarely or never in the past year. Having a partner, being monogamous, and not engaging in sex trade predicted contraceptive nonuse or rare use (odds ratios 2.43–4.73, P < .05). Partner dislike and uncertainty about which contraceptive to use were also associated with failure to use contraception (odds ratios 2.64–2.96, P < .05). Having a regular source of care and having been encouraged to use contraception protected against failure to use contraception. Conclusions Homeless women, including those at apparently low risk for unintended pregnancy, need to be targeted with integrated services that include education, a regular source of medical care, and encouragement to use contraception.     

Failure of family-planning referral and high interest in advanced provision emergency contraception among women contacted for STD partner notification

BACKGROUND: Few data are available on the risk of unintended pregnancy in women with STD or how contraceptive services can be integrated into STD control activities. OBJECTIVE: To define the risk for unintended pregnancy and assess the effectiveness of family-planning (FP) referral and interest in advanced provision emergency contraception (APEC) among women with gonorrhea or chlamydial infection. METHODS: Female participants in a randomized trial of different approaches to partner notification were interviewed, offered referral for FP services and asked if they would want APEC. RESULTS: Among participants ages 14-24, the observed past pregnancy rate and age-adjusted anticipated past pregnancy rate were, respectively, 196 and 72 per 1000 women-years. Of 474 nonpregnant participants who did not desire pregnancy, 127 (34%) were using no contraception or condoms alone, of whom 8 (6%) requested a FP appointment and 81% wanted APEC. CONCLUSIONS: Women treated for STD are at high-risk for unintended pregnancy. Although referral for FP was ineffective, interest in APEC was very high.     

Contraceptive use and risk of unintended pregnancy in California

California is home to more than one out of eight American women of reproductive age. Because California has a large, diverse and growing population, national statistics do not necessarily describe the reproductive health of California women. This article presents risk for pregnancy and sexually transmitted infections among women in California based on the California Women's Health Survey. Over 8900 women of reproductive age who participated in this survey between 1998 and 2001 provide estimates of access to care and use of family-planning methods in the state. We find that 49% of the female population aged 18-44 in California is at risk of unintended pregnancy. Nine percent (9%) of women at risk of an unintended pregnancy are not using any method of contraception, primarily for method-related reasons, such as a concern about side effects or a dislike of available contraceptive methods. Among women at risk for unintended pregnancy, we find disparities by race/ethnicity and education in use of contraceptive methods.     

The correspondence between intention to avoid childbearing and subsequent fertility: a prospective analysis

CONTEXT: Retrospective studies of pregnancy intendedness have revealed some characteristics that can help identify which women are more likely than others to experience an unintended birth. A comparison of these findings with those from a prospective analysis may shed greater light on the characteristics associated with unintended pregnancy. METHODS: Data were taken from the 1988 National Survey of Fertility Growth and a telephone reinterview of respondents conducted in 1990. Separate analyses were conducted of women intending to postpone childbearing for at least three years and of women intending to forgo all future childbearing. Logistic regression models were used to identify the effects of social and demographic characteristics, as well as change in marital status and certainty of intentions, on the odds of experiencing a birth in the interval between interviews. RESULTS: Only 10% of women intending to postpone pregnancy for more than three years and 8% of respondents seeking to forgo future childbearing had a birth in the interval between interviews. (These births, referred to as unpredicted births in this article, are roughly analogous to those labeled unintended in retrospective analyses.) Women with incomes below the poverty level were 2-3 times as likely as women with incomes between 100% and 199% of poverty to experience an unpredicted birth. Race was not a significant factor among women intending to avoid future childbearing, and became nonsignificant among those intending to postpone when change in marital status and contraceptive status were taken into account. Women aged 35 and older who wanted no more children were significantly less likely than women aged 20-29 to have an unpredicted birth. Women aged 30-34 who wanted to postpone childbearing were roughly 70% less likely than women aged 20-29 to experience an unpredicted birth. Overall, women who were at risk for a pregnancy but not practicing contraception were 2-3 times more likely than women using an effective method to have an unpredicted birth. CONCLUSIONS: There are at least two potential explanations for instances where the correlates of unintended births in the prospective analysis differ from those identified in retrospective studies. Certain subgroups of women may be more likely to classify births as wanted when they are asked retrospectively; alternatively, they may be more likely to experience changes in their living conditions that alter their fertility intentions.     

Associations between low-income women's relationship characteristics and their contraceptive use

CONTEXT: Women's relationship context likely influences both their ability and their motivation to use contraceptives. No recent studies, however, have examined associations between women's relationship characteristics and use of different methods. METHODS: Data were collected in a longitudinal study of 839 low-income women at risk of unintended pregnancy who visited public family planning and postpartum clinics and maternity wards in two Southeastern cities. Simulated probabilities calculated from multivariate analyses assessed associations between a wide range of relationship characteristics and the use of no method, condoms, withdrawal, female methods or dual methods. RESULTS: Women who had had a child with their partner had an increased likelihood of contraceptive nonuse and use of withdrawal, and a decreased likelihood of using any female method. Respondents who were in a relationship for a relatively long time had an elevated likelihood of nonuse and use of female methods, but a lowered likelihood of condom use. Furthermore, married or cohabiting women were less likely than others to use dual methods. Respondents who had good communication with their partner had an elevated likelihood of using condoms. In addition, women who expected to receive a lot of emotional support from their partner if they became pregnant were more likely than others to report any condom use or dual method use, and less likely to report contraceptive nonuse. CONCLUSIONS: When counseling family planning clients, providers should consider women in the context of their relationships. Future research exploring factors associated with contraceptive method use should examine variables related to the establishment, quality and expectations of their relationships.