The Impact of Emotional, Physical & Sexual Abuse on Contraceptive Method Selection & Discontinuation

We evaluated the impact of exposure to emotional, physical, or sexual abuse on contraceptive method selection and discontinuation.

We performed a secondary analysis of 7170 women enrolled in the Contraceptive CHOICE Project in St. Louis, Missouri, a prospective cohort study in which 9256 women were provided their preferred method of contraception at no cost from 2007 to 2011. We defined contraceptive discontinuation as device removal or nonuse for at least 4 weeks within the first 12 months after initiation.

One third of women experienced some abuse in their lifetimes. Women with an abuse history were as likely as those without to select a long-acting reversible contraceptive method and more likely to choose a contraceptive injection, the patch, or the ring. When we compared women who were abused to those who were not, rates of discontinuation at 12 months were higher among women who selected long-acting reversible contraception (17% vs 14%; P = .04) and significantly higher among women who selected non–long-acting methods (56% vs 47%; P < .001). Type of abuse did not alter the association between abuse and contraceptive continuation.

Previous experiences of abuse are associated with both contraceptive method selection and continuation.

Method of Contraception Chosen at Baseline by Women: Contraceptive CHOICE Project by Lifetime History of Abuse, St. Louis, MO, 2007–2011

		Prevalence of Baseline Chosen Contraceptive Method, %
Type of Abuse	No.	LARC	PPR	DMPA	LARC vs non-LARC, RR (95% CI)	DMPA vs PPR, RR (95% CI)
Childhood (aged < 14 y)
None	5631	72	20	7	1.00 (Ref)	1.00 (Ref)
Any	1532	75	16	8	1.04 (1.01, 1.08)	1.28 (1.09, 1.51)
Emotionala	896	76	17	8	1.04 (1.00, 1.09)	1.18 (0.96, 1.45)
Physicala	641	78	14	8	1.08 (1.03, 1.13)	1.37 (1.09, 1.73)
Sexual	763	75	15	10	1.03 (0.99, 1.08)	1.47 (1.21, 1.78)
≥ 2 types	609	78	13	8	1.08 (1.03, 1.13)	1.42 (1.13, 1.78)
Adult (aged ≥ 14 y)
None	5854	73	20	7	1.00 (Ref)	1.00 (Ref)
Any	1307	74	18	8	1.02 (0.98, 1.06)	1.14 (0.95, 1.36)
Emotionala	964	74	18	8	1.03 (0.98, 1.07)	1.11 (0.91, 1.36)
Physicala	453	74	18	8	1.02 (0.97, 1.08)	1.12 (0.85, 1.49)
Sexual	484	73	18	9	1.00 (0.94, 1.06)	1.22 (0.94, 1.57)
≥ 2 types	496	74	18	9	1.01 (0.96, 1.07)	1.20 (0.93, 1.55)
Lifetime
None	5078	72	20	7	1.00 (Ref)	1.00 (Ref)
Any	2092	74	18	8	1.03 (0.99, 1.06)	1.22 (1.04, 1.41)
Emotionala	1353	75	17	7	1.04 (1.00, 1.07)	1.10 (0.91, 1.31)
Physicala	898	76	16	8	1.05 (1.01, 1.09)	1.28 (1.05, 1.56)
Sexual	1044	74	16	10	1.02 (0.98, 1.06)	1.39 (1.16, 1.65)
≥ 2 types	931	76	16	8	1.05 (1.01, 1.10)	1.28 (1.05, 1.56)

Note. CI = confidence interval; DMPA = depot medroxyprogesterone acetate contraceptive injection; LARC = long-acting reversible contraception (intrauterine device or hormonal implant); non-LARC = contraceptive pill, patch, ring, or injection; PPR = contraceptive pill, patch, or ring; RR = relative risk. The sample size was n = 7170.

aEmotional and physical abuse classified as abuse if more than a single occurrence of abuse.

Below:  Cumulative discontinuation rates by contraceptive method and experience of abuse for (a) childhood abuse and (b) adult abuse: Contraceptive CHOICE Project, St. Louis, MO, 2007–2011.

Note. LARC = long-acting reversible contraception (intrauterine device or hormonal implant); non-LARC = contraceptive pill, patch, ring, or injection.

Full article at: http://goo.gl/vqeJ8G

By: Jenifer E. Allsworth, PhD, Gina M. Secura, PhD, MPH, Qiuhong Zhao, MS, Tessa Madden, MD, MPH, and Jeffrey F. Peipert, MD, PhD

The authors are with Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.

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