Professional Abstract

Objective

To test whether reproductive life planning alone or in combination with contraceptive action planning increases contraceptive use and adherence among women compared with information about contraception only

Study Design

Design Element	Description
Design	Randomized controlled trial
Population	984 women ages 18–40
Interventions/ Comparators	Reproductive life planning Reproductive life planning plus contraceptive action planning Contraceptive information
Outcomes	Any contraceptive use, prescription contraceptive use, contraceptive use congruency with pregnancy intention, contraceptive adherence, a change to a more effective contraceptive method
Timeframe	2-year follow-up for study outcomes

This randomized controlled trial compared the effectiveness of reproductive life planning alone, reproductive life planning plus contraceptive action planning, and contraceptive information alone on women’s contraceptive use and adherence. In reproductive life planning, individuals set goals for having or not having children and make a plan to achieve those goals. In contraceptive action planning, individuals make a specific plan for what they will do when faced with common obstacles to using contraception.

The study included 984 women who were insured by a large private health insurer in Pennsylvania. Most of the women were white (94%), had graduated from college (93%), and had no children (68%). Of the women in the study, 45% were ages 18 to 25, 37% were ages 26 to 33, and 18% were ages 34 to 40. All of the women had coverage for prescription medication and were not planning to become pregnant in the next 12 months. At baseline, 50% of women were using short-acting prescription methods, 30% were using nonprescription methods, 12% reported using no method, and 8% were using long-acting, reversible contraceptives (LARC), such as intrauterine devices or hormonal implants.

All women completed a baseline survey. The research team then randomly assigned women to one of three groups. The first group viewed an interactive website adapted from the Centers for Disease Control and Prevention’s reproductive-life-planning tool. The website helped women determine if they wanted to become pregnant based on their current life circumstances and goals. The website also provided information to help each woman with individual decision making and displayed a summary of contraceptive options that met each woman’s needs. The second group viewed the same website and completed an action plan for the contraceptive method they were using, if any. The third group viewed a website with standard information on all contraceptive methods approved by the U.S. Food and Drug Administration. All groups completed follow-up surveys and revisited their assigned website every six months during the two-year study.

Patient and clinician advisory groups provided input to the research team throughout the study.

Results

After two years, there were no statistically significant differences among the three groups in any of the study outcomes. Overall contraceptive use and LARC use increased significantly among all groups during the study (p<0.05), but there were no differences among the three groups.

Limitations

Most women in the study were white and well-educated and all had private insurance and were from a single state, which may limit the generalizability of the findings. The study sample had relatively high contraceptive use and satisfaction at baseline, so participants may have already been knowledgeable about their contraceptive options.

Conclusions and Relevance

The study did not find evidence that reproductive life planning alone or combined with contraceptive action planning affects contraceptive use or adherence, compared with standard contraceptive information alone.

Future Research Needs

Future research could include women from different backgrounds. Future studies could also focus on women who express an interest in changing their method of contraception or have a problem with consistently using their current method.