Using a Reproductive Life Planning Website and Action Plan to Help Women Choose and Use Birth Control

• Download Summary
• Español (pdf)
• Audio Recording (mp3)

What was the research about?

In the United States, 45 percent of pregnancies aren’t planned. A reproductive life plan based on a woman’s goals, resources, and values may help her decide whether, when, and how to have children.

In this study, the research team wanted to learn if a website on reproductive life planning helped women to choose and use birth control. The team also wanted to know if the website worked better when used with an action plan. In action planning, a woman makes plans for dealing with barriers to using birth control, such as how to remember to take a pill every day.

What were the results?

The research team didn’t find differences in birth control use among women who used reproductive life planning, reproductive life planning plus action planning, or only received information on birth control. Use of birth control increased for all groups during the study. Use of long-acting, reversible contraceptives, such as hormonal implants and intrauterine devices, or IUDs, also increased in all groups.

Who was in the study?

The study included 984 women who had health insurance with a company in Pennsylvania. Most of the women were white (94 percent), had graduated from college (93 percent), and had no children (68 percent). In addition, 45 percent of women were ages 18 to 25, 37 percent were ages 26 to 33, and 18 percent were ages 34 to 40. None of the women were planning to get pregnant in the next year. At the start of the study, 88 percent of women were using some form of birth control, and 12 percent reported using no birth control.

What did the research team do?

At the start of the study, all women in the study took a survey. The team then assigned the women to one of three groups by chance. The first group viewed an interactive website on reproductive life planning. Information on the site came from the U.S. Centers for Disease Control and Prevention. The information helped women decide if they wanted to become pregnant based on their current life goals. The website also gave women information on pregnancy and the birth control options that met their needs. The second group viewed the same website and completed an action plan for their current form of birth control. The third group viewed a website with standard information on common forms of birth control. All groups completed follow-up surveys and revisited their website every six months during the two-year study.

What were the limits of the study?

Most women in the study were white and well-educated. Also, all women had private health insurance and were from only one state. The findings may have been different with women from other backgrounds. At the start of the study, most women already used birth control and were satisfied with their choices. They may have already known about their birth control options.

Future studies could include women from different backgrounds. Future research could also focus on women who don’t always use birth control or on women who want to change their birth control method.

How can people use the results?

Researchers can use the results from this study to learn more about reproductive life planning and action planning programs.

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

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.