Shame, bluffs and drug mules – experiences of young women obtaining contraception

Problem

Despite a wide range of available contraceptive methods, clinical guidelines and national policies, young women continue to be at highest risk of unplanned and unwanted pregnancies. We aimed to explore the experiences of young women about information and access to contraception.

Approach

We recruited young women from Instagram and allocated them into: 16 to 19 and 20 to 24 age groups to reflect the different life stages, experiences and policy focus. Focus group discussions lasted 90 minutes and were facilitated by two researchers. These were recorded digitally and sent to commercial transcription service; transcripts were validated with the participants. We used a topic guide and a range of contraceptive methods out on display to stimulate discussions about experiences and access from healthcare settings.Three researchers analysed the transcripts through discussions of categories from initial reading, further thematic analysis, comparing and agreeing on coding. We used NVivo to organise the data.

Findings

10 women aged 16 to 19 years and 11 aged 20 to 24 years participated in their respective focus groups. They were ethnically diverse, and most were from London. Contraceptive pills and patches were often a default and only choice that was discussed and made available to them. Hormonal side effects were recognised as a common trade off of these methods.Condom use was encouraged from an early age, particularly from school. Some chose to purchase condoms as “free” condoms incurred other costs such as efforts to get on a "condom card scheme", time to attend a venue, and condoms were often limited in quantity and variety. Female condoms were neither popular or acceptable.Women reported they assumed responsibility for contraception and sexual health within a relationship no matter how brief, and men were seen as complacent. Some women had to bluff to test out their trust in partners’ attitudes to contraception and sexual health.Sex was shameful and disapproved by family and cultural norms. Women felt judged obtaining contraception and some resorted to asking peers to obtain on their behalf. In addition to confidentiality and accessibility, women want services that recognise their maturity and responsibility, as well as being holistic, empathic and non-judgemental. Parents (particularly mums) were viewed as overprotective and controlling, often restricting what young women were allowed to use. However, they also wanted a degree of "mothering"; for example, they reminisced about support school nurse offered them.Women also found it liberating and informative discussing sex and contraception in the focus groups setting.The data from focus group are still being analysed and further themes will be presented at the conference in July.

Consequences

Young women face challenges obtaining contraception they need. Although individual services can make changes to improve individual experiences, more needs to be done to change societal attitudes to gender roles and sexuality.