Having fun in bed without worrying about unplanned pregnancies. Sounds nice, right? Today, there are several “remedies” on the market to prevent unplanned pregnancies, each with its own pros and cons. There are also still the long-standing methods such as calendar methods or “getting out of church before singing” (aka withdrawal). In short, the choice of contraceptive method is very personal and can change throughout your life. We also see certain trends in society on this topic. That made us curious! We, Leen, Nina and Naomi, are researchers at the Center for Population, Family and Health at the University of Antwerp and, like the Isala researchers, we wondered which choices the Isala participants make when it comes to contraception. And are their choices related to their socioeconomic status and other lifestyle factors? Isala collected -thanks to all of you- a unique dataset. So, we explored it together and wrote an interesting scientific article! 🙂
What do we already know?
In the 2018 Belgian Health Survey, all sexually active women between the ages of 15 and 49 were asked if they used contraception. This was the case for 83.8%. When this subset was asked which method they used, “the pill” proved to be the most popular method with 48% users. Yet, pill use has declined in recent years. There are now many other “modern” contraceptive methods available (such as a patch, a ring, an IUD, etc.). In addition, within the group of women who used contraception, 1.7% preferred natural methods (such as periodic abstinence or withdrawal).
Let’s dig a little deeper… Are these differences in contraceptive choices linked to differences in socioeconomic status? Well, researchers from several countries have found that women of lower socioeconomic status use fewer or less reliable contraceptive methods. This is because they may experience more barriers (such as the cost of contraception), have less knowledge about contraception, and mirror the behavior of others around them (more info). On the other hand, people with a higher education generally use more contraception and more often ‘modern’ methods (more info here). And what about the link between contraceptive choices and lifestyle factors? Previous research shows that individuals who are more concerned about their health are also more likely to use (reliable) contraception (more info here). For example, women who are more likely to engage in preventive health behaviors such as having a smear test are also more likely to use the pill (more info here). On the other hand, the chances of someone not using a condom are higher among individuals who regularly smoke, binge drink and/or use drugs (more info here).
But researchers also see movement in the contraceptive landscape, and that could influence the aforementioned relationships between contraceptive use, socioeconomic status and lifestyle factors. For example, it seems that women today are increasingly choosing a contraceptive method with fewer or even no hormones (more info here). We wondered who exactly are the women who choose to do this, and if so, is this a conscious choice to promote health?
What did we do?
In 2020, 4682 Isala participants between the ages of 18 and 98 completed a detailed questionnaire. We focused on 4316 fertile women who were not trying to get pregnant. For these women, we checked what type of contraception they were using and whether it contained hormones. In addition, we looked at whether their contraceptive choices were related to their age, relationship status, having children, educational level, and any migration background. Finally, we also looked at associations with various lifestyle factors such as physical activity, vegetarian diet, smoking, alcohol and drug use, HPV vaccination status, having a smear test, and annual dental visits.
What did we discover?
Our study revealed some interesting results! We found that Isala participants with a higher level of education were less likely to use hormonal contraception. However, within the category of participants who did not use modern methods of contraception (preferring either no contraception or natural methods), we saw no differences in education level.
Regarding lifestyle factors, we found that participants with healthy, active lifestyles preferred non-hormonal methods. In addition, there was a group of women potentially at greater health risks because of their contraceptive choices. For example, women who smoked did not reduce their use of hormonal contraception, despite recommendations against it due to increased cardiovascular risks (more info here). In addition, participants who were not vaccinated against HPV or never had a smear test were more likely to use natural contraceptive methods, modern non-hormonal methods (mainly barrier methods such as condoms) or used no contraception at all.
How do we explain these results?
In recent decades, the use of hormonal contraception has faced increasing criticism. For example, women questioned its physical side effects, impact on their mental health and libido, fertility and overall health. As a result, there was a growing desire for alternatives such as “natural” solutions (more info here). In addition, our society is increasingly placing the responsibility for good health on the individual. For example, ‘health tracking’ also increasingly encourages people to closely monitor their own health (more info here). By this we mean tracking your own health, often with the help of all kinds of technological tools such as apps, smart watches, and so on.
The observed shift towards non- (or less) hormonal methods more among participants with a high level of education is not coincidental. We know from previous research that they are just more likely to use new innovations (more info here) and can more easily gather the right information, tools and skills to do so (more info here). Thus, they may be more likely to monitor their own health, and often have more resources to pay the higher cost of modern contraceptive methods (for example hormone or copper IUDs). In addition, they may also have more access to information about the impact of hormones on the female body, which may lead them to choose non-hormonal methods. Women of lower socioeconomic status tend to experience more barriers in life in general and in health care, and often have fewer resources and mental energy to engage in their health.
Thus, our research suggests that it could indeed be that women who are concerned with what it means to be “healthy” seek alternatives to the -previously taken for granted- pill. It also seems that this may go along with preferring contraceptive methods with fewer or even no hormones. In the future, we would love to hear from these women themselves why they chose this type of contraception!
Who am I?
Hello, I am Leen De Kort, sociological researcher at the Center for Population, Family and Health at the University of Antwerp. I am passionate about sexual and reproductive health, and more specifically about the stigma that often surrounds these topics. In my personal life I try to break taboos around this by talking about it openly and of course I hope to achieve this with my research as well. I have already worked on HIV and abortion, and I am currently focusing on contraceptive use. When I heard about the Isala project, I was immediately super excited. My colleagues, Nina and Naomi, and I decided to see if we as sociologists could do something with the data the Isala team was collecting. This curiosity led to a fun and productive collaboration! Our first joint scientific article was recently published, and who knows, more may follow in the future! 🙂
Written in collaboration with Nina Van Eekert