Joseph Earl Potter

Many people at risk of an undesired pregnancy are not using their preferred contraceptive method. On its own, discordant use is an important indicator of reproductive autonomy. It may also affect reproductive outcomes, although little research has explored the consequences of unsatisfied contraceptive preferences. Using prospective data for the two years following delivery for a cohort of low‐income postpartum women in Texas, many of whom would have preferred to be using a more effective method than the one they were using, we ask: How would the pregnancy trajectories of those not using their preferred contraceptive have differed had they been able to access their preferred method? Taking an inverse probability of treatment weighting approach, we show that using a preferred method was associated with half the likelihood of conceiving a pregnancy likely to result in a birth within 21 months postpartum (adjusted hazard ratio 0.43; 95 percent confidence interval 0.32, 0.57). Our findings highlight the consequences of failing to provide people with their preferred method and reveal how, in a context where people face substantial barriers to reproductive healthcare, discordant use increases the risk that people will have a baby that they did not desire at that time or, in some cases, ever.

Fertility surveys have rarely asked people who are using contraception about the contraceptive method they would like to be using, implicitly assuming that those who are contracepting are using the method they want. In this commentary, we review evidence from a small but growing body of work that oftentimes indicates this assumption is untrue. Discordant contraceptive preferences and use are relatively common, and unsatisfied preferences are associated with higher rates of method discontinuation and subsequent pregnancy. We argue that there is opportunity to center autonomy and illuminate the need for and quality of services by building on this research and investing in the development of survey items that assess which method people would like to use, as well as their reasons for nonpreferred use. The widespread adoption of questions regarding method preferences could bring indicators of reproductive health services into closer alignment with the needs of the people they serve.

Levels of fertility and the shape of the age-specific fertility schedule vary substantially across U.S. regions with some states having peak fertility relatively early and others relatively late. Structural institutions or economic factors partly explain these heterogeneous patterns, but regional differences in personality might also contribute to regional differences in fertility. Here, we evaluated whether variation in extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience measured at the U.S. state-level was associated with the level, timing, and context of fertility across states above and beyond sociodemographics, voting behavior, and religiosity. Generally, states with higher levels of agreeableness and conscientiousness had more traditional fertility patterns, and states with higher levels of neuroticism and openness had more nontraditional fertility patterns, even after controlling for established correlates of fertility (r ~ |.50|). Personality is an overlooked correlate that can be leveraged to understand the existence and persistence of fertility differentials.

Background: Prior research has shown that a small proportion of U.S. women attempt to self-manage their abortion. The objective of this study is to describe Texas women’s motivations for and experiences with attempts to self-manage an abortion. The objective of this study is to describe Texas women’s motivations for and experiences with attempts to self-manage an abortion. Methods: We report results from two data sources: two waves of surveys with women seeking abortion services at Texas facilities in 2012 and 2014 and qualitative interviews with women who reported attempting to self-manage their abortion while living in Texas at some time between 2009 and 2014. We report the prevalence of attempted self-managed abortion for the current pregnancy among survey respondents, and describe interview participants’ decision-making and experiences with abortion self-management. Results: 6.9% (95% CI 5.2–9.0%) of abortion clients (n = 721) reported they had tried to end their current pregnancy on their own before coming to the clinic for an abortion. Interview participants (n = 18) described multiple reasons for their decision to attempt to self-manage abortion. No single reason was enough for any participant to consider self-managing their abortion; however, poverty intersected with and layered upon other obstacles to leave them feeling they had no other option. Ten interview participants reported having a complete abortion after taking medications, most of which was identified as misoprostol. None of the six women who used home remedies alone reported having a successful abortion; many described using these methods for several days or weeks which ultimately did not work, resulting in delays for some, greater distress, and higher costs. Conclusion: These findings point to a need to ensure that women who may consider self-managed abortion have accurate information about effective methods, what to expect in the process, and where to go for questions and follow-up care. There is increasing evidence that given accurate information and access to clinical consultation, self-managed abortion is as safe as clinic-based abortion care and that many women find it acceptable, while others may prefer to use clinic-based abortion care.