%0 Journal Article
%T An Exploration of Contraceptive Choice Pathways in Adolescents and Young Adults.
%A Ash MD
%A Watson IS
%A Matera LE
%A Ebersole AM
%A Stewart HL
%A Price E
%A Taylor J
%A Berlan ED
%A Bonny AE
%J J Pediatr Adolesc Gynecol
%V 0
%N 0
%D 2024 Jul 11
%M 39002697
%F 2.046
%R 10.1016/j.jpag.2024.06.009
%X <B>OBJECTIVE: </B>To visualize contraceptive choice pathways among adolescent and young adults (AYA) designated female at birth (DFAB) as a means of exploring the relationships between current contraceptive use, desired contraceptive, and ultimately, chosen contraceptive method.<BR><B>METHODS: </B>A retrospective cross-sectional study was conducted of AYA DFAB (N=2369), aged 14-24 years, presenting for initial visit at a contraceptive clinic with standardized efficacy-based counseling. Sankey diagrams were utilized to visualize patient flow through the contraceptive decision-making process. Outcomes of interest were current contraceptive method, desired contraceptive prior to contraceptive counseling, and then chosen contraception. Chi-Square tests were conducted to quantify the strength of the relationships identified by the Sankey diagrams.<BR><B>RESULTS: </B>Sankey diagrams demonstrated a fair amount of change from current contraceptive to desired contraceptive and from current contraceptive to chosen contraceptive. A stronger relationship was evident between desired contraceptive method and chosen method; most patients did not change their desired contraceptive after receiving counseling except AYA who were undecided about their desired contraceptive who flowed variably into all available methods. Chi-Square test assessing the association between desired and chosen contraceptive method was significant at p-value <0.001, validating the patterns identified with the Sankey diagrams.<BR><B>CONCLUSIONS: </B>We identified distinct contraceptive decision-making pathways among AYA which could inform the framework for a more tailored counseling approach. These findings are aligned with national medical organizations' recommendations for provision of non-coercive, patient-centered contraceptive counseling to promote adolescent reproductive autonomy.