Table 2 Contraceptive phases and factors associated with contraceptive decision-making as part of the contraceptive journey

Identification of need

How does someone get to the place where they decide they need a new method?

I had really bad cramps and really heavy periods. So, I got on it [contraception] mostly for that. Also with the hope that it would get rid of my acne, but it did not

–Amaia, age 27

It was like, a year and a half before I started any other contraceptive, just because I was so focused on being a mom. I didn’t have any kind of interest in pursuing relationships or even having sex. So, I just didn’t see the point of having any kind of birth control. I wanted my body to heal from my pregnancy and get back in shape and take care of myself mentally because of the whole new transition into being a new mom and everything

—Kiara, age 26

“As a young teenage girl, I was excited to start the pill because I had seen and heard some of my friends who are on the pill, who their boobs got bigger, maybe their butt got bigger. You know, I was all about that.”

—Valerie, age 34

At the time, I just was really sure that I needed something foolproof because at that point, I was really traveling a lot and it was hard. I wasn’t seeing my regular doctor anymore and every time I moved, if I did have to go to the doctor, I was usually going to urgent care or something and it was difficult to do certain things remotely…I was like, I don’t know, I may go to Asia, I may go backpacking or something after this and I don’t want to always be worried if I can’t get in touch with my doctor. —Romina, age 29

That was also a lot of the reason why I kind of always wanted to be on contraception, because when there were incidences where I felt like I wasn’t safe or I couldn’t get out of a situation, I always wanted to be on contraception so that way I didn’t have to worry about rape and pregnancy.”

—Begonia, age 26

Initiation

What is the initial experience with the method?

What is the process of getting a new method?

Ok, so the first time I used… I had sex I pretty much did not know that I was allergic to condoms. So now I know I’m allergic to condoms. Latex, that’s what it is

—Mari, age 25

I don’t think it’s [hormonal contraception] is for every body and all the different types I’ve tried have told me that. Now I’m reading a really great book about fertility in women and your body and I’m trying to get better at the fertility awareness method. I’m just trying to be more in tune with my body instead of just ignoring it and flatlining everything

—Roxanna, age 31

“I always wanted to use condoms. So, I always used condoms. And then one boy asked, ‘Are you on birth control?’ And I said…at the time, I liked and said yes because I didn’t want him to freak out and then the next day I went and got Plan B because we hadn’t used protection.” —Elle, age 24

When I got the Skyla, my doctor put it through my insurance, and she thought it was covered. I came home and discovered I had a bill for $300 and I was supposed to be on a payment plan. And I was supposed to petition them or something and forgot. —Romina, age 29

I felt comfortable with telling them I had started a new relationship and wanted a new method. And I explained the ones I had already tried and why they didn’t work. I think they slightly were pressuring me to do the pill. But I was like, “Alright, I don’t think you know how much I would forget to take the pill, so that’s a bad method for me.” Elle, age 24

Continuation

What are the ongoing experiences of using a contraceptive method?

What happens after uptake?

And my struggle with the IUD was that I remember looking up and I was just doing research and seeing, they said you typically have really bad cramps for six months or so… And I had really bad cramps for over a year…And it was awful. But I don’t know, just eventually it went away… I almost got it taken out a few times, but they kept telling me it was normal. And so I stuck it out. Now that I have none of the side effects, it’s fantastic

—Syndey, age 25

“I just did not take it consistently. I feel like I had some weird religious guilt during the time, so I think I would go through phases of being like, ‘Oh, I don’t want to have sex’ and then wanting to have sex and having sex. And so I think that’s why the pill didn’t really stick with me then, because I would go through phases of being like, ‘I don’t really need this.’ And that’s not really how you take the pill and it works.” —Selena, age 26

“Initially I liked it [vaginal ring]. But I just had really bad depression on it and it was my freshman year in college and I was just so depressed on it and it really decreased my libido. So I was having all these issues with it, so my stepmom was just like, “it takes your body a little while to acclimate, so just try to keep it in.”

—Selena, age 26

The pill was the easiest for me to get and it was the cheapest. But what I didn’t like about it was that I often forgot to take it and forgetting would make me super anxious about getting pregnant afterwards. So I really wanted an IUD because then I wouldn’t have to think about it or worry about it for years. And so I was looking into that, but I saw the prices. It was over my budget. I remember it was super expensive. So I stuck with the pills because I wasn’t able to afford that

—Sydney, age 25

And then, when I started the pill, got married and had been on it for probably seven or eight months…I was taking a pathophysiology class and the professor told us a story of a girl who had just gotten married and was on the pill and had a stroke because she got a blood clot. And all of a sudden, I started getting super paranoid and nervous because I remembered I had a cousin who had, like, a blood clot when she was pregnant on an airplane. And so, I like couldn’t stop thinking about it, decided to go get my blood tested for it and it turns out I did have it…so then the doctor was like, “Okay you should not be on this pill because there’s estrogen in it and the chances of a blood clot were really high.” —Alexis, age 28

Cessation

What leads someone to decide to stop using a method?

I had to go inpatient for suicidal ideation. I think it was at that point where they were like, “We want to limit the amount of pills you’re on so that we can figure out what you’re [experiencing].” They kind of wanted to mainline me so that I wasn’t having as many mood swings and stuff. So I think it was at that point when I stopped taking the birth control pill. —Lydia, age 29

I have tried basically every hormonal type, except for the Mirena IUD and realized all those times that for me and my mental health I needed to look for something different. I don’t want to feel like I’m foreign within myself and that’s honestly how I felt when I was on all those other birth controls. I felt more like a stranger. —Kiara, age 26

“My parents had heard some information that the patch caused, like, blood clots and some other harmful things so they wanted me to stop taking the patch and start taking the pill.” —Valerie, age 34

Well, I didn’t have insurance and just paying out-of-pocket, it was getting really expensive. That was a big reason [to stop birth control pills] as well. —Romina, age 29

I was using them [condoms] pretty religiously in the sense that I wouldn’t have sex without them. But somehow, I don’t know, but it must have broken or something. But I did end up getting pregnant in high school and just the whole decision of having to decide to get an abortion and figuring out the right path for me…just afterwards I didn’t want anything to do with them ever again. —Izzy, age 24