Perceived Subfecundity and Contraceptive Use Among Young Adult U.S. Women.

CONTEXT: Women who view themselves as having difficulty becoming pregnant (i.e., being subfecund) may feel that they do not need to use contraceptives to prevent unintended pregnancy. However, subfecundity perceptions are not always medically accurate and may therefore confer a false sense of protection. The extent to which perceived fecundity is related to contraceptive use is not well understood.

METHODS: Multinomial logistic regression was used to investigate the relationship between perceived fecundity at age 25-30 and contraceptive use among 2,091 women from the National Longitudinal Survey of Youth 1997 cohort.

RESULTS: Compared with women who considered themselves very likely to become pregnant, those who thought that they were only somewhat likely and those who viewed themselves as not very likely to do so had significantly higher risks of not using contraceptives within the next year (risk ratios, 1.9 and 2.4, respectively). Results were similar in analyses controlling for either a medical diagnosis of infertility, a history of multiple miscarriages or stillbirths, or absence of pregnancy following at least six months of unprotected sex, suggesting that perceived subfecundity operates independently of experienced subfecundity.

CONCLUSION: Because few studies have investigated fecundity perceptions in their own right, more research is needed to understand how women evaluate their fecundity and to integrate these perceptions into broader frameworks describing women's perception of pregnancy risk. Such work may help identify potential levers to improve contraceptive use.