Perceived likelihood of becoming pregnant and contraceptive use: Findings from population-based surveys in Côte d'Ivoire, Nigeria, and Rajasthan, India.

Abstract Objective Advancing reproductive autonomy requires targeted strategies and interventions that address barriers to contraceptive use. The primary objective of this study is to investigate whether perceptions of low pregnancy likelihood are associated with lower likelihood of using contraception among presumably fecund, sexually active women. Study design We use population-based survey data of reproductive age women at risk of pregnancy collected in 2018 from Cote d'Ivoire (N=1,447), Nigeria (N=4,110), and Rajasthan, India (N=1,994). To assess one's perceived biological likelihood of pregnancy we used two measures: likelihood following a single act of unprotected sex and likelihood following one year of regular, unprotected sex. Response options included: definitely yes, maybe yes, maybe no, definitely no, and do not know. We conducted multivariable logistic regression to assess the relationship between each perception measure with odds of contraceptive use separately by country. Results Perceived chance of definitely or maybe becoming pregnant after one act of unprotected sex ranged from 54-55% in Nigeria and Rajasthan to 80% in Cote d'Ivoire, while it was higher for regular unprotected sex (76-88%). Multivariable results indicate that perceptions of pregnancy likelihood are associated with contraceptive use among presumably fecund women, with a stronger relationship observed in relation to cumulative likelihood (ORs 0.11 to 0.57) than likelihood after one act (ORs 0.37 to 0.75) and a dose-response pattern by strength of perceived chance. Conclusions Findings suggest that understanding women's pregnancy risk perceptions may aid in the development of interventions to help women achieve their reproductive goals. Implications Results indicate that women's current use of contraception is associated with their perceived likelihood of becoming pregnancy after unprotected sex. Understanding women's pregnancy risk perceptions may aid in the development of interventions to help women achieve their reproductive goals.