191. Adolescent and Young Adult Women’s Reasons for Not Using Contraception Before an Unplanned Pregnancy, Pregnancy Risk Assessment Monitoring System, 2020

We used population-based data to examine reasons for not using contraception before pregnancy among postpartum women reporting they were not trying to get pregnant. Data were analyzed from the 2020 Pregnancy Risk Assessment Monitoring System (PRAMS), a site-specific, population-based surveillance system that surveys women with a recent live birth 2-6 months postpartum. We used data from the 20 sites that asked: “What were your reasons or your husband’s or partner’s reasons for not doing anything to keep from getting pregnant?” Respondents could select from 8 response options; those selecting “other” could write-in their reason. The question was asked of women who reported that when they became pregnant with their new infant, they were not trying to get pregnant and not using doing anything to prevent pregnancy. Restricting analyses to respondents ≤24 years (n=1,869), we examined descriptive statistics and bivariate differences by maternal age, race/ethnicity, parity, and health insurance before becoming pregnant using Chi-square tests. Analyses were weighted to account for the complex sample. Overall, nearly half (48.0%) of respondents reported they did not mind if they got pregnant, and nearly one-third (32.1%) reported they thought they could not get pregnant at the time. Lower percentages reported not doing anything to prevent pregnancy because: their husband or partner did not want to use anything (19.2%); they had side effects from the birth control method they were using (17.3%); they thought they or their husband or partner was sterile (10.3%); they forgot to use a birth control method (9.3%); or they had problems getting birth control when they needed it (7.7%). Reasons reported for not using contraception before pregnancy varied by respondent characteristics. Respondents who reported that they did not mind if they got pregnant varied by age (50.2%, 20-24 years; 40.3%, ≤19 years), race/ethnicity (61.2%,non-Hispanic [NH] other; 53.2%, NH white; 50.8%, Hispanic; 37.1%, NH Black), and health insurance in the month prior to becoming pregnant (53.5%, private; 52.5%,none; 44.0%, public). Respondents who reported they thought their husband or partner was sterile varied by parity (13.0%, nulliparous; 5.4%, parous), and respondents who reported they thought they could not get pregnant at the time varied by both parity (37.7%, nulliparous; 22.4%, parous) and race/ethnicity (41.3%, Hispanic; 37.6%, NH other; 30.8%, NH black; 27.4%, NH white). Finally, respondents who reported they did not use birth control because of side effects varied by age (18.9%, 20-24 years; 11.8%, ≤19 years) and race/ethnicity (22.3%, NH white; 16.8%, NH other; 14.2%, NH Black; 13.8%, Hispanic). We found a variety of reasons why young, postpartum women who were not trying to get pregnant were not doing anything to prevent pregnancy when they became pregnant. Given that nearly half of respondents did not mind if they got pregnant, recognizing and respecting pregnancy ambivalence through pregnancy desire screening can help support reproductive autonomy for this population. If young people desire to prevent pregnancy, patient-centered contraceptive counseling that educates patients about fertility and method side effects may help support contraceptive use.