Background: The United States has one of the highest teen birth rate in the entire developed world, despite a decline in rates over the last two decades. Declining teen pregnancy rates have been due in part to increasing knowledge, access, and utilization of contraception. Teen birth rates of American Indian and Alaska Native (AI/AN) women in North Dakota rank among the highest in the United States. In order to develop targeted public health campaigns aimed at reducing teen pregnancy rates, there is a critical need to better understand the knowledge and attitudinal barriers to effective contraceptive method, particularly amongst the rural AI/AN communities in North Dakota.
Objectives: The purpose of this study is to explore attitudes toward contraception among AI/AN women from North Dakota. Specifically,
1) Examine how social, cultural, logistical, educational, and economic factors influence AI/AN women’s attitudes regarding contraception.
2) Describe how attitudes about contraception influence AI/AN women’s contraceptive choices.
Methods: We conducted semi-structured, in-depth face-to-face interviews on an American Indian reservation in rural North Dakota. A convenience sample of 40 AI/AN women aged 18-45 years old (mean age 23.5 years) were interviewed from August 2013 to September 2013. We stratified participants by age: (18-24 years (n=22) and 25-45 years (n=18)) for analysis. Interviews were audio recorded, transcribed verbatim with identifiers removed, and entered into ATLAS.ti software. All of the interviews were independently coded by two team members and reconciled.
Results: Most (70 %) of participants have been pregnant. The median age of first pregnancy is 18 years old (range15-24). All participants had access to free contraception through their health care plan; only 59% of the women who were not currently pregnant or recently post-partum were using any form contraception. Investigators identified three major themes related to contraceptive attitudes and practice. These include (1) understanding of contraception and available choices; (2) pregnancy ambiguity; and (3) tacit community acceptance of early parenting. These factors influenced initiation and sustained the use of contraception.
Conclusion: Teen pregnancy and low adherence to contraceptive use is a complex and multi-faceted problem involving knowledge, attitudinal and social barriers. North Dakota AI/AN women in this study confronted no direct economic barriers to contraception since Indian Health Services (I.H.S.) provides modern contraceptive methods free of charge. Effective public health strategies aimed to reduce teen pregnancy in this and similar populations must improve contraceptive knowledge and sociocultural assumptions that currently influence contraceptive use.