Contraceptive and hormonal medication decision-making for pregnancy prevention and gynaecological symptoms: a systematic review and conceptual framework.

Abstract

Background: There has been a decline in the number of contraceptive appointments and prescriptions in the UK. Existing evidence explores the impact of access, barriers and awareness on contraception use. However, less is known about the nuance of how individuals make these decisions. This review aimed to synthesise recent UK evidence on those assigned female at birth's attitudes, experiences and decision-making around contraception and hormonal medication for pregnancy prevention and/or gynaecological reasons.

Methods: Five academic databases and six online sources were systematically searched. Included studies were published in English from 2015 onwards and contained primary data on contraceptive decision-making for pregnancy prevention and/or gynaecological treatment in the UK. Studies were critically appraised for methodological reliability and usefulness in answering the review question. Data were coded deductively, inductively grouped conceptually and mapped onto a conceptual framework.

Results: Twenty-one studies met the inclusion criteria. There were ten qualitative, seven mixed methods and four quantitative studies with more focusing on pregnancy prevention (n=10) than on gynaecological management (n=5) and six focusing on both. The synthesis of substantive decision drivers from both quantitative and qualitative data demonstrates that decision-making is shaped by how methods felt in relation to the body; effects; seeking and navigating information; pressure and reproductive autonomy; and risk perception and desire. A decision-making conceptual framework was developed demonstrating the impact of contextual factors and the process of decision-making.

Conclusions: Contraceptive and hormonal medication decision-making is a dynamic process shaped by complex trade-off balances, trial-and-error processes, evolving needs and individual contexts. Individuals often want to involve and trust others by sharing the decision-making process. Healthcare consultations must recognise the complexity of choice and use, and support contraceptive and hormonal medication decision-making across the life course.