Toward person-centred measures of contraceptive demand: a systematic review of the intentions to use contraception and actual use

Background Understanding people’s motivation and need for modern contraception is critical to ensuring access to quality rights-based contraceptive care and supporting reproductive justice. Current population level measures of contraception demand are proving limited; but there is a promising, more person-centred alternative - intention to use (ITU) contraception. ITU captures a person’s self-reported preferences and could better predict contraceptive use. This systematic review examines whether ITU predicts future contraceptive use and may be a better way to estimate desire to use contraception. Methods We searched PubMed, PsycInfo, Web of Science, and the Cochrane Collaboration to identify studies published from 1975-2020 that: (1) examined contraceptive behaviour, (2) included measures of ITU and future contraceptive use, and (3) included at least one quantitative measure of association between ITU and actual use. The inclusion criteria were: 1) examined contraceptive behaviour (excluding condom use only), (2) included disaggregated integral measures of ITU contraceptives and later contraceptive use, (3) included at least one quantitative measure of the association between ITU contraceptives and actual contraceptive use, (4) study population was women of reproductive age, (5) were peer-reviewed, and (6) written in English. Results 10 prospective cohort studies were included. Six indicated significant, increased, unadjusted odds of subsequent contraceptive use after reporting ITU. Of those, three reported adjusted values for contraceptive use across several covariates that were also significant and positive. The range of potential confounding factors indicate that contraceptive behaviour is a complex psychosocial process shaped by individual and contextual factors. Conclusions People’s self-reported ITU contraception have the potential to be a strong predictor of subsequent contraceptive use. Few studies directly examined the relationship between ITU and contraceptive uptake and recruitment was primarily pregnant or postpartum samples. Further high-quality research measuring the relationship between ITU and contraceptive use using standardized measures and variables are needed.