Measuring contraceptive agency in the community

Objectives

This study aimed to evaluate the Contraceptive Agency Scale (CAS), developed as a clinic-based measure, within a community population and to assess how agency varied by demographic and reproductive characteristics.

Study design

We conducted a cross-sectional survey of 1917 participants aged 15–45 years living in Oregon in 2023. Participants responded to the 7-item CAS, comprised items relating to active decision-making, freedom from coercion, and nonjudgmental care during their last health care visit involving contraceptive counseling. We assessed the dimensionality of the CAS and fit data to a partial credit model to analyze its psychometric performance in our community-based sample. Differences in agency by characteristics were assessed with multivariable linear regression.

Results

The CAS showed adequate to good internal consistency reliability (Cronbach alpha: 0.78). The CAS items mostly loaded onto a single factor and demonstrated reasonable fit to a partial credit model (information-weighted fit statistics ranged from 0.73 to 1.01). While participants identifying as Black had lower CAS scores than White participants (β coefficient: −1.39 [−2.19, −0.59], p < 0.001), Asian/Pacific Islander, Latino/a, and multiracial participants had significantly higher levels of contraceptive agency than White participants. Not desiring pregnancy was associated with higher contraceptive agency (β coefficient: 1.27 [0.72, 1.82], p < 0.001) In contrast, lower education, some college or less vs college or above (β coefficient: −2.14 [−2.69, −1.60], p < 0.001) and nonbinary/transgender identity vs female gender identity (β coefficient: −1.32 [−2.15, −0.50], p < 0.01) were associated with lower contraceptive agency.

Conclusions

The CAS can be used in a community sample to evaluate patient centered contraceptive decision making as a standard of care.

Implications

Analysis of contraceptive agency among a community-based participant population offers valuable insights into experiences with contraceptive counseling.