REPRODUCTIVE GOVERNANCE AND THE ROLE OF UNCERTAINTY IN CONTRACEPTIVE DECISION MAKING

Objectives

The Dobbs v. Jackson Women’s Health Organization decision introduced heightened abortion policy uncertainty across the US, disproportionately impacting Black women already navigating intersecting structural barriers to reproductive care. This study examined how Black women in Ohio respond to this uncertainty by exploring the personal, social, and institutional factors influencing their contraceptive decision making in a restrictive and evolving reproductive policy landscape.

Methods

In-depth interviews were conducted with 27 Black women of reproductive age from diverse socioeconomic and geographic backgrounds across Ohio. Using a phenomenological qualitative approach, we employed semi-structured interviews to examine participants’ contraceptive decision making processes. Thematic analysis, guided by Braun and Clarke’s six-step framework, was used to identify recurring patterns and themes. We synthesized findings from these narratives to capture the complexities of reproductive decision making amid policy uncertainty.

Results

While some participants modified their contraceptive use to mitigate perceived threats to their reproductive autonomy, political discourse had a limited impact on contraceptive behaviors overall. Decision making was primarily driven by personal, social, and health-related factors, rather than political narratives.

Conclusions

The research underscores the nuanced and deliberative nature of contraceptive decision making in the face of policy-driven uncertainty around abortion access. Contraceptive decision making among Black women in Ohio is shaped by intersecting personal, relational, and systemic factors, reflecting the complexity of navigating reproductive autonomy in a restrictive policy environment. Addressing each of these factors is essential to ensuring informed, autonomous reproductive health decision making in the post-Dobbs era.