The Contraceptive Paradox may be caused partially by value dilemmas of a natural way of living. Findings from cross sectional surveys among the general population and women having an abortion and their partners in Austria.

Background The Contraceptive Paradox is observed in many countries. Abortion rates did not decline over the past three decades, despite widespread availability of an unprecedented increasing number of highly effective contraceptive methods. To understand better the Paradox, we studied the contraceptive decisions of women and their partners. Globally, this is the first study to examine conflicting values regarding naturality as contributing factor.

Methods Regular population surveys (n ~ 4800) were combined with a cross-sectional-survey (n = 551) among women having an abortion and their partners. The in depth questionnaire was developed based on thorough analysis of international research in cultural psychology, public health ethics, quality of life and contraception. Perception, attitudes, knowledge, values and behaviour were recorded in the clinic by a self-completed printed questionnaire, after an abortion, 2016–2018. Statistical analysis included dynamic multiple logistic regression modelling.

Results 80 % underestimated natural fertility, without difference in gender, age, previous pregnancy. Higher SES and number of children improved the estimation slightly but significantly (OR 1.18; 1.36 resp.). 79 % experienced a dilemma between avoiding an unwanted pregnancy and their desire to live in a natural way. The dilemma was strongest for higher SES (OR 1.15), and pharma distrusters (p = 0.004), but not age. Those who perceived a high dilemma used significantly less effective contraception (p = 0.000).

Conclusions / Limitations The described dilemma may be a contributing factor for the Contraceptive Paradox. A desire to live naturally is associated with ineffective contraceptive behaviour in Austria. Due to our cross-sectional-design we cannot conclude what factors improve contraceptive effectiveness.

Publication History

Article published online:
26 May 2020