Conceptualizing risk and effectiveness: a qualitative study of women's and providers' perceptions of nonsurgical female permanent contraception.
OBJECTIVE
Novel approaches to nonsurgical permanent contraception (NSPC) for women that are low cost and require no incision or hysteroscope/surgical equipment could improve access to, and the acceptability of, permanent contraception (PC). To better understand opportunities and limitations for NSPC approaches, we examined women's and obstetrician-gynecologist (OB/GYN) providers' perceptions of NSPC in Portland, OR.


METHODS
Semistructured, qualitative interviews were conducted with 40 women recruited from outpatient clinics with purposive sampling, and a focus group was conducted with 9 OB/GYNs in academic and community practice. Transcripts were coded and inductively analyzed with a grounded theory approach.


RESULTS
The majority of women identified as white (67%) or Latina (25%). They had a median age of 31.5 years, and median number of children was one. Perspectives on NSPC were closely aligned with women's general attitudes towards PC; over half were considering PC for themselves or partners in the future. Most respondents valued multiple aspects of a nonsurgical approach, with themes of minimizing recovery time, invasiveness and risk and avoiding hormonal contraception. Many assumed that NSPC would be less effective than surgery, however, and felt that a confirmation test would be necessary regardless of the failure rate. Providers welcomed efforts to expand contraceptive choice with NSPC, but would require long-term safety and efficacy data before recommending, and voiced concerns that NSPC's potential relative ease of administration could undermine the inherent seriousness of choosing PC.


CONCLUSIONS
Women's and providers' perceptions of NSPC hinged on the ways in which they conceptualized risk and effectiveness. While perceptions were generally favorable, confirmation of safety and effectiveness would be required for a new approach to be accepted.


CONCLUSIONS
This hypothesis-generating study elucidates women's and provider's perspectives on new methods of NSPC and contributes to understanding their perceptions of various types of risk. A technique to verify tubal occlusion would be needed for women and providers to accept NSPC.
Oregon Health & Science University, Department of Obstetrics & Gynecology, Mail code L466, 3181 SW Sam Jackson Park Rd, Portland, OR 97239. Electronic address: harringe@ohsu.edu.
Elizabeth K
EK
Harrington
Oregon National Primate Research Center, 1505 NW 185th Ave, Beaverton, OR 97006.
Diana
D
Gordon
Oregon Health & Science University, Department of Obstetrics & Gynecology, Mail code L466, 3181 SW Sam Jackson Park Rd, Portland, OR 97239.
Isabel
I
Osgood-Roach
Oregon Health & Science University, Department of Obstetrics & Gynecology, Mail code L466, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; Oregon National Primate Research Center, 1505 NW 185th Ave, Beaverton, OR 97006.
Jeffrey T
JT
Jensen
Oregon Health & Science University, Department of Obstetrics & Gynecology, Mail code L466, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; Portland State University, Department of Anthropology, P.O. Box 751, Portland, OR 97207.
Jennifer
J
Aengst
D000328:Adult; D001291:Attitude of Health Personnel; D005186:Fallopian Tube Patency Tests; D005193:Family Planning Services / Q000639:trends; D005260:Female; D017144:Focus Groups; D066296:Grounded Theory; D006176:Gynecology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009774:Obstetrics; D009922:Oregon; D010044:Outpatient Clinics, Hospital; D036301:Qualitative Research; D012747:Sexual Partners; D013246:Sterilization, Tubal / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D000078329:Workforce; D055815:Young Adult
Contraceptive development; Perception; Permanent contraception; Qualitative; Risk; Sterilization