Berkeley Public Health and Social Welfare join forces to study contraceptive need

Associate Professor Anu Manchikanti Gómez, who leads the Sexual Health and Reproductive Equity (SHARE) program in the School of Social Welfare, has been awarded a two-year, $621,196 grant from Arnold Ventures to establish the national level of unmet need for contraception.

Currently, estimates of the need for contraception in the U.S. are based on population-level characteristics — and some of those characteristics are surprisingly broad. According to the Guttmacher Institute, women have a potential need for contraception if they are between the ages of 13 and 44, have ever had voluntary vaginal intercourse, are not known to be medically infertile, and are neither pregnant nor trying to become pregnant. Another metric assumes that all women who are not infertile, not seeking pregnancy, and not using contraception have an unmet need for contraception.

At the same time, any woman using contraception is assumed to have her contraceptive needs met. No consideration is given to cost, ease of access, side effects or desire to stop using the method — a significant omission when 46% of American women have discontinued a method of contraception due to dissatisfaction.

Dr. Gómez’s study aims to move beyond this “one-size-fits-all” approach to develop person-centered metrics based on women’s expressed needs and preferences.

Assessing contraceptive need nationally and by group characteristics — such as income level, prior pregnancy status, location (rural or urban), and race — is critical, as understanding these factors can support policy and funding decisions to advance health equity. For instance, investing in telehealth in rural areas makes sense if women are interested in birth control pills, but telehealth is less useful if women’s needs center on intrauterine devices or implants, methods that must be inserted by a healthcare provider.

An emphasis on person-centered care, lived experiences, and reproductive self-determination lies at the heart of Gómez’s work. In recent articles, she has explored questions such as the grey area between planned and unplanned pregnancy as well as young Black and Latina women’s attitudes towards long-acting reversible contraception.

“For too long, we have relied on imperfect proxies for contraceptive access that fail to center the needs and lived experiences of under-resourced communities,” Gómez said. “Through this project, our goal is to develop person-centered metrics that describe whether individuals’ contraceptive needs are met and to inform policy strategies to alleviate unmet need.”

In collaboration with Dr. Cassondra Marshall in UC Berkeley’s School of Public Health, Gómez and the SHARE team will develop metrics of person-centered contraceptive need through deep engagement with stakeholders and testing proposed measures through a nationally representative survey. They will assess preferences for different contraceptive methods and service delivery models (in-person care, telehealth, etc.). And they will investigate factors that influence women’s willingness to interact with the medical system, like discrimination in family planning settings or experiences of interpersonal racism. To ensure that the data aligns with the priorities of the organizations that will use it and who work to advance reproductive justice for under-resourced communities, measures will be developed in consultation with a broad array of stakeholders, including grassroots organizations.

This project has the potential to inform policy and guide efficient use of public funding. More importantly, Gómez’s study can lead to better care, especially in under-resourced communities.

In Dr. Gómez’s words: “We can’t develop targeted strategies to increase contraceptive access with high-quality care without centering the people who use or want to use different types of birth control. We want these data to inform policy strategies that can best meet people’s needs, prioritize service delivery approaches, and transform how we think about contraceptive needs and whether they are met.”