Preference-Concordant Contraceptive Use in a Nationally Representative Sample of Adolescents and Young Adults

Concordance between contraceptive preferences and use is an indicator of person-centered contraceptive care. Adolescents and young adults (AYA) face barriers that may prevent them from fulfilling their contraceptive preferences. We sought to assess the prevalence and predictors of preference-concordant contraceptive use among AYA and examine its associated with person-centered contraceptive counseling (PCCC).

We conducted a secondary analysis of a cross-sectional survey.

The survey was nationally representative of the United States and administered in 2022.

The sample included 516 participants, including adolescents (aged 15-17) and young adults (aged 18-24), who were assigned female at birth.

The primary exposure was receipt of PCCC at most recent contraceptive care visit. The main outcome was preference-concordant contraceptive use, measured among contraceptive users and nonusers.

Fewer than 60% of AYA had preference-concordant contraceptive use or nonuse, and 19% were uncertain about their preferences. Adolescents were less likely than young adults to use a preferred method and more likely to be content nonusers or uncertain nonusers. Only 28% of participants received PCCC at their most recent visit. PCCC was associated with increased preference-concordant vs preference nonconcordant use (adjusted risk ratio: 1.45; 95% CI: 0.75, 2.82), though this was not statistically significant.

Many AYA are not fulfilling their contraceptive preferences, and uncertainty about method use is common, particularly among adolescents. Person-centered contraceptive counseling may support preference-concordant use, but broader structural, interpersonal, and informational barriers must also be addressed to promote equitable, preference-aligned contraceptive care and access.