DOI: 10.1177/17455057261502054 ISSN: 1745-5057

Age and frequency of clinical contraceptive coercion: An analysis of age-based differences in upward and downward clinical coercion in a national sample

Elizabeth Pleasants, Brooke Whitfield, Lindsay M. Cannon, Ellen Schenk, Kavita Shah Arora, Laura E. T. Swan
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Background

Clinical contraceptive coercion—pressure from healthcare providers to use (upward) or not use (downward) contraception—threatens reproductive autonomy. Adolescents and young adults (AYA) may be at heightened risk of clinical contraceptive coercion due to age-based clinical biases and post- Dobbs shifts in clinician counseling practices, but quantitative evidence comparing AYA and adult experiences is limited.

Objectives

To assess the frequency of upward and downward clinical contraceptive coercion among AYA (ages 18–25) and adults (26–49) and examine age-based differences.

Design

In 2023, we surveyed 1,500 respondents of reproductive age assigned female at birth in the United States. Using the Coercion in Contraceptive Care Checklist, participants reported experiences of coercion during their most recent contraceptive counseling, categorized as any, upward, and downward coercion.

Methods

Chi-square tests and Poisson regression models with robust error variance assessed associations between age and clinical contraceptive coercion, adjusting for sexual identity, socioeconomic status, race and ethnicity, ever being pregnant, relationship status, and how long ago they spoke to a clinician about contraception.

Results

AYA included in this analysis (n=1,169) were significantly more likely than adults to report experiencing any clinical contraceptive coercion (25.6% vs. 15.8%, p<0.001) and upward coercion (21.5% vs. 13.0%, p=0.001). Adjusted models confirmed these associations (any coercion: aRR=1.53, 95% CI: 1.14–2.06; upward coercion: aRR=1.58, 95% CI: 1.13–2.21).

Conclusions

AYA more commonly reported clinical contraceptive coercion than adults, particularly upward coercion. This pattern suggests that pregnancy prevention may be disproportionately emphasized in clinical encounters with younger patients, potentially at the expense of AYA reproductive autonomy. These findings underscore the need for person-centered contraceptive counseling that safeguards reproductive autonomy across the life course, especially for younger patients navigating care in a shifting post- Dobbs landscape.

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