Contraceptive Alignment: A Descriptive Study of Concordance between Preferred and Actual Contraceptive Method Use.

Conventional metrics of contraceptive need focus on contraceptive use among those not seeking pregnancy, ignoring individuals' contraceptive preferences beyond pregnancy prevention. We examine contraceptive alignment, a novel metric describing agreement between actual and preferred method use/nonuse, among a 2022 nationally representative U.S. sample of 15-44-year-olds assigned female sex at birth (unweighted n = 3,044). Most respondents (62.2 percent) were classified as having contraceptive alignment (using a method they preferred or not using a method when they preferred not to), while 37.8 percent did not have contraceptive alignment. Contraceptive alignment was higher among contraceptive nonusers who were older and in a serious relationship, as well as both contraceptive users and nonusers who were classified as having higher contraceptive self-efficacy. Contraceptive alignment was lower among contraceptive users who selected their current method due to being unable to obtain the method they originally wanted and those who were using more than one method of contraception. Our findings suggest that conventional measures of contraceptive need may mask important discordance in individuals' contraceptive preferences and actual use that can contribute to misdirected efforts to expand contraceptive access and undermine reproductive autonomy. Contraceptive alignment may more accurately portray individuals' contraceptive needs.