“I am the expert of my own self, and this is what I choose”: a qualitative investigation of diverse cultural experiences with birth control

Despite medical advances and widespread use, approximately 1 in 4 current and prospective female contraceptive users in the United States do not access their preferred method of contraception. Understanding how to address cultural barriers to contraceptives is critical to improving access. This study investigated how different aspects of cultural background influence contraceptive perceptions and experiences. We explored this question with an intersectional lens, recruiting participants with a range of multicultural identities. Between 2023 and 2024, we conducted 32 in-depth interviews with a diverse sample of pregnancy-capable people around the puget sound in Washington, asking how culture influences attitudes and decisions regarding birth control. Codes were created inductively from interview transcripts and were grouped by definitional similarities and co-occurrences with each other. The research team identified themes that represented the overarching influences of cultural norms and experiences on birth control perceptions and use. From analysis of 32 in-depth interviews, our analysis revealed four main themes: (1) Cultural Birth Control Stigma Spread Through Gossip, Misinformation, and Silence; (2) Expectations from Family and Gendered Norms Hinder Preferred Birth Control Use; (3) Autonomy, Access to Culturally Competent Providers, and Access to Comprehensive Information Facilitate Positive Perceptions of Birth Control; (4) Desire for Birth Control Accessibility, Comprehensive Education, Decreased Stigma, and Shared Contraceptive Responsibility. A diverse group of participants reported nuanced themes of cultural birth control stigma and familial and gendered expectations as barriers to positive birth control perceptions and use, while values of autonomy, culturally understanding healthcare providers, and comprehensive education facilitated positive birth control perceptions. To address unique patient needs, providers should acknowledge perceptions of stigma, address patient and familial knowledge gaps through tailored contraceptive counseling, and prioritize full transparency on benefits and side effects. Providers must recognize patients’ individual experiences and consider culture as a nuanced and complex influence. In the United States, access to preferred contraception remains out of reach for almost a quarter of current and prospective female contraceptive users. This study explores themes of social and cultural influences on contraceptive perceptions as well as the contraceptive narratives of 32 pregnancy-capable individuals from the greater Puget Sound region in Washington State. In-depth interviews of participants were coded and thematically analyzed to identify themes that represented overarching concepts of cultural influences on birth control perceptions and experiences. Our thematic analysis found themes of stigma and familial and gendered expectations acting as barriers to positive birth control perceptions and use amongst our sample, while values of autonomy, access to understanding healthcare providers, and access to comprehensive birth control information improved positive perceptions of birth control. Participants expressed desire for reduced contraceptive stigma, better education, and greater transparency from healthcare providers. Our participants’ narratives highlight the importance of healthcare providers tailoring contraceptive counseling to each individual’s unique experiences and needs. With growing legal challenges to contraceptive access, it is more important than ever to protect patients’ reproductive autonomy. Our findings add nuanced cultural birth control narratives from the Puget Sound region to the emerging understanding of factors influencing perceptions of birth control and connect these findings to how healthcare providers can play a positive role in navigating reproductive decision making with patients.