Association Between Provision of Initial Family Planning Services and Unintended Pregnancy Among Women Attending an STD Clinic

Background: Most sexually transmitted disease (STD) clinics focus solely on STD treatment and prevention. However, women seeking care are also at high risk for unintended pregnancy. We sought to examine the relationship between baseline demographic and clinical characteristics and incident pregnancy among women provided initial contraceptive services in an STD clinic.

Methods: Computerized record review of women attending an STD clinic who initiated contraception, were seen at least twice within a 4-year period (repeat attendees), and indicated no intention of pregnancy were included in these analyses. Associations between baseline demographic, behavioral, and clinical characteristics and incident pregnancy were assessed using multivariate logistic regression.

Results: Among 4617 women seen from 2003 to 2006, 710 (15%) were repeat attendees and 3907 (85%) were single attendees (seen only during a single year). Among the repeat attendees, 642 (90%) indicated no interest in pregnancy, of whom 124 (19%) had a subsequent pregnancy. Using multivariate analysis and controlling for age and race/ethnicity, incident pregnancy was associated with previous pregnancy (OR 2.57, 95% CI 1.63-4.04), <or=150% federal poverty level (OR 2.22, 95% CI 1.05-4.71), and no contraceptive use at last sex (OR 1.67, 95% CI: 1.11-2.52). Incident pregnancy was not associated with educational level, sexual frequency, age of first pregnancy, number of partners, prior therapeutic abortion, or provision of effective contraception at the initial STD clinic visit.

Conclusions: Certain baseline characteristics identified a subset of women seen in an STD clinic that were associated with future unintended pregnancy. Targeted interventions addressing these factors are needed.