{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:47:32Z","timestamp":1792100852654,"version":"4.4.0"},"update-to":[{"DOI":"10.1371\/journal.pmed.1003878","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,1,20]],"date-time":"2022-01-20T00:00:00Z","timestamp":1642636800000}}],"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T00:00:00Z","timestamp":1641340800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Postpartum contraception prevents unintended pregnancies and short interpregnancy intervals. The Pregnancy Risk Assessment Monitoring System (PRAMS) collects population-based data on postpartum contraception nonuse and reasons for not using postpartum contraception. In addition to quantitative questions, PRAMS collects open-text responses that are typically left unused by secondary quantitative analyses. However, abundant preexisting open-text data can serve as a resource for improving quantitative measurement accuracy and qualitatively uncovering unexpected responses. We used PRAMS survey questions to explore unprompted reasons for not using postpartum contraception and offer insight into the validity of categorical responses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>We used 31,208 categorical 2012 PRAMS survey responses from postpartum women in the US to calculate original prevalences of postpartum contraception use and nonuse and reasons for contraception nonuse. A content analysis of open-text responses systematically recoded data to mitigate survey bias and ensure consistency, resulting in adjusted prevalence calculations and identification of other nonuse themes. Recoded contraception nonuse slightly differed from original reports (21.5% versus 19.4%). Both calculations showed that many respondents reporting nonuse may be at a low risk for pregnancy due to factors like tubal ligation or abstinence. Most frequent nonuse reasons were not wanting to use birth control (27.1%) and side effect concerns (25.0%). Other open-text responses showed common themes of infertility, and breastfeeding as contraception. Comparing quantitative and qualitative responses revealed contradicting information, suggesting respondent misinterpretation and confusion surrounding the term \u201cpregnancy prevention.\u201d Though this analysis may be limited by manual coding error and researcher biases, we avoided coding exhaustion via 1-hour coding periods and validated reliability through intercoder kappa scores.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In this study, we observed that respondents reporting contraception nonuse often described other methods of pregnancy prevention and contraception barriers that were not included in categorical response options. Open-text responses shed light on a more comprehensive list of pregnancy prevention methods and nonuse options. Our findings contribute to survey questions that can lead to more accurate depiction of postpartum contraceptive behavior. Additionally, future use of these qualitative methods may be used to improve other health behavior survey development and resulting data.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1003878","type":"journal-article","created":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T18:39:18Z","timestamp":1641407958000},"page":"e1003878","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Use of open-text responses to recode categorical survey data on postpartum contraception use among women in the United States: A mixed-methods inquiry of Pregnancy Risk Assessment Monitoring System data"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0135-2425","authenticated-orcid":true,"given":"Nicole K.","family":"Richards","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Morley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha A.","family":"Wojtowycz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Bevec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3716-3818","authenticated-orcid":true,"given":"Brooke A.","family":"Levandowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,1,5]]},"reference":[{"key":"pmed.1003878.ref001","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1093\/epirev\/mxq012","article-title":"Family Planning and the Burden of Unintended Pregnancies","volume":"32","author":"A Tsui","year":"2010","journal-title":"Epidemiol Rev"},{"key":"pmed.1003878.ref002","article-title":"The Social and Economic Benefits of Women \u2018 s Ability To Determine Whether and When to Have Children","author":"A Sonfield","year":"2013","journal-title":"Guttmacher Inst"},{"key":"pmed.1003878.ref003","doi-asserted-by":"crossref","DOI":"10.1111\/jmwh.12149","article-title":"The Role of Previous Contraception Education and Moral Judgment in Contraceptive Use","volume":"59","author":"V Bader","year":"2014","journal-title":"J Midwifery Womens Health"},{"key":"pmed.1003878.ref004","doi-asserted-by":"crossref","DOI":"10.1089\/jwh.2009.1735","article-title":"Providers\u2019 perspectives on challenges to contraceptive counseling in primary care settings","author":"AY Akers","year":"2010","journal-title":"J Women\u2019s Health"},{"key":"pmed.1003878.ref005","doi-asserted-by":"crossref","first-page":"e0228142","DOI":"10.1371\/journal.pone.0228142","article-title":"Young women\u2019s reproductive health conversations: Roles of maternal figures and clinical practices","volume":"15","author":"NK Richards","year":"2020","journal-title":"PLoS ONE"},{"key":"pmed.1003878.ref006","article-title":"Health Literacy and Women\u2019s Reproductive Health: A Systematic Review.","author":"KA Kilfoyle","year":"2016","journal-title":"J Women\u2019s Health"},{"key":"pmed.1003878.ref007","article-title":"Patient understanding and use of oral contraceptive pills in a southern public health family planning clinic","author":"TC Davis","year":"2006","journal-title":"South Med J"},{"key":"pmed.1003878.ref008","article-title":"The role of health literacy and numeracy in contraceptive decision-making for urban Chicago women","author":"LM Yee","year":"2014","journal-title":"J Community Health"},{"key":"pmed.1003878.ref009","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.2105\/AJPH.2018.304563","article-title":"The Pregnancy Risk Assessment Monitoring System (PRAMS): Overview of Design and Methodology","volume":"108","author":"HB Shulman","year":"2018","journal-title":"Am J Public Health"},{"key":"pmed.1003878.ref010","doi-asserted-by":"crossref","DOI":"10.1016\/j.contraception.2007.01.011","article-title":"Reasons for unprotected intercourse: analysis of the PRAMS survey.","volume":"75","author":"MD Nettleman","year":"2007","journal-title":"Contraception"},{"key":"pmed.1003878.ref011","volume-title":"Survey Research Methods","author":"FJ Fowler","year":"2014","edition":"5"},{"key":"pmed.1003878.ref012","doi-asserted-by":"crossref","DOI":"10.1111\/1475-6773.12117","article-title":"Achieving integration in mixed methods designs\u2014Principles and practices","volume":"48","author":"MD Fetters","year":"2013","journal-title":"Health Serv Res"},{"key":"pmed.1003878.ref013","unstructured":"Center for Disease Control and Prevention. 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Popping","year":"2015","journal-title":"BMS Bull Sociol Methodol Bull Methodol Sociol."},{"key":"pmed.1003878.ref020","first-page":"7","article-title":"Section E: Contraceptive History and Pregnancy Wantedness.","author":"National Center for Health Statistics","year":"2017","journal-title":"National Survey of Family Growth"}],"updated-by":[{"DOI":"10.1371\/journal.pmed.1003878","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,1,20]],"date-time":"2022-01-20T00:00:00Z","timestamp":1642636800000}}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003878","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,20]],"date-time":"2022-01-20T18:40:56Z","timestamp":1642704056000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003878"}},"subtitle":[],"editor":[{"given":"Sarah J.","family":"Stock","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,1,5]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1003878","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pmed.1003878","asserted-by":"object"}]},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,5]]}}}