Abstract
Health education highlights the role of fear and knowledge as a means to improve women's use of contraception. This paper explores the ways in which contraception use is more complex than this and argues for a central role of beliefs, aspects of the situation and negotiation in determining whether or not a woman decides to use contraception and which form of contraception is best for her. In terms of beliefs, research highlights the role of a range of beliefs about the costs and benefits of each form of contraception, the risk of pregnancy and STDs and people's feelings of competency at using contraception. Contraception use however, arises out of the sexual situation, which involves an interaction between people. This situation can result in emotions such as anxiety and embarrassment and is often associated with high levels of arousal, which may be exacerbated by drugs or alcohol. At such times using contraception may not always be high priority. Finally, contraception use involves communication and negotiation both between sexual partners and with health professionals. Research indicates that whilst people are prepared to become intimate with each other physically, discussing contraception can be embarrassing, leading to non-use if either partner is less than determined. Furthermore, contact with health professionals such as the GP, pharmacist or nurse may also feel uncomfortable and be a barrier to seeking help. Contraception use is therefore the result of a complex set of cognitions and emotions, which are not sufficiently addressed by knowledge and education. It is suggested that such factors should be given more attention within health education if contraception use is to increase. Further it is argued that whilst health professionals may aim to encourage 'best case' contraception use, a compromise approach such as the use of emergency contraception is always worth pursuing. © 2005 Elsevier Ltd. All rights reserved.