Primary care physicians' perceptions of rates of unintended pregnancy

Background: Primary care physicians (PCPs) treat many women of reproductive age who need contraceptive and preconception counseling. Study Design: To evaluate perceptions of rates of unintended pregnancy, we distributed an online survey in 2009 to 550 PCPs trained in General Internal Medicine or Family Medicine practicing in Western Pennsylvania, Central Pennsylvania, Rhode Island or Oregon. Results: Surveys were completed by 172 PCPs (31%). The majority (54%) of respondents underestimated the prevalence of unintended pregnancy in the United States [on average, by 23±8 (mean±SD) percentage points], and 81% underestimated the risk of pregnancy among women using no contraception [on average, by 35±20 (mean±SD) percentage points]. PCPs also frequently underestimated contraceptive failure rates with typical use: 85% underestimated the failure rate for oral contraceptive pills, 62% for condoms and 16% for contraceptive injections. PCPs more often overestimated the failure rate of intrauterine devices (17%) than other prescription methods. In adjusted models, male PCPs were significantly more likely to underestimate the rate of unintended pregnancy in the United States than female PCPs [adjusted odds ratio (95% confidence interval): 2.17 (1.01-4.66)]. Conclusions: Many PCPs have inaccurate perceptions of rates of unintended pregnancy, both with and without use of contraception, which may influence the frequency and the content of the contraceptive counseling they provide.