Contraceptive use, adherence, and perceptions among women aged 18–45 years in Czechia: a 2019 cross-sectional quota-based online survey

BACKGROUND: Unintended pregnancies remain common globally, underscoring the need to understand real-world contraceptive behaviors and their determinants to optimize counseling and public health planning. In Czechia, robust evidence on contraceptive method mix and perceptions has been limited. METHODS: We analyzed a cross-sectional online survey conducted in September 2019, among women aged 18-45 years (n = 1501) irrespective of current contraception usage. The survey used quota sampling for age, education, household income/size, and region; no weighting was applied. We analyzed prior and current contraceptive use, emergency contraception, drivers and barriers to method choice, pill adherence, and information sources. Age-group differences (18-24, 25-34, 35-45 years) were tested with Cochran-Armitage test for trend (categorical) and ANOVA (continuous). RESULTS: This survey provides a detailed age-stratified picture of contraceptive experience, current use, and perceptions among women aged 18-45 years in Czechia. One-third reported no current method (33%, 95% CI [31%, 35%]) and the current method mix concentrated on short-acting methods (oral contraception [OC] 38% [36%, 41%] and barrier methods 14% [12%, 16%]). Intrauterine device (IUD) use was comparatively low overall (hormonal 4.7% [3.6%, 5.7%]; non-hormonal 3.5% [2.6%, 4.5%]) but increased with age (hormonal 2.5%→2.9%→7.4%, p < 0.001; non-hormonal 0.9%→3.6%→4.8%, p < 0.01), while barrier use declined (22%→14%→10%, p < 0.001). Among current OC users, 37% reported forgetting at least one pill in the preceding 3 months. Younger women had the highest missed-pill rates among OC users, greater concern after a missed pill, and more frequent recent emergency contraception use. The major source of information were various internet-based sources combined, while gynecologists were the main single source of information (73%, [70%, 75%]), followed by internet search engines specifically (44%, [42%, 47%]). While the relevance of gynecologist increased with age, the relevance of internet search engines declined. CONCLUSIONS: Contraceptive use was dominated by short-acting methods, with low but age-increasing IUD uptake. Younger women more frequently reported at least one missed OC pill, greater concern after missed pills, and more frequent recent emergency contraception use. Interpretation should consider mainly the use of non-probability quota sampling, the absence of weighting, and reliance on self-reported questionnaire data.