Assessing contraceptive choices and decision-making in young women in regional, rural and remote New South Wales, Australia

Abstract Background Unintended pregnancy disproportionately affects young women living rurally. Inconsistent and ineffective contraceptive use contributes to this. To date, no published studies have explored young women’s views regarding contraceptive choice and decision-making in rural Australia. This qualitative study aimed to explore how young women in rural New South Wales, Australia, choose methods of contraception and to improve understanding of what factors influence these decisions when initiating and continuing contraception. Methods Eighteen semi-structured online interviews were conducted, with one participant per interview, aged 17–23 years, across rural New South Wales using the Health Belief Model as a framework. Reflexive thematic analysis was used to analyse the data. Results The decision to initiate contraception typically followed a health threat: risk of an unintended pregnancy, a menstrual cycle disorder, sexually transmitted infections and/or acne. Choice of contraception was impacted by contraceptive familiarity and knowledge, accessibility to healthcare providers, relationship status, affordability, self-efficacy and non-contraceptive benefits. Additionally, contraceptive decision-making was influenced by medical advice, peer and family experiences and particularly, social media content. As a young woman’s personal circumstances change, contraceptive choice may also change, and it is important to re-evaluate these health needs. Conclusion In rural areas, young women’s contraceptive choice is impacted by limited provider access, confidentiality concerns in close-knit communities, and logistical and financial barriers. These rural specific challenges contribute to reliance on self-managed methods and decision-making is often influenced by external opinions, particularly from social media. Increasing access to telehealth, local service information, and trustworthy online resources may support informed use. Further research could explore how rurality influences contraceptive attitudes, especially following unintended pregnancy, declining hormonal contraceptive use, and disparities in sexual health education to inform equitable health strategies.