The contraceptive CHOICE project: Recruiting women at highest risk for unintended pregnancy and sexually transmitted infection

Background: Unintended pregnancy disproportionately affects younger, minority, and low-income women. The purpose of this analysis is to describe our recruitment strategies and to determine if targeted efforts to reach women at greatest risk for unintended pregnancy and sexually transmitted infection (STI) were successful. Methods: The Contraceptive CHOICE Project is a prospective cohort study providing reversible contraception at no cost to 10,000 women aged 14-45 years in the St. Louis area in order to evaluate method satisfaction and continuation and to reduce unintended pregnancies in the region. We describe four strategies for effective outreach and recruitment of high-risk women, including forming strong community partnerships. We analyze the evolution of baseline demographic and behavioral characteristics over the three waves of enrollment of the first 2,500 participants in order to assess whether our outreach efforts were successful. Results: Overall, >60% of participants were aged ≤25 years. There was a significant increase in the percentage of minority participants enrolled throughout the first 2,500 subjects (p<0.001). The number of women who reported trouble paying for basic necessities significantly increased over the three waves (p=0.025). Throughout the three waves of enrollment, there was a significant increase in the number of women who tested positive for an STI at baseline (p<0.001). Conclusions: A multiple method approach with collaboration of key community partners led to successful recruitment of hard to reach populations at high risk for unintended pregnancy and STI.