(044) “Messing with the Natural”: South Asian and Southeast Asian Attitudes Towards Contraception Use for Menstrual Bleeding Management

Abstract Introduction Contraception access is a critical public health issue, with over 160 million women lacking access to contraception worldwide. Beyond preventing pregnancy and controlling family size, contraceptive methods have proven utility in managing heavy menstrual bleeding, yet stigma around their use remains. One major barrier to accessing contraception for menstrual management is social stigma, specifically stemming from strongly religious immigrant communities. Immigrant communities in the United States experience unique challenges in navigating the healthcare system, with limited access to quality sexual and reproductive healthcare. South Asians have a statistically lower likelihood of using birth control methods, and contraceptive use in Southeast Asians is lower than the global average. While South Asian and Southeast Asian communities comprise one of the largest growing immigrant populations in the United States, they remain underrepresented in gynecological health disparities research, and drivers impacting poor utilization of contraception for menstrual and sexual health are unknown. Understanding this population’s attitudes towards contraception can inform equitable access, menstrual equity, and reproductive health literacy. Objective This secondary analysis aims to describe the attitudes of South Asian and Southeast Asian community members regarding access, knowledge, and use of preferred contraceptive methods for sexual and menstrual health needs. Methods This IRB-approved qualitative study conducted Zoom-based, semi-structured interviews with participants, recruited via purposeful sampling. Inclusion criteria included self-identification as South Asian or Southeast Asian, age 18 years or above, English proficiency, United States residency, and having a uterus and menstrual cycles. Descriptive statistics were performed to characterize demographic data, and the Rigorous and Accelerated Data Reduction (RADaR) was utilized for thematic analysis of the textual data. Data presented is a secondary analysis of parent data on menstrual health. Results Participants (n = 27) self-identified as South Asian (85%, n = 23) and Southeast Asian (15%, n = 4). Roughly 56% (n = 10) reported current or prior usage of contraceptives, including oral contraceptive pills, hormonal intrauterine devices (primarily Kyleena and Mirena), and subdermal etonogestrel implants (Nexplanon). While few participants obtained contraception for menstrual symptom management, the majority of respondents understood contraception as primarily intended for pregnancy prevention and family planning. Nearly 40% (n = 10) of participants reported fear or recognized societal stigma about contraception use, while 30% (n = 8) stated their concerns were influenced by their mothers’ negative attitudes toward birth control. Of these participants, most expressed apprehension with hormonal methods of contraception due to perceived risks of physiological side effects, altered endogenous hormonal function, and long-term health consequences, which mirrored maternal concerns about the safety of birth control. Conclusions Findings reveal that attitudes towards contraception among South Asian and Southeast Asian communities are shaped by religiocultural norms, intergenerational influences regarding sexual deviancy, and concerns of physiological maladies with hormonal methods. Hesitancy toward contraceptive use and lack of awareness regarding alternate uses for contraception like bleeding management reflect persistent cultural taboos related to sexual health and limited reproductive health literacy. Future directions include community-based and educational interventions to challenge cultural stigma, dismantle misconceptions, and promote evidence-based, culturally sensitive counseling regarding contraception uses in reproductive and sexual healthcare settings. Disclosure No.