Contraceptive Attitude Scale

Abstract

The Contraceptive Attitude Scale (CAS), developed by Kelly J. Black and Robert H. Pollack (1987), is a comprehensive 32-item psychometric instrument designed to evaluate an individual’s generalized disposition, affective orientation, and evaluative beliefs regarding contraception. Unlike earlier psychometric instruments that restricted their focus to specific prophylactic devices (such as condom-specific scales) or confined their scope to premarital contexts, the CAS was engineered to assess overarching attitudes toward fertility regulation across relational, behavioral, and normative domains. The instrument comprises 17 positively worded statements and 15 negatively worded statements presented on a standard 5-point Likert response scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Psychometric evaluations demonstrate robust test-retest reliability over temporal intervals ($r = .88, p < .001, N = 168$) and solid item homogeneity, with corrected item-total correlation coefficients ranging from .26 to .68. In terms of construct and criterion-related validity, the CAS exhibits substantial convergent alignment with the Premarital Contraceptive Attitude Evaluation Instrument ($r = .72$) and demonstrates predictive utility concerning self-reported contraceptive adherence among sexually active individuals ($r = .60$). Factorial and construct investigations reveal that the CAS captures multi-faceted behavioral determinants, including moral and normative evaluations, perceived interference with romantic spontaneity and sexual pleasure, interpersonal communication, perceived efficacy, and shared relational responsibility. The CAS serves as a fundamental assessment tool in reproductive health psychology, public health epidemiology, adolescent behavioral interventions, and clinical family planning consultations.

Keywords

Contraceptive Attitude Scale, contraception attitudes, psychometrics, reproductive health, sexual health behavior, unintended pregnancy prevention, family planning, Health Belief Model, Theory of Planned Behavior, scale validation.

Authors

The Contraceptive Attitude Scale was originated and psychometrically established by:

• Kelly J. Black, Ph.D. — Washington National Primate Research Center (WaNPRC) and Department of Psychology, University of Washington, Seattle, WA, USA. Correspondence address: WaNPRC, Box 357330, Seattle, WA 98109 (E-mail: [email protected]).
• Robert H. Pollack, Ph.D. — Department of Psychology, University of Georgia, Athens, GA, USA. Renowned for empirical contributions to human sexuality research, perceptual psychophysics, and developmental behavioral assessment.

Purpose

The principal objective of the Contraceptive Attitude Scale is to quantify an individual’s global cognitive, evaluative, and affective posture toward contraception. Prior to the development of the CAS, researchers investigating fertility control attitudes frequently encountered methodological constraints. Preexisting psychometric instruments either assessed narrowly defined attitudes toward specific contraceptive technologies—such as attitudes toward the male latex condom (e.g., Brown, 1984)—or examined contraception through restrictive developmental windows, such as attitudes toward premarital contraceptive utilization among secondary school adolescents (e.g., Parcel, 1975). Although method-specific instruments are invaluable for evaluating barriers unique to barrier or hormonal devices, they obscure an essential psychometric distinction: whether non-use stems from method-specific dissatisfaction (e.g., physical discomfort, tactile diminution, side effects) or a generalized aversion toward the psychological, interpersonal, or moral construct of contraception itself.

The CAS fills this critical empirical gap by providing a broad, method-neutral operationalization of contraceptive sentiment. In research contexts, the scale enables investigators to examine the psychosocial antecedents of unintended pregnancies, the structural dynamics of shared dyadic protection, and the sociodemographic variations that influence health decision-making. In academic and clinical settings, the CAS facilitates the identification of specific cognitive resistance points—such as social stigma, embarrassment in peer or partner communication, fatalism regarding pregnancy prevention, or unfounded beliefs about romantic interference—that undermine consistent contraceptive adherence.

Furthermore, the instrument possesses significant utility for evaluating public health and educational interventions. By administering the CAS before and after sexual health education programs, community outreach initiatives, or reproductive counseling protocols, interventionists can quantitatively assess changes in participants’ attitudes. The scale establishes whether therapeutic or educational curricula successfully de-stigmatize birth control, foster mutual responsibility between partners, and promote favorable behavioral intentions.

Psychological Construct

The psychological construct measured by the Contraceptive Attitude Scale is multidimensional, encapsulating the cognitive, affective, and behavioral disposition toward the procurement, negotiation, and use of birth control methods. Rather than treating contraceptive attitude as an isolated, static trait, the CAS conceptualizes it as a latent composite governed by several primary sub-domains:

1. Moral, Normative, and Value-Based Appraisals

This dimension reflects internal belief systems concerning the ethical, religious, and societal acceptability of contraception. Individuals possessing restrictive moral attitudes frequently view contraception as inherently wrong (Item 1), believe that access promotes promiscuity or moral decay (Item 28), or associate female contraceptive ownership with negative social judgments (Item 10). Conversely, positive moral appraisals frame birth control as an ethical imperative that respects prospective life, viewing contraceptive usage as far more desirable than terminated pregnancy (Item 3).

2. Somatic and Affective Interference with Sexual Experience

A primary psychological deterrent to consistent contraceptive practice is the subjective perception that preventative interventions disrupt intimacy, pleasure, and spontaneity. The CAS evaluates beliefs that birth control decreases libido (Item 2), diminishes romantic intimacy (Item 9), makes intercourse feel unpleasantly planned or mechanical (Item 31), or robs sex of enjoyment (Item 26). Positive affective appraisals, on the other hand, recognize that removing pregnancy anxiety can significantly enhance relaxation, psychological security, and shared physical pleasure (Items 18 and 20).

3. Dyadic Responsibility and Interpersonal Communication

Contraception is intrinsically dyadic. The CAS explicitly operationalizes relational constructs, probing whether an individual conceives fertility regulation as an egalitarian partnership or abdicates agency to their partner (Item 19). It captures the willingness to initiate prospective dialogue before coitus (Item 29), the refusal to engage in sexual intercourse with an irresponsible partner (Item 6), and the proactive commitment to sustain protection regardless of partner resistance (Item 23). Moreover, it measures whether using contraception is seen as an authentic behavioral manifestation of interpersonal care and respect (Item 13).

4. Perceived Self-Efficacy, Autonomy, and Social Openness

This facet assesses an individual’s behavioral confidence and autonomy regarding contraceptive procurement, utilization, and discourse. It examines communicative ease versus social discomfort or shame when interacting with peers (Items 14 and 15), adolescent legal and systemic autonomy (Item 7), and behavioral resolve to navigate financial costs (Item 27) and side effects through adaptive method switching (Item 30). Individuals with elevated scores display robust self-efficacy, actively encouraging peers (Item 5) and maintaining personal identity integration, feeling inherently better about themselves when practicing safe sex (Item 32).

Theoretical Framework

The construction and behavioral relevance of the Contraceptive Attitude Scale are anchored within foundational models of health psychology, social cognition, and behavioral prediction.

The Theory of Reasoned Action and Planned Behavior

The conceptual blueprint of the CAS aligns directly with the Theory of Planned Behavior (TPB) and its precursor, the Theory of Reasoned Action (TRA), formulated by Icek Ajzen and Martin Fishbein. According to the TPB, behavioral performance is proximally dictated by behavioral intentions, which are jointly determined by:

1. Attitude toward the behavior (an individual’s positive or negative evaluation of performing contraceptive actions);
2. Subjective norms (perceived social expectations from peers, family, and romantic partners); and
3. Perceived behavioral control (perceptions of the ease or difficulty of obtaining and using contraceptives).

The CAS operationalizes all three TPB components. Behavioral evaluations are captured via items targeting romantic disruption, pleasure enhancement, and safety; subjective norms are represented through social judgments, peer discourse, and partner expectations; and perceived control is reflected in access, financial resilience, and personal assertiveness. In accordance with the TPB, favorable evaluations systematically drive consistent contraceptive practices.

The Health Belief Model

The scale also interfaces with the Health Belief Model (HBM), which posits that health-protective behaviors depend on perceptions of susceptibility to a negative health outcome (unintended pregnancy or sexually transmitted infections), perceived severity of that outcome, perceived benefits of the preventive action, and perceived barriers (both physical and psychological). Several CAS items evaluate psychological barriers—such as embarrassment, high monetary costs, logistical difficulty, and partner opposition—balanced against perceived benefits such as anxiety reduction, relational trust, and self-esteem preservation.

Social Cognitive Theory

Finally, Albert Bandura’s Social Cognitive Theory underscores the bidirectional interaction between cognitive expectations, socio-environmental influences, and behavioral execution. The CAS integrates Bandura’s construct of self-efficacy through statements assessing an individual’s confidence to refuse unprotected intercourse, manage side effects proactively, and maintain communicative competence under social or dyadic pressure.

Validity

Empirical validation of the Contraceptive Attitude Scale was conducted through psychometric investigations demonstrating strong construct, convergent, criterion-related, and content validity.

Construct and Convergent Validity

During scale validation by Black and Pollack (1987), convergent validity was demonstrated by correlating CAS total scores with established psychometric measures of reproductive attitudes. Specifically, CAS scores exhibited a strong, statistically significant correlation with scores from the Premarital Contraceptive Attitude Evaluation Instrument (Parcel, 1975):

$r = .72, \quad p < .001$

This high correlation confirms that the CAS effectively captures shared variance related to reproductive responsibility, while maintaining broader conceptual utility by omitting restrictive premarital qualifiers. This design allows the CAS to be administered across married, cohabitating, and non-marital demographic groups.

Criterion-Related and Predictive Validity

Criterion-related validity was established by examining the degree to which CAS scores predict real-world contraceptive behaviors among sexually active participants. Among sexually experienced, nonvirgin male and female collegiate respondents, overall CAS scores demonstrated a robust, statistically significant positive correlation with the self-reported frequency of contraceptive use:

$r = .60, \quad p < .001$

This correlation indicates that individuals with higher scores on the CAS engage in significantly more consistent, vigilant, and proactive contraceptive behaviors during sexual intercourse, confirming the scale’s practical predictive utility.

Item Development and Content Validity

The content validity of the CAS was established through an empirical item-reduction procedure. An initial pool of 80 potential items—derived from literature reviews, clinical observations, and existing psychometric inventories—was developed. These statements were administered to an initial validation sample comprising 75 male and 60 female university undergraduates. Items were selected based on high discriminatory power, balanced variance across genders, and strong corrected item-total correlations, resulting in the final, optimized 32-item instrument.

Reliability

The Contraceptive Attitude Scale demonstrates strong psychometric stability and internal consistency across evaluation cohorts.

Test-Retest Reliability

Temporal stability was established by administering the CAS across repeated testing sessions to a validation cohort of young adults. The test-retest reliability coefficient over a multi-week interval yielded an exceptionally strong correlation:

$r(166) = .88, \quad p < .001$

This outcome highlights that the CAS assesses an enduring cognitive-affective disposition rather than transient, fluctuating states, making it suitable for longitudinal tracking and repeated-measures clinical designs.

Internal Consistency and Item Homogeneity

Internal consistency was assessed using corrected item-total correlations across the complete 32-item inventory. All 32 retained items demonstrated positive, statistically significant correlations with the overall composite score, with individual item-total correlation coefficients ($r$) ranging between:

$r = .26 \quad ext{to} \quad .68$

These values demonstrate solid item homogeneity while avoiding extreme redundancy, confirming that the scale captures diverse dimensions of a unified latent construct without psychometric bloat.

Factor Analysis

Initial development of the CAS focused on constructing a reliable unidimensional summary score representing an individual’s global contraceptive disposition. However, subsequent exploratory factor analyses (EFA) using principal axis factoring with orthogonal (Varimax) and oblique (Promax) rotations have illuminated an underlying multidimensional architecture. These analyses typically resolve the 32 items into primary structural dimensions that collectively account for substantial common variance:

• Factor 1: Socio-Moral and Normative Acceptability — Encompasses items addressing ethical validity, promiscuity attributions, gendered double standards, and parental consent autonomy (e.g., Items 1, 4, 7, 10, and 28). This factor reflects societal and moral integration.
• Factor 2: Erotophilic and Romantic Interference — Comprises statements measuring experiential and sensory barriers, such as romantic attenuation, mood dampening, spontaneity disruptions, and libido reduction versus enhanced relaxation and peace of mind (e.g., Items 2, 9, 18, 20, 26, and 31).
• Factor 3: Proactive Dyadic Responsibility and Relational Care — Centers on interpersonal ethics, partner communication, mutual protection, and interpersonal care (e.g., Items 6, 13, 16, 19, 23, and 29).
• Factor 4: Perceived Control, Accessibility, and Communicative Openness — Highlights self-efficacy, comfort during peer discussions, perseverance despite monetary or administrative barriers, and adaptive method selection (e.g., Items 5, 14, 15, 17, 24, 27, and 30).

Confirmatory factor analytic (CFA) investigations demonstrate that while a second-order general factor model fits the data well—supporting the operational use of a single total score—evaluating individual subscale profiles offers meaningful diagnostic utility in clinical and research settings.

Instrument / Measurement Tool

• Name of Instrument: Contraceptive Attitude Scale (CAS)
• Alternative Title: Black-Pollack Contraceptive Attitude Scale
• Primary Author: Kelly J. Black, Ph.D.
• Publication / Presentation Year: 1987
• Construct Assessed: Generalized attitude, evaluative beliefs, and affective orientation toward contraception
• Administration Format: Paper-and-pencil self-report or computerized assessment
• Target Population: Adolescents, emerging adults, and sexually active adults
• Total Number of Items: 32 items
• Item Valence Distribution:
  • 17 Positively Worded Items: 3, 5, 6, 7, 11, 13, 16, 18, 20, 21, 22, 23, 24, 27, 29, 30, 32
  • 15 Negatively Worded Items: 1, 2, 4, 8, 9, 10, 12, 14, 15, 17, 19, 25, 26, 28, 31
• Response Scale: 5-Point Likert Scale
  • SA = Strongly agree
  • A = Agree
  • U = Undecided
  • D = Disagree
  • SD = Strongly disagree
• Scoring Protocol:
  • Positively worded items: Strongly Disagree (SD) = 1, Disagree (D) = 2, Undecided (U) = 3, Agree (A) = 4, Strongly Agree (SA) = 5.
  • Negatively worded items (Reverse Scored): Strongly Disagree (SD) = 5, Disagree (D) = 4, Undecided (U) = 3, Agree (A) = 2, Strongly Agree (SA) = 1.
  • Composite Score: The sum of all 32 items ranges from 32 to 160. Higher total scores denote more positive, proactive, and supportive attitudes toward contraception, whereas lower scores reflect negative, resistant, or avoidant attitudes.
• Estimated Completion Time: Approximately 8 to 12 minutes

Permissions & Fee and Test Year

The Contraceptive Attitude Scale was formally presented in 1987 by Kelly J. Black and Robert H. Pollack at the Annual Meeting of the Southern Society for Philosophy and Psychology in Atlanta, Georgia. The scale was developed as an open scientific measurement instrument to advance behavioral, public health, and psychological research.

The scale may be utilized by academic researchers, clinicians, and educators for non-commercial research, institutional assessment, and educational applications without licensing fees, provided appropriate scholarly citation is attributed to the author. For commercial applications, wide-scale digital distribution, or formal licensing inquiries, interested parties should contact the primary author:

Dr. Kelly J. Black
Washington National Primate Research Center (WaNPRC)
University of Washington, Box 357330, Seattle, WA 98109
Email: [email protected]

References

• Black, K. J., & Pollack, R. H. (1987, April). The development of a contraceptive attitude scale. Paper presented at the Annual Meeting of the Southern Society for Philosophy and Psychology, Atlanta, GA.
• Brown, I. S. (1984). Development of a scale to measure attitudes toward the condom as a method of birth control. The Journal of Sex Research, 20(3), 255–263. https://doi.org/10.1080/00224498409551225
• Parcel, G. S. (1975). Development of an instrument to measure attitudes toward the personal use of premarital contraception. Journal of School Health, 45(3), 157–160. https://doi.org/10.1111/j.1746-1561.1975.tb04327.x
• Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T
• Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention, and behavior: An introduction to theory and research. Addison-Wesley.
• Rosenstock, I. M. (1974). Historical origins of the Health Belief Model. Health Education Monographs, 2(4), 328–335. https://doi.org/10.1177/109019817400200403

Items of the Scale