Contraceptive Care Disparities Among Sexual Orientation Identity and Racial/Ethnic Subgroups of U.S. Women: A National Probability Sample Study

Agénor, Madina; Pérez, Ashley E.; Wilhoit, Amanda; Almeda, Florence; Charlton, Brittany M.; Evans, Megan L.; Borrero, Sonya; Austin, S. Bryn

doi:10.1089/jwh.2020.8992

Cited by 21 publications

(21 citation statements)

References 43 publications

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“…In a study of PH providers, only 9% of physicians reported discussing reproductive issues with patients at every visit. 10 Black and Hispanic/Latina women had lower odds of receiving contraceptive counseling, 16 which was consistent with our study, with fewer Hispanic women having a documentation of reproductive counseling or contraceptive use. Similarly, the rheumatology literature also reports inconsistent family planning discussions with patients who would have high-risk pregnancies.…”

Section: Discussionsupporting

confidence: 88%

Low Rates of Reproductive Counseling Documentation in Women With Interstitial Pneumonia With Autoimmune Features

Joerns

Mills

Makris³

et al. 2022

J Clin Rheumatol

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Background/Objective Women with interstitial pneumonia with autoimmune features (IPAFs), a subset of interstitial lung disease (ILD), are at risk for pregnancy complications. Family planning discussions improve pregnancy outcomes in women with ILD. The objective of this study was to evaluate the documentation of reproductive counseling in IPAF female patients of childbearing age by pulmonary and rheumatology providers at an academic medical center. Methods We conducted a medical record review study of pulmonary and rheumatology encounters in reproductive-aged women with IPAF to evaluate documentation of family planning discussions and contraceptive use. We used nonparametric measures of association and logistic regression to evaluate the relationship between patient characteristics and the presence of reproductive counseling documentation by providers. Results Thirty-one women met IPAF classification and were ≤50 years at initial ILD clinic visit. Twenty-five (81%) of these women had risk factors for adverse pregnancy outcomes. Ten women (32%) had a record of reproductive counseling during any visit with their pulmonary provider. Of the 21 patients who also saw a rheumatology provider, 12 (57%) women had a record of reproductive counseling during any visit with their rheumatology provider. No baseline characteristics were associated with odds of reproductive counseling documentation. Conclusions Neither pulmonary nor rheumatology providers consistently discussed family planning/contraceptive use with reproductive-aged women with IPAF. There was a trend for rheumatology providers to discuss reproductive issues with IPAF patients more frequently than pulmonary providers. Efforts should focus on educating providers about the need for reproductive counseling in women with IPAF of childbearing age.

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Section: Discussionsupporting

confidence: 88%

Low Rates of Reproductive Counseling Documentation in Women With Interstitial Pneumonia With Autoimmune Features

Joerns

Mills

Makris³

et al. 2022

J Clin Rheumatol

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“…Agénor and colleagues, using NSFG data, found that white, Black, and Latina sexual minority women had lower adjusted odds of receiving any contraceptive counseling compared to white heterosexual women. 36 Our findings add to their report to show that in addition to sexual minority women receiving contraceptive counseling less often, they are more likely to report a worse contraceptive care experience compared to heterosexual women.…”

Section: Discussionsupporting

confidence: 64%

“…Sexual minority women represent a significant minority of contraceptive patients, yet a growing body of literature, mostly qualitative in nature, describes experiences of discrimination by sexual minority women seeking reproductive care and lack of provider preparation for and engagement on topics such as contraceptive care with them. 12,[35][36][37][38][39] Capturing the difference in reported quality of contraceptive counseling experience within a national probability sample adds to our understanding of the scope of this disparity and underwrites the importance of capturing this dimension of identity in national surveys, particularly as it intersects with other identity characteristics. Agénor and colleagues, using NSFG data, found that white, Black, and Latina sexual minority women had lower adjusted odds of receiving any contraceptive counseling compared to white heterosexual women.…”

Section: Discussionmentioning

confidence: 99%

The status of person‐centered contraceptive care in the United States: Results from a nationally representative sample

Wingo,

Sarnaik,

Michel

et al. 2023

Perspect Sexual Reproductive

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ContextThe Person‐Centered Contraceptive Care measure (PCCC) evaluates patient experience of contraceptive counseling, a construct not represented within United States surveillance metrics of contraceptive care. We explore use of PCCC in a national probability sample and examine predictors of person‐centered contraceptive care.MethodsAmong 2228 women from the 2017–2019 National Survey of Family Growth who reported receiving contraceptive care in the last year, we conducted univariate and multivariable linear regression to identify associations between individual characteristics and PCCC scores.ResultsPCCC scores were high (: 17.84, CI: 17.59–18.08 on a 4–20 scale), yet varied across characteristics. In adjusted analyses, Hispanic identity with Spanish language primacy and non‐Hispanic other or multiple racial identities were significantly associated with lower average PCCC scores compared to those of non‐Hispanic white identity (B = −1.232 [−1.970, −0.493]; B = −0.792 [−1.411, −0.173]). Gay, lesbian, or bisexual identity was associated with lower average PCCC scores compared to heterosexual (B = −0.673 [−1.243, −0.103]). PCCC scores had a positive association with incomes of 150%–299% and ≥300% of the federal poverty level compared to those of income <150% (150%–299%: B = 0.669 [0.198, 1.141]; ≥300%: B = 0.892 [0.412, 1.372]). Cannabis use in the past year was associated with lower PCCC scores (B = −0.542 [−0.971, −0.113]).ConclusionsThe PCCC can capture differential experiences of contraceptive care to monitor patient experience and to motivate and track care quality over time. Differences in reported quality of care have implications for informing national priorities for contraceptive care improvements.

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“…The two Research Assistants leading data collection were native Spanish speakers and offered to conduct focus group discussions and interviews in Spanish, but everyone in our study sample chose to participate in English. Therefore, we did not capture the experiences of people who do not speak English and who may experience greater provider bias in the clinic visit, as seen in studies of contraceptive and pregnancy care 46,47 …”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we did not capture the experiences of people who do not speak English and who may experience greater provider bias in the clinic visit, as seen in studies of contraceptive and pregnancy care. 46,47…”

Section: Discussionmentioning

confidence: 99%

“She should support me, she's my doctor:” Patient perceptions of agency in contraceptive decision‐making in the clinical encounter in Northern California

Rao

Rocca

Muñoz

et al. 2023

Perspect Sexual Reproductive

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Introduction: Agency in contraceptive decision-making is an essential aspect of reproductive autonomy. We conducted qualitative research to investigate what agency means to patients seeking contraceptive care to inform the development of a validated measure of this construct. Methodology:We held four focus group discussions and seven interviews with sexually-active individuals assigned female at birth, ages 16-29 years, recruited from reproductive health clinics in Northern California. We explored experiences in contraceptive decision-making during the clinic visit. We coded data in ATLAS.ti and by hand, compared codes across three coders, and used thematic analysis to identify salient themes.Results: The sample mean age was 21 years, with 17% of participants identifying as Asian, 23% as Black, 27% as Latinx, 17% as Multiracial/other, and 27% as white.Overall, participants reported active and engaged decision-making in their recent contraceptive visit but noted experiences that had undermined their agency in the past. They described how non-judgmental care allowed them to communicate openly, affirming their ability to make their own decisions. However, several mentioned how unexpected contraceptive side effects after the visit had reduced their sense of agency over their decision in retrospect. Several participants, including those who identified as Black, Latinx, and/or Asian, described prior experiences where pressure to use a contraceptive method had undermined their agency and where they had switched providers to regain agency over their contraceptive decisions.Discussion: Most participants were aware of their agency during contraceptive visits and how it varied in different experiences with providers and the healthcare system.

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Contraceptive Care Disparities Among Sexual Orientation Identity and Racial/Ethnic Subgroups of U.S. Women: A National Probability Sample Study

Cited by 21 publications

References 43 publications

Low Rates of Reproductive Counseling Documentation in Women With Interstitial Pneumonia With Autoimmune Features

Low Rates of Reproductive Counseling Documentation in Women With Interstitial Pneumonia With Autoimmune Features

The status of person‐centered contraceptive care in the United States: Results from a nationally representative sample

“She should support me, she's my doctor:” Patient perceptions of agency in contraceptive decision‐making in the clinical encounter in Northern California

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