Racial and ethnic differences in patterns of long-acting reversible contraceptive use in the United States, 2011–2015

Abstract

Objective To investigate whether demographic, socioeconomic, and reproductive health characteristics affect long-acting reversible contraceptive (LARC) use differently by race-ethnicity. Results may inform the dialogue on racial pressure and bias in LARC promotion. Study design Data derived from the 2011–2013 and 2013–2015 National Surveys of Family Growth (NSFG). Our study sample included 9321 women aged 15–44. Logistic regression analyses predicted current LARC use (yes vs. no). We tested interaction terms between race-ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic) and covariates (for example, education, parity, poverty level) to explore whether their effects on LARC use vary by race-ethnicity. Results In the race-interactions model, data did not show that low income and education predict LARC use more strongly among Black and Hispanic women than among White women. There was just one statistically significant race-interaction: experience of unintended pregnancy (p=.014). Among Whites and Hispanics, women who reported ever experiencing an unintended pregnancy had a higher predicted probability of LARC use than those who did not. On the other hand, among Black women, the experience of unintended pregnancy was not associated with a higher predicted probability of LARC use. Conclusions With the exception of the experience of unintended pregnancy, findings from this large, nationally representative sample of women suggest similar patterns in LARC use by race-ethnicity. Implications Results from this analysis of NSFG data do not provide evidence that observed differences in LARC use by race-ethnicity represent socioeconomic disparities, and may assuage some concerns about reproductive coercion among women of color. Nevertheless, it is absolutely critical that providers use patient-centered approaches for contraceptive counseling that promote women’s autonomy in their reproductive health care decision-making.

Predictors of contraceptive switching and discontinuation within the first 6 months of use among Highly Effective Reversible Contraceptive Initiative Salt Lake study participants

“…Prior studies have documented the additional contraceptive barriers faced by women of color, as well as differences and disparities in contraceptive use. [23][24][25] Our findings suggest that these differences are also apparent in method change, underscoring the importance of future qualitative work to further assess how to better support women of color in method use.…”

Factors associated with postpartum use of long-acting reversible contraception

“…Studies show that women of color may perceive more provider pressure to use LARC, 30,31 raising concerns about disparities in access to care and inappropriate LARC promotion. 32 Despite the lack of difference in the association between education or income and LARC use by race/ethnicity shown by a study that examined the 2011-2015 National Survey of Family Growth data using a multiple race-interactions model, 33 it is important that an individual's autonomy, culture, values, and preferences be taken into account when selecting a contraceptive method. 34 Increased efforts to educate all women, regardless of education levels or race/ethnicity about the full range of contraceptive methods, is critical in ensuring that women have access to all methods.…”

<p>The Association of Public Insurance with Postpartum Contraception Preference and Provision</p>

“…However, women choose contraceptive methods based on multiple factors in addition to simply effectiveness; therefore, future pregnancy intention and choice of postpartum contraception method are not always linked 17,31. Physician-level factors may include potential implicit bias in counseling based on clinical, demographic, and insurance-based differences as well as practice pattern differences between individual providers 32–34. Regardless of the reason for these differences in preference, barriers to the provision of the desired contraceptive plan should be minimized.…”