Racial and Ethnic Differences in Contraceptive use Among Women Who Desire No Future Children, 2006–2010 National Survey of Family Growth

Abstract

Unintended pregnancies are either mistimed pregnancies occurring sooner than desired or unwanted pregnancies occurring when no children (or no more children) are desired. Unwanted pregnancies appear to be associated with poor pregnancy outcomes, specifically higher risk of preterm delivery and premature rupture of membranes. Women from racial and ethnic minority groups are more likely than white women to experience an unwanted pregnancy. Racial/ethnic differences in contraceptive use patterns among black and Hispanic women are the most likely proximal cause of observed disparities in unintended pregnancy. Several studies have reported that black women are more likely than white women to not use contraceptives or use contraception inconsistently, to have more contraceptive failures, and to less frequently use some prescription methods. Little is known about disparities in contraceptive use among the specific subset of women who do not want any (more) children and who may be at particularly high risk for having an unwanted pregnancy. This study evaluated racial/ethnic differences in contraceptive use among women who do not desire future pregnancy. Nationally representative data were obtained from the 2006–2010 National Survey of Family Growth (NSFG) to examine the relationships between race/ethnicity and contraceptive use among a sample of sexually active, reproductive-age women who stated that they do not desire any (more) children. The primary study outcome measures were (1) use of any contraceptive method and (2) the effectiveness of contraceptive methods used by women using any method at last heterosexual intercourse. Multivariable logistic regression models were used to assess the independent effect of race/ethnicity on contraceptive use patterns, adjusting for sociodemographic factors, reproductive characteristics, and indicators of health care access and utilization. The study sample comprised 2900 sexually active women, aged 15 to 44 years, who were at risk of an unwanted pregnancy. The vast majority (91.2%) used contraception at last sex, although use varied significantly by race/ethnicity; 93.2% of white women reported use of any method, compared with 84.7% of black and 90.5% of Hispanic women; P < 0.01. In the fully adjusted model, black women were significantly less likely than whites to use any contraception at last sex (odds ratio [OR], 0.43; 95% confidence interval, 0.27–0.73); in contrast, there was no significant difference among Hispanic women (OR, 0.95; 95% confidence interval, 0.52–1.72). In bivariate analysis, the type of contraceptive method used at last sex among women who used a method at last sex varied significantly by race/ethnicity (P < 0.01), although most women (59%) used a highly effective method. In the fully adjusted model, however, racial/ethnic differences were no longer significant: There were no significant differences between white women and black or Hispanic women with regard to use of highly/moderately effective contraception. Among the subset of women who report that they do not want (more) children, black women are significantly less likely than white women to use any contraception at last intercourse; this disparity does not appear to be due to differences in sociodemographic characteristics, reproductive factors, or utilization of health care.