Social Determinants of Health and Patient-Reported Difficult Removal of Long-Acting Reversible Contraception [ID 2683430

Abstract

INTRODUCTION: Lack of access to high-quality reproductive health care has been reported by persons negatively affected by social determinants of health (SDH). The inability to discontinue a contraceptive method when desired can deleteriously affect a person’s reproductive autonomy. The objective of this study is to evaluate the association of SDH with participant-reported difficult long-acting reversible contraception (LARC) removal. METHODS: A retrospective cross-sectional analysis of data from the 2017–2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal. RESULTS: Seven hundred fifty-four respondents reported wanting to have their LARC removed. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). 105 (11%) reported difficult LARC removal. After adjusting for age, race, education, geographic location, parity, and body mass index, persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficult LARC removal compared to respondents without any SDH (2.11 [95% CI: 1.21, 3.69]). Transportation barriers demonstrated the largest aOR of 2.90 [95% CI: 1.07, 7.87]. CONCLUSION: Social determinants of health are unique risk factors that can negatively affect reproductive justice. Social determinants of health are associated with participant-reported difficult LARC removal. Consideration of SDH at the time of contraceptive selection may be a critical step in addressing equitable and safe access to contraceptives with attention to method discontinuation.