Sociodemographic Trends in Long Acting Reversible Contraception vs. Female Sterilization, 2006-2017 [33I

Abstract

INTRODUCTION: Historically, female sterilization (FS) has been disproportionately concentrated among racial minorities and women with lower education and income. Given increasing popularity of long-acting reversible contraception (LARC), we examined changing socio-demographic patterns of FS and LARC usage. METHODS: We used data files from the National Survey of Family Growth 2006-2010 (earlier) and 2015-2017 (later) survey waves. We analyzed all women of reproductive age not seeking pregnancy, with a sub-analysis of FS and LARC, and extracted socio-demographic information. RESULTS: We included 11,073 respondents. From the earlier to later cohort, the prevalence of LARC increased 3-fold (7% to 20%), while FS dropped (25% to 22%). In our sub-analysis comparing LARC vs FS users (n=3918), the adjusted likelihood of LARC use was greater in the later cohort (OR 2.3 [1.6, 3.4]). When comparing LARC to FS in both cohorts, there were non-significant trends of reduced LARC use in black women (OR 0.51 [0.3, 1.1]), while Hispanic women emerged as more likely to use LARCs in the later cohort (OR 1.5 [0.9, 2.7]). Overall, the most significant predictors of LARC use in the later cohort remained younger age (>35), higher income ($75,000), and more education (OR 3.6 [1.9, 6.6], 5.3 [1.8, 15.9], and 4.5 [2.1, 9.7], respectively). Living in a metropolitan area emerged as a new predictor of LARC use over FS in the later cohort (OR 3.0 [1.3, 7.3]). CONCLUSION: Although LARC use increased and FS decreased, the most significant predictors of LARC over FS include higher income, more education and metropolitan residence, suggesting inequities in access.