Abstract
INTRODUCTION: The prevalence of hypertension among reproductive-aged women in the United States is increasing, and hypertension increases risks of adverse pregnancy and fetal outcomes. Cardiovascular events are the leading cause of pregnancy-related death in the United States. Therefore, contraceptive counseling should be an essential aspect of hypertension management. Our objective was to compare contraceptive counseling and use among hypertensive and nonhypertensive people at risk of unintended pregnancy. METHODS: Using the 2015–2017 and 2017–2019 National Survey of Family Growth (NSFG) Female Respondent Files, we compared contraceptive counseling and contraceptive use in the previous 12 months among people with and without hypertension. Linear probability models were used to estimate the adjusted probability of receiving contraceptive counseling and using contraception. RESULTS: Among 8,625 participants, 771 (8.7%) were hypertensive. 26.2% (95% CI 20.4–31.9) with hypertension and 20.7% (95% CI 19.3–22.2) without hypertension reported receiving contraceptive counseling. 39.8% (95% CI 33.2–46.5) with and 35.3% (95% CI 33.3–37.2) without hypertension reported using contraception. Adjusted results indicate hypertensive participants were 8.0% (95% CI 2.4–13.6) more likely to receive counseling, and 9.4% (95% CI 2.7–16.1) more likely to receive birth control. The most used contraceptive method by hypertensive participants was combined oral contraceptive pills (54.0% [95% CI 44.3–63.5%]). CONCLUSION: Among people at risk for unintended pregnancy, only 26.2% with hypertension received contraceptive counseling, and less than 40% used a contraceptive method. These results illuminate a large, unmet need for contraceptive access. Given the association of hypertension and maternal health, improving contraceptive delivery to this group provides an opportunity to prevent pregnancy-related morbidity.
Published Version
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