National Survey Of Family Growth Research Articles

Declines in Non-marital Births Among Black Women Between 2004 and 2014: Are Recent Trends the Result of Increases in Contraception?

Non-marital birth rates for women in their twenties began declining in 2008, but the mechanisms driving this decline are not yet well understood. Using a proximate determinants of fertility framework and decomposition techniques, we consider the importance of changes in relationship status, contraceptive use, and other dimensions of deliberate fertility control in understanding trends in the non-marital fertile pregnancy rate between 2004 and 2014. We use data from several cycles of the National Survey of Family Growth to identify relationship and contraceptive use status at the time of conception for pregnancies that resulted or were likely to result in live births (i.e., fertile pregnancies), and focus our analysis on non-Hispanic Black women in their twenties. We find that changes in relationship status and sexual activity did not contribute to the decline in fertile pregnancy rates, nor did changes in the distribution of contraceptive method use. Instead, changing fertile pregnancy rates within contraceptive use categories, including among those who report using no method of contraception, account for the observed trend. Though contraceptive method mix is an insufficient explanation for recent trends, our results suggest that considering the sources of within-method variation in fertile pregnancy rates over time is key to understanding declines in non-marital births, and that some women not using contraception likely engaged in a form of deliberate fertility control not captured by the National Survey of Family Growth.

Family formation trajectories and migration in the United States by the end of the 20th century

Studies often explain differences in family behaviors by migration status by testing four hypotheses: socialization, selection, disruption, and assimilation/ adaptation. These hypotheses were initially formulated as competing explanations, but some scholars have argued that they are complementary. Currently, however, this complementary relationship is not well understood. In this article, I draw on intersectionality theory to challenge this hypothesis-based narrative of the relationship between migration and family formation and dissolution trajectories. I use retrospective information on marriages, union dissolutions, and births of men and women from five waves of the National Survey of Family Growth (1995–2015) to construct a six-category typology of family trajectories. This typology divides men and women into groups with similar family formation and dissolution trajectories. I correlate this typology with information on each respondent’s race/ethnicity, educational attainment, place of birth, and age at migration. The exploratory analysis of these correlations underlines the need for approaches that move beyond testing the above-mentioned hypotheses toward nuanced descriptions of the multiple ways in which family formation and migration paths are intertwined, and how these relationships are influenced by gender and social class inequalities.

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

Sexual Contact Patterns in High-Income Countries-A Comparative Analysis Using Data From Germany, the United Kingdom, and the United States.

Sexual contact patterns determine the spread of sexually transmitted infections and are a central input parameter for mathematical models in this field. We evaluated the importance of country-specific sexual contact pattern parametrization for high-income countries with similar cultural backgrounds by comparing data from two independent studies (HaBIDS and SBG) in Germany, a country without systematic sexual contact pattern data, with data from the National Survey of Sexual Attitudes and Lifestyles (Natsal) in the UK, and the National Survey of Family Growth (NSFG) in the US, the two longest running sexual contact studies in high-income countries. We investigated differences in the distribution of the reported number of opposite-sex partners, same-sex partners and both-sex partners using weighted negative binomial regression adjusted for age and sex (as well as stratified by age). In our analyses, UK and US participants reported a substantially higher number of lifetime opposite-sex sexual partners compared to both German studies. The difference in lifetime partners was caused by a higher proportion of individuals with many partners in the young age group (<24 years) in the UK and the US. Partner acquisition in older age groups was similar. The number of same-sex partners was similar across countries, while there was heterogeneity in the reported experience with partners from both sexes, consistent with the differences observed for opposite-sex sexual partners. These patterns can lead to substantially different dynamics of sexually transmitted infections across ages, and have strong impact on the results of modeling studies.

Disparities in HPV Vaccination Among Young Women From the 2017-2019 National Survey of Family Growth [A110

INTRODUCTION: While human papillomavirus (HPV) vaccination is recommended for all individuals through age 26, uptake remains limited. As minorities are disproportionately affected by cervical cancer, characterizing HPV vaccination disparities among young women is necessary to guide prevention of HPV. METHODS: We analyzed weighted survey data from young female respondents (aged 15-25 years) from the 2017-2019 US National Survey of Family Growth (NSFG), comparing sociodemographic characteristics of HPV vaccine recipients versus unvaccinated women. We summarize self-reported probabilities of HPV vaccination in the next 12 months, examining factors linked to vaccination likelihood via bivariate analyses. RESULTS: Approximately half (49.9%; n=864/1786) of women reported receiving the vaccine. Among unvaccinated women, 52.1% reported being “not at all likely” to become vaccinated in the next 12 months; only 5% reported being “very likely.” Hispanic (41.4%) and non-Hispanic Black (43.0%) women were less likely to be vaccinated than non-Hispanic White (54.7%) women (P&lt;.01), as were respondents who did not speak English at home (37.3% vs 51.1%, P=.02). Unvaccinated women who had never had sex were less likely to get vaccinated than women reporting prior intercourse (56.4% vs 42.9%, P=.03). HPV vaccination was more common among those with higher education, higher income, health insurance, and those previously tested for sexually transmitted infections (STIs) or a Pap smear (P&lt;.05) in the last 12 months. CONCLUSION: The HPV vaccine remains underutilized among young women, particularly among non-English speaking, Hispanic and non-Hispanic Black women and uninsured women. Providers of STI testing and cervical cancer screening should continue offering HPV vaccination, regardless of intercourse history.

Endometriosis Management Patterns Among Women in the National Survey of Family Growth (2017-2019) [A98

INTRODUCTION: Endometriosis is a common gynecologic condition among women of reproductive age. Optimal treatment should be utilized, especially among those who have not completed childbearing. METHODS: We described the prevalence of endometriosis and treatment patterns among reproductive-aged women from the National Survey of Family Growth (NSFG, 2017-2019), focusing on treatments received by individuals reporting a desire for future childbearing. We conducted weighted bivariate analyses using t-tests and chi-square tests as appropriate. RESULTS: Endometriosis was diagnosed in 5.7% (n=314/6,141) of reproductive-aged women, of whom 43.6% reported a current diagnosis. Women with endometriosis were aged 38 years, commonly identified as non-Hispanic White (7.3%), and nearly all (92.7%) had health insurance (65% from private insurance). Reported treatments included: non-narcotic medicines (58.5%), hormonal medicines (47.7%), narcotics (34.6%), hysterectomy (30.1%), and progesterone-releasing intrauterine devices (IUDs) (12.2%); 11.2% never received any treatment. Treatments received did not vary by race and ethnicity, education, income, marital status, or insurance coverage. Prior to hysterectomy among 74 women, 56.7% received non-narcotic medicines, 54.7% hormonal medicines, 47.0% narcotics, and 26.1% progesterone-releasing IUDs. Twenty women (15.5%) who underwent hysterectomy reported a desire for future childbearing. Among these, 81.8% received narcotics, 76.2% received hormonal medicines, 73.0% received non-narcotic medicines, and 23.1% received a progesterone-releasing IUD prior to hysterectomy. CONCLUSION: Nearly one-third of reproductive-age women with endometriosis underwent a hysterectomy, among whom approximately 16% had not completed childbearing. Narcotics are overutilized and progesterone-releasing IUDs underutilized among individuals receiving hysterectomy prior to completion of childbearing.

Heterosexual Identification and Same-Sex Partnering: Prevalence and Attitudinal Characteristics in the USA.

This paper used the 2011-2017 National Survey of Family Growth to estimate population sizes and attitudinal characteristics of heterosexual-identified men who have sex with men (MSM) and women who have sex with women (WSW) aged 15-44 years. Analyses estimated population sizes in stages: after excluding respondents who reported only one lifetime same-sex partner, which happened before the age of 15; after excluding males who reported nonconsensual male-male sex; after excluding respondents who reported only one lifetime same-sex partner, regardless of the age at which that experience occurred; after excluding respondents who reported only two lifetime same-sex partners, the first of which occurred before age 15; and after excluding males who reported male-male sex work. The broadest criteria included many individuals with limited same-sex sexual histories or those who experienced nonconsensual sex or potentially coerced sex in youth. After excluding those respondents, analyses showed that heterosexual-identified MSM and WSW had a diversity of attitudes about gender and LGB rights; only a distinct minority were overtly homophobic and conservative. Researchers should carefully consider whether to include respondents who report unwanted sexual contact or sex at very young ages when they analyze sexual identity-behavior discordance or define sexual minority populations on the basis of behavior.

Primary Contraceptive Method use and Sexually Transmitted Infections in a Nationally Representative Sample of Young Women

Study objectiveRates of sexually transmitted infections (STIs) in the United States have increased for the sixth consecutive year. Young people ages 15-24 account for over half of all new infections despite comprising only a quarter of the sexually active population. A potential explanation for this is the increased use of long-acting reversible contraceptives, (LARCs) which could result in lower condom use and/or increased sexual risk-taking due to higher pregnancy prevention efficacy. DesignThis paper uses the National Survey of Family Growth to examine the relationship between primary contraceptive method use among young women ages 15-24 and STI treatment in the past year, as well as the extent to which this association is mediated by relationship status and frequency of condom use. ResultsFindings did not show differences in STI treatment in the past year by primary contraceptive method, indicating that LARC use among young women does not equate to increased STI risk. Findings did show that young women who had been in casual-only relationships or a mix of relationship types in the past year were more likely to have been treated for an STI than young women in serious or dating-only relationships, regardless of the primary method used. Additionally, young women who used condoms “some” of the time were more likely to have been treated for an STI compared with women who used condoms “all” or “most” of the time. This association was mediated by relationship status (P = .05). ConclusionFindings suggest that efforts to address the growing STI burden should be directed at providing comprehensive, gender-equitable sexual health education that enables young people to engage in healthy relationships and consistent condom use.

Threats to ACA associated with temporary increase in Long-Acting Reversible Contraception

ABSTRACT Long-Acting Reversible Contraception methods (LARCs) have a lower uptake rate than oral contraception, despite being more reliable and potentially cheaper in the long run. Historically, high insertion costs have stunted their uptake. The Affordable Care Act eradicated these costs by classifying contraception as preventative care that insurers must offer at no charge as of late 2012. Additionally, the ACA required that all employer-provided insurance plans have contraceptive coverage. After four years of coverage, the 2016 national election represented a credible threat to the ACA and contraceptive coverage and access. Utilizing the National Survey of Family Growth, I estimate how LARC uptake changed during and after 2016 using data from 2011 to 2019. I find that use of LARCs spiked in 2016 and 2017 for Medicaid users and 2017 and 2019 for women with private insurance.

Racial/Ethnic and Sexual Orientation Identity Differences in the Receipt of a Sexual History Assessment from a Health Care Provider among Women in the United States.

Differential sexual history assessment, whereby certain groups are more or less likely to be asked questions about their sexual behavior by a health care provider, may lead to differential sexual health care and counseling. Using nationally representative data from the 2013 through 2019 waves of the National Survey of Family Growth, we examined racial/ethnic and sexual orientation identity differences in receiving a sexual history assessment from a health care provider in the last 12months among U.S. women aged 15-44years (N=14,019). Adjusting for survey wave, Black and Latina heterosexual women; White, Black, and Latina bisexual women; and Black or Latina lesbian women had higher odds (odds ratio range, 1.47 [Latina heterosexual] to 2.71 [Black bisexual]) of having received a sexual history assessment in the last 12months compared with White heterosexual women. All differences except for those among Black or Latina lesbian women persisted after controlling for demographic, socioeconomic, and health care factors (odds ratio range, 1.43 [Latina heterosexual] to 2.14 [Black bisexual]). Of note, Black bisexual women, about whom providers may hold biased assumptions of promiscuity rooted in both racism and biphobia, had the highest predicted probability of being asked about their sexual behavior by a provider. Person-centered, structurally competent, and anti-oppressive practices and programs aimed at combating bias, stigma, and discrimination in the health care system and facilitating an inclusive clinic environment for all patients are needed to address differences in the provision of sexual health services and promote sexual health equity.

Sexual Violence Against Women With Disabilities: Experiences With Force and Lifetime Risk

Emerging research suggests that people with disabilities experience an increased risk of sexual violence. However, few studies have examined the relationship between disability types and various forms of sexual violence, involving either physical or nonphysical force. This cross-sectional study used nationally representative data from years 2011-2017 of the National Survey of Family Growth among women aged 18-44 years. Analyses were conducted in March 2020-June 2021. Using binary and multinomial logistic regression models, lifetime risk of sexual violence and experience of physical or nonphysical force at first intercourse were modeled as a function of disability type (sensory, physical, cognitive, or ≥2 disabilities). Models also controlled for relevant demographic confounders. Women with any type of disability reported experiencing sexual violence in their lifetime approximately double the proportion of that experienced by nondisabled women (∼30% vs 16.9%), with women with multiple disabilities experiencing the greatest prevalence (42.1%) and risk (AOR=2.94, p<0.001) than nondisabled women. Women with cognitive disabilities or multiple disabilities were significantly more likely to experience either physical (cognitive: AOR=1.55, p<0.001; multiple: AOR=1.50, p<0.05) or nonphysical force (cognitive: AOR=2.28, p<0.01; multiple: AOR=2.74, p<0.001) during their first intercourse than nondisabled women. Results of this study suggest that future research should focus on the association between various types of disability and sexual violence. The development of inclusive evidence-based violence intervention and prevention programs for girls and women with disabilities is recommended.

Associations Between Social Determinants of Health and Adolescent Contraceptive Use: An Analysis From the National Survey of Family Growth.

This research assessed social determinants of contraceptive use among a nationally representative sample of adolescents. This study analyzed nationally representative, publicly available data from the 2013-2015 National Survey of Family Growth (NSFG). The sample consisted of sexually active males and females between the ages of 15 and 19 (n = 775). Independent variables were social determinant questions asked on the NSFG, selected based on the Healthy People Social Determinants of Health Framework. We tested associations between adolescents' social determinants of health and 2 outcomes, use of any contraceptive at last sex, and effectiveness level of contraceptive method at last sex. Results indicated high contraceptive use at last intercourse (91.5%) and a significant association between any use of contraceptive and family structure (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI] = 1.04-4.03), employment (AOR = 2.00, 95% CI = 1.06-3.77), and education (AOR = 3.43, 95% CI = 1.06-11.13). Few participants reported use of a highly effective method of pregnancy prevention (4.3%). In regression analyses, access to health care (AOR = 0.34, 95% CI = 0.14-0.84) and language and literacy (AOR = 2.92, 95% CI = 1.03-8.26) were found to be associated with using moderately effective contraceptive method to prevent pregnancy compared with not using any method. Although adolescents report overall high rates of contraceptive use, not all contraceptives have the same rates of effectiveness, and adolescents are often choosing those with lower effectiveness. This study found low rates of highly effective contraceptives to prevent pregnancy use (ie, intrauterine device and implant). It is also important to further explore the associations between family structure (measured in this study as intact childhood family) and distal links to contraceptive use. Future research should also further distinguish pathways to adolescent decision-making to use contraceptive methods to protect against STIs and pregnancy.

Discrepant abortion reporting by interview methodology among men from the United States National Survey of Family Growth (2015-2017)

Objective: To examine discrepancies in men's abortion reporting when queried via face-to-face interview versus audio computer-assisted self-interviewing (ACASI) in the National Survey of Family Growth (NSFG). Study Design: The NSFG collects nationally representative data on family life, sexual behavior, and reproductive health in the United States. The questionnaire is administered to participants via face-to-face interview (FTF), with selected items also asked of the same participant via ACASI for direct comparison. As the 2015-2017 NSFG queried individuals’ abortion history via both methods, we examined discrepant reporting among respondents. We additionally explored sociodemographic and reproductive characteristics associated with discrepant abortion reporting in a multivariable logistic regression model. Results: Of 4540 male respondents ages 15-49, 45.3% reported a pregnancy. Via FTF, 12.3% reported an abortion, compared to 19.9% via ACASI (p < 0.01). With respect to discrepancies in the number of reported abortions, 8.5% of respondents reported more abortions via ACASI versus FTF. Multivariable logistic regression modeling noted independently greater odds of abortion reporting in ACASI among non-Hispanic Black men (aOR 2.31, 95% CI 1.19-4.45), men living below the Federal Poverty Level (less than 100% FPL: aOR 3.65, 95% CI 1.93-6.89; 100-400% FPL: aOR 2.04, 95% CI 1.20-3.45), and those desiring more children in the future (aOR 1.91, 95% CI 1.20-3.04). Conclusion: Men were more likely to disclose their abortions in ACASI compared to FTF interview. Disproportionate, discrepant abortion reporting among low-income, minority men who report desiring more children in the future warrants further research. Implications: Surveys utilizing ACASI as an adjunct to FTF interviews may more accurately capture men's abortion experience.

Risk of Sterilization Regret and Age: An Analysis of the National Survey of Family Growth, 2015-2019.

To estimate the risk of sterilization regret based on age at the time of sterilization in a contemporary group of women. We conducted a retrospective analysis of cross-sectional data from the 2015-2017 and 2017-2019 National Survey of Family Growth, Female Respondent Files, to estimate the proportion of women who experience sterilization regret. Descriptive statistics were used to describe the population and the proportion with regret. Sterilization regret was defined as someone who either underwent sterilization reversal or who definitely wanted sterilization reversal. Multivariable logistic regression models were used to assess associations with sterilization regret. A total of 1,549 women who underwent sterilization were included in the analysis; 8% were aged 21-30 years, and 92% were aged older than 30 years. Of the participants, 16.9% identified as Black, 22.0% as Hispanic, and 57.2% as White. Most (58.4%) underwent a tubal sterilization procedure between age 21 and 30 years. The cumulative proportion of regret was 10.2% (12.6% for women who underwent sterilization at age 21-30 years and 6.7% for those who underwent sterilization at older than age 30 years). After controlling for covariates including age, race, parity, educational attainment, and medical reason for sterilization, the only variable that had a statistically significant association with regret was age at the time of the interview (P<.001). As women got older, they were less likely to report sterilization regret. Younger women experience more sterilization regret. As women get older, sterilization regret decreases. Counseling about sterilization should reveal the unpredictability of future desire, but age alone must not be a barrier to performing sterilization.

An intersectional analysis of contraceptive types chosen among sexual minority women: A nationally representative study

ObjectiveThe purpose of this study is to use an intersectional approach in which race, insurance, care setting, and disclosure of sexual orientation to a provider are used to assess patterns of contraceptive use in sexual minority women. Study designThis study analyzes cross-sectional data from the 2011–2019 National Survey of Family Growth (NSFG). Sexual orientation of 21,075 respondents’ data was used to investigate contraceptive use in sexual minority women, specifically lesbian and bisexual women, as compared to heterosexual women, controlling for variables such as race, age, and socioeconomic factors. ResultsBlack and Hispanic lesbian women (adjusted odds ratio [aOR] = 0.39 confidence interval [CI] 0.20–0.76 and aOR = 0.44 CI 0.23–0.82, respectively) and Hispanic and Other Race bisexual women use hormonal contraceptive methods less than their White lesbian and bisexual peers (aOR = 0.45 CI 0.29–0.69 and aOR = 0.43 CI 0.20–0.94). Care setting was not correlated with long-acting reversible contraceptive methods (LARC; such as intra-uterine device, hormonal implants) or prescription-based hormonal methods (such as oral contraceptive pills, injectables, vaginal rings, and patches) in lesbian women (aOR = 2.92 CI 0.60–14.2 and aOR = 1.43 CI 0.47–4.38, respectively) or bisexual women (aOR = 0.90 CI 0.48–1.58 and aOR = 0.83 CI 0.37–1.86), but it was for straight women (aOR = 1.28 CI 1.03–1.59 and aOR = 0.68 CI 0.53–0.86). Similarly, insurance status did not correlate with contraceptive patterns in sexual minority women. Importantly, adjusting for nationally representative data did not impact the results; in other words, the odds ratios after adjusting yielded the same results as before adjustment. ConclusionsInsurance and care setting are important determinants of straight women's contraceptive use patterns with fewer effects seen among sexual minority women. These findings support previous work and indicate that known advantages of insurance coverage or use of public clinics may not positively impact sexual minority women as much as they do straight women. Provider awareness of sexual identity and sexual orientation is important for adequate contraceptive care. ImplicationsWhile prior research has presented findings on sexual minority women contraceptive use, to our knowledge there are limited studies that address the social and demographic implications for contraceptive use in this population.

Reasons for Intent to Discontinue and Remove Long-Acting Reversible Contraceptives: National Survey of Family Growth 2017-2019.

Background: Long-acting reversible contraceptives (LARCs) are highly effective forms of contraception, which can reduce the risk of unintended pregnancy. Despite LARC effectiveness, women may desire to discontinue this method. This study will examine reasons for intent to discontinue and remove LARCs among U.S. women 15-49 years of age from 2017 to 2019. Methods: The National Survey of Family Growth 2017-2019 was utilized with a sample of 6141 female respondents. Descriptive statistics for intention to discontinue LARCs, difficulty removing LARCs, and reasons for LARC discontinuation and removal were examined. Rao-Scott chi-square tests were conducted in SAS. Results: Overall, 22.9% of women reported ever using LARCs. Among LARC users, most women (81.2%) reported using LARC in the past 10 years. Among these women, 63.9% intended to discontinue LARCs, and 11.5% had difficulty removing LARCs. Reasons for wanting to discontinue LARCs include side effects (29.6%), LARC expiration (26.8%), LARC complications (19.3%), and decided to get pregnant (15.9%). Primary reasons reported for difficulty removing LARCs included: complications (68.3%), other reasons (13.4%), discouragement by provider (5.8%), and provider's inability to remove (4.9%). Conclusions: Given that women who use a LARC method rely on providers to remove this contraceptive method, understanding the reasons for discontinuation and difficulties encountered is needed. Findings from this nationally representative sample identified provider-level and system-level barriers for LARC removal. To respect the reproductive autonomy of LARC users' method for pregnancy prevention, these barriers must be overcome.

A Web-Based Event History Calendar Approach for Measuring Contraceptive Use Behavior.

Event history calendars (EHCs) are frequently used in social measurement to capture important information about the time ordering of events in people's lives, and enable inference about the relationships of the events with other outcomes of interest. To date, EHCs have primarily been designed for face-to-face or telephone survey interviewing, and few calendar tools have been developed for more private, self-administered modes of data collection. Web surveys offer benefits in terms of both self-administration, which can reduce social desirability bias, and timeliness. We developed and tested a web application enabling the calendar-based measurement of contraceptive method use histories. These measures provide valuable information for researchers studying family planning and fertility behaviors. This study describes the development of the web application, and presents a comparison of data collected from online panels using the application with data from a benchmark face-to-face survey collecting similar measures (the National Survey of Family Growth).

Women's experiences with person-centered family planning care: Differences by sociodemographic characteristics

ObjectivePerson-centered contraceptive care is associated with positive reproductive health outcomes. Our objective was to analyze patients’ ratings on the newly developed Person-Centered Contraceptive Counseling scale (PCCC) to provide distributions for a nationally representative population and to assess differences by sociodemographic characteristics. Study designUsing data from 2017 to 2019 National Survey of Family Growth (NSFG), we analyzed ratings across the four PCCC items among 2242 women who received contraceptive counseling in the past year. Items measured patients’ reports of how providers respected them, let them describe their contraceptive preferences, took their preferences seriously, and adequately informed them about their options. We studied each PCCC item individually as well as the combined scale, distinguishing between ratings of “excellent” versus lower ratings. Bivariate and multivariate logistic regression models assessed how patients’ characteristics (age, race/ethnicity and English proficiency, sexual orientation, income, and parity) and provider type were associated with the likelihood of experiencing person-centered care. ResultsThe majority of women (59%–69%) reported that their family planning provider was “excellent” across the four PCCC items and just over half (51%) reported “excellent” on all items. In multivariate analyses, having a lower income, Black race, non-heterosexual identity, and Hispanic ethnicity combined with low English proficiency were associated with lower PCCC ratings. ConclusionsIn a nationally representative sample, the PCCC captured variation in women's experiences with person-centered family planning care by sociodemographic characteristics. Findings highlight the need for contraceptive counseling that centers on clients’ preferences and experiences, particularly for patients who belong to groups experiencing health inequities. ImplicationsPerson-centered care is a key component of high-quality family planning services. This analysis highlights sociodemographic disparities in person-centered care by analyzing PCCC ratings. Findings show the value of this new health care performance measure and affirm the need for family planning care that centers individuals' preferences and lived experiences.

Associations between unfulfilled contraceptive preferences due to cost and low-income patients’ access to and experiences of contraceptive care in the United States, 2015–2019

ObjectiveTo identify prevalence of unfulfilled contraceptive preferences due to cost among low-income United States female contraceptive method users and nonusers, and associations between access to, and experience with, contraceptive care and this outcome. MethodsWe drew on data from the 2015–2019 National Surveys of Family Growth to conduct simple and multivariable logistic regression analyses on unfulfilled contraceptive preferences due to cost among nationally representative samples of low-income women ages 15 to 49 who were current contraceptive users (N = 3178) and nonusers (N = 1073). ResultsOverall, 23% of female contraceptive users reported they would use a different method, and 39% of nonusers reported they would start using a method, if cost were not an issue. Controlling for user characteristics, low-income contraceptive users who received recent publicly supported contraceptive care reported significantly higher levels of unfulfilled contraceptive preferences due to cost than those without any access to SRH care (aOR = 1.6, CI 1.0–2.5), while having private (aOR = 0.6, CI 0.4–0.9) or public (aOR = 0.7, CI 0.5–1.0) health insurance was associated with significantly lower levels of this outcome. Nonusers of contraception who had recently received publicly supported contraceptive care also reported marginally higher levels of this outcome (aOR = 2.2, CI 1.0–5.1). Contraceptive users who received recent person-centered contraceptive counseling had marginally lower odds of unfulfilled contraceptive preferences due to cost (aOR = 0.6, CI 0.4–1.0). ConclusionsCost is a barrier to using preferred contraception for both contraceptive users and nonusers; health insurance coverage and person-centered contraceptive counseling may help contraceptive users to overcome cost barriers and realize their contraceptive preferences. ImplicationsFactors related to contraceptive access at the systems level—specifically the subsidization and experience of contraceptive care—impact whether cost serves as a barrier to individuals’ contraceptive preferences. Delivery of patient-centered care and shoring up health insurance coverage for all can help to mitigate cost barriers and enable individuals to realize their contraceptive preferences.

Employment Status in the United States and Use of Moderately Effective or Long-Acting Reversible Contraception Before and after the Affordable Care Act: National Survey of Family Growth 2006-2010 and 2015-2017

Employment Status in the United States and Use of Moderately Effective or Long-Acting Reversible Contraception Before and after the Affordable Care Act: National Survey of Family Growth 2006-2010 and 2015-2017