Contraceptive Initiation Among Women in the United States: Timing, Methods Used, and Pregnancy Outcomes

Abstract

BACKGROUND: Timely contraceptive initiation is increasingly common, yet population trends by method and among subgroups with increased risk of unintended pregnancy are not well described. The impact of timing and type of contraceptive initiation on risk of unwanted pregnancy is unknown. METHODS:We used nationally representative cross-sectional data from 4 cycles of the National Survey of Family Growth, 2002-2015. We calculated outcomes from self-reported dates of sexual debut, contraceptive initiation, and unwanted pregnancy. We compared trends in timely contraceptive initiation (within 1 month of sexual debut) by method and by race and/or ethnicity and income. Using multivariable regression, we identified predictors of delayed contraceptive initiation. We compared the risk of unwanted pregnancy for delayed versus timely contraceptive initiation.

Association of race and ethnicity with postpartum contraceptive method choice, receipt, and subsequent pregnancy

“…However, contrary to our hypothesis, Black and Hispanic women were more—not less—likely to choose every method of contraception (though not statistically significant for combined hormonal contraception) than White women for use as postpartum contraception. Little is known about racial/ethnic differences in planned method of postpartum contraception as most prior studies focus on contraceptive use, rather than plan [ 5 – 8 ]. Our study demonstrates that Black and Hispanic women plan on using contraception postpartum more often than their White counterparts.…”

“…For example, Black and Hispanic women are more likely to utilize less effective methods of contraception than White women, but also more likely to utilize the highly effective method of sterilization—a relationship which is also associated with age [ 12 , 13 ]. Prior assessments of differences in contraceptive method choice by race/ethnicity largely did not take into account the potential impact of all of these clinical and demographic factors [ 5 , 6 , 8 – 10 , 14 , 15 ].…”

“…We also sought to analyze racial/ethnic variation in postpartum contraceptive method fulfillment, time to fulfillment, postpartum visit attendance, and subsequent pregnancy. Given differences in contraceptive method used outside of the postpartum period, we hypothesized that Black and Hispanic women would be more likely to plan on using less-effective methods or sterilization after delivery, while White women would be more likely to plan on using a long-acting reversible contraception (LARC) method [ 6 , 8 ]. Furthermore, given structural barriers to care and known disparities in access, we also hypothesized Black and Hispanic women would be less likely to have their contraceptive method choice fulfilled, more likely to experience delays in receipt, less likely to attend postpartum care, and more likely to be diagnosed with a subsequent pregnancy within one year of delivery [ 1 ].…”

“…Disparities in contraceptive use are especially troubling given the United States' history of valuing reproduction based on a woman's race and/or class, the importance of family planning in attaining personal educational and workforce goals, and the downstream impact on maternal and child health by reduction of short interpregnancy intervals [2][3][4]. However, Black and Hispanic women are reported to have higher rates of contraceptive non-use, differences in contraceptive method choice, lower rates of method fulfillment, contraceptive failure, and unintended pregnancies than White women [5][6][7][8].…”

Low Rates of Contraception Use in Women With Human Immunodeficiency Virus

“…We did not observe differences in likelihood of contraception in our cohort by race/ethnicity nor year of clinic entry. While race has not been described as a factor associated with contraceptive use in WWH in the US, previous studies in women in the general population have suggested delayed contraception initiation among Black women [ 33 , 34 ]. We also observed that of all women in the clinic, those who had a pregnancy during follow-up had a higher cumulative incidence of contraception use.…”