Impact of Social Determinants of Health on the Choice and Use of Long Acting Reversible Contraceptives

Abstract

Modern women have increased options for birth control with the development of Long Acting Reversible Contraceptives (LARCs). These methods are reliable, easy to use, and require less daily maintenance while providing contraception for an extended period of time. However, despite the surge of LARCs as contraceptive options, the prevalence of unintended pregnancies is still alarmingly high in the United States. As LARCs are the most effective reversible method of birth control at preventing pregnancy, and therefore the potential social, financial, and medical complications associated, we examined whether social determinants of health play a role in LARC usage. While parity and marriage do not seem to affect LARC utilization, increased research is needed to determine the effects of race. Age can affect the type of LARC implemented, as younger women prefer implants to intrauterine devices (IUDs). Insurance coverage was an apparent influencer of LARC usage, as low out-of-pocket costs translate to increased utilization. This is linked to socioeconomic status (SES), as lower SES is associated with decreased access to healthcare in general. Increased research is needed in order to draw conclusions about the effects of education, intimate partner violence, geographic location, and other SDH on LARC usage.

Measurement and Operationalization of the Social Determinants of Health and Long-Acting Reversible Contraception Use in the U.S.: A Systematic Scoping Review

“…Thus, a growing body of literature demonstrates increasing attention to the social determinants of health (SDOH) that influence LARC initiation and usage. 10 The SDOH framework emphasizes factors above individual behavior, biology, or genetics such as the conditions in which patients live, work, learn, and play that shape health status. 11,12 Specifically, research studies may examine which SDOH among many (e.g., insurance status, educational attainment) are associated with LARC initiation and usage with the goal of increasing initiation and use of these contraceptives in groups with comparatively low rates.…”

“…While previous scholarship has reviewed some social determinants that impact LARC use, 10 this review explicitly focuses on factors above the individual-level. This decision is in keeping with guidance from Dahlgren and Whitehead, developers of a widely-cited "rainbow" model of the SDOH, as well as other leading SDOH researchers.…”

“…Thus, a growing body of literature shows increasing attention to the social determinants of health (SDOH) that influence LARC initiation and usage. 10 …”

“…11 , 12 Specifically, research studies may examine which SDOH among many (e.g., insurance status, educational attainment) are associated with LARC initiation and usage with the goal of increasing initiation and use of these contraceptives in groups with comparatively low rates. Although previous scholarship has reviewed some social determinants that impact LARC use, 10 this review explicitly focuses on factors above the individual level. This decision is in keeping with guidance from Dahlgren and Whitehead, developers of a widely cited rainbow model of the SDOH, as well as from other leading SDOH researchers.…”