Variations in Receipt of Contraceptives by Insurance Status and Race/Ethnicity

Abstract

D espite decreases in unintended pregnancies over the past decade, more than half of pregnancies among US women aged 18-29 are unplanned [1]. At 51%, the US unintended pregnancy rate is substantially higher than that of most European countries [2], with costs estimated at $21 billion in 2010 [3]. Unplanned pregnancies are associated with poorer outcomes including delayed or inadequate prenatal care, increased levels of stress and depression, and decreased rates of breastfeeding among mothers [4-6], and prematurity, low birth weight, and physical and mental health problems among children [1,7]. Black and Hispanic women experience greater burden of unintended pregnancy than White women [1,6,8], for reasons that include lack of education about effective contraceptive methods [9], less access to family planning services [10,11], distrust of the health care system stemming from historical injustices [9], cultural differences, and levels of acculturation [11,12]. The burden of unintended pregnancy among younger women, especially women of color, is generally high in the United States. In North Carolina, 54% of all pregnancies and 70% of pregnancies among women under age 24 were considered unintended in 2015 [13]. Young women of reproductive age (15-34) make up 26.8% of the North Carolina population, with 24% being Black and 11% Hispanic [14]. Therefore, understanding the family planning needs of these women is an important and urgent public health need.Long-acting reversible contraceptives (LARC), includ-ing intrauterine devices (IUDs) and subdermal hormonal implants, are an extremely effective contraception method associated with reducing unintended pregnancies with a failure rate of less than 1% [15]. However, cost as well as patient and provider knowledge and attitudes are key barriers to increased LARC use [16,17]. While some insurance providers cover LARC, they still require an initial copay that can hinder access [18,19]. For example, based on different insurance plans, the birth control shot (also known as Depo-Provera or the Depo shot

Respondent Demographics and Contraceptive Use Patterns in the United States: A National Survey of Family Growth Analysis

“…It is clear through multiple studies that socioeconomic status and race overlap and may compound barriers to care that patients of minority racial and ethnic backgrounds may face. For example, one study found that compared to White women with commercial insurance, Black and Hispanic women with Medicaid had higher odds of receiving LARC, suggesting implicit biases that may influence contraception counseling [ 15 ].…”