September 26, 2013 —Summary of "Racial and Ethnic Differences in U.S. Women's Choice Of Reversible Contraceptives, 19952010," Jacobs/Stanfors, Perspectives on Sexual and Reproductive Health, September 2013.
Nearly half of all pregnancies in the U.S. are unintended, and a disproportionate number of them occur among minority populations, according to Josephine Jacobs of the University of Toronto and Maria Stanfors of Lund University in Sweden. Compared with white women, black and Hispanic women, respectively, are "about three and two times as likely ... to experience an unintended pregnancy," they wrote.
Jacobs and Stanfors sought to "examine whether the association between race and ethnicity and the use of highly effective reversible contraceptive methods has changed in the [U.S.] over time."
For the study, Jacobs and Stanfors analyzed data on 4,727 women who were at risk of becoming pregnant and completed the 1995 cycle of the National Survey of Family Growth. They compared this group with 5,775 women of similar reproductive health who completed the 2006-2010 cycle of NSFG. All of the women in the study were ages 15 through 44.
The researchers categorized women based on the effectiveness of their methods of birth control: most-effective reversible methods, such as the pill, injectable, intrauterine device, implant, patch or ring; less-effective reversible methods, such as a diaphragm, male or female condom, withdrawal or emergency contraception; or no method. The most-effective methods are 92% to 99.9% effective with typical use, while the less-effective methods are 73% to 85% effective. Not using contraception at all typically results in pregnancy 85% of the time across one year, the researchers noted.
The researchers also analyzed data by race and ethnicity, placing respondents into one of four racial and ethnic groups: blacks; Hispanics; whites; and others, which included Asians, Alaska Natives, Native Americans and Pacific Islanders.
In addition, Jacobs and Stanfors analyzed the data by demographic and socioeconomic characteristics, including age, highest level of education, employment status, annual household income and health insurance status.
The analysis showed that the proportion of all women using the most-effective reversible contraceptive methods increased from 46% in 1995 to 53% in 2006-2010, while the proportion that used no method increased from 12% to 16%. The researchers noted that the number of highly effective reversible methods on the market also grew during this time. Meanwhile, the proportion of women using less-effective contraceptive methods decreased by 12 percentage points from 1995 to 2006-2010.
When assessing the data among racial groups, the researchers found the changes "were not uniformly experienced." Among white women, there were increases in both the proportion using the most-effective methods (from 47% to 58%) and using no method (11% to 15%).
By contrast, black women initially used the most-effective methods "at a level comparable to that of the overall sample (46%) but did not experience an increase between surveys," the researchers wrote. The proportion of black women using no method increased (from 16% to 26%), while the proportion using less-effective methods decreased (from 37% to 26%).
The distribution of Hispanic women according to method effectiveness did not significantly vary across survey cycles. However, compared with white women, they were more likely to use less-effective methods in 2006-2010 than in 1995. In addition, relative to white women, black women were less likely to use more-effective methods than no method in the later survey than the earlier survey.
The results also indicated "a changing association between contraceptive choice and age" during the study period. In 1995, compared with women ages 17 and younger, those ages 18 to 24 were more likely and those ages 35 to 44 were less likely to use the most-effective methods. However, by 2006-2010, there was no association between contraceptive choice and age, except among women ages 35 to 44.
In both surveys, the number of sexual partners women had in the past 12 months was negatively associated with use of the most-effective methods. It was positively associated with use of less-effective methods in 2006-2010 but not in 1995.
Discussion and Conclusion
"Overall, our findings that black women were less likely than whites to use the most effective contraceptive methods fall in line with those of previous studies," Jacobs and Stanfors wrote. "However, our results are novel in that they indicate that this racial gap is growing," as significant racial disparities in the use of highly effective methods were nonexistent in 1995, they added.
The researchers noted that the increasing disparity is "even more striking," considering that public spending on family planning increased by 50% from 1995 to 2010, adjusted for inflation and population. "In this context, our findings indicate that black women did not benefit from this spending to the same extent that white and Hispanic women might have," they wrote.
The researchers noted that "the significance of age diminished over time," which "could be an indication that the contraceptive choices of women across the age spectrum have converged over time."
Further, the "positive association between having additional sexual partners and the use of less effective contraceptives ... points to the possibility that since 1995, women who have a higher number of sexual partners have increased their use of condoms (the most prevalent of the less effective methods), likely for disease prevention," according to the researchers.
Overall, the study's findings "emphasize our need to learn more about the factors that generate disparities in method use," they wrote, concluding, "In particular, investigators need to incorporate supply-side and policy factors, in addition to demand-driven ones, in future research, as it appears that these factors are becoming increasingly important in explaining differences in contraceptive choices."