Unintended pregnancy, an important public health issue, disproportionately affects minority populations. Yet, the independent associations of race, ethnicity and other characteristics with contraceptive choice have not been well studied.
Racial and ethnic disparities in contraceptive use among 3,277 women aged 18–44 and at risk for unintended pregnancy were assessed using 2006–2008 data from of the California Women’s Health Survey. Sequential logistic regression analyses were used to examine the independent and cumulative associations of racial, ethnic, demographic and socioeconomic characteristics with method choice.
Differences in contraceptive use persisted in analyses controlling for demographic and socioeconomic characteristics. Blacks and foreign-born Asians were less likely than whites to use high-efficacy reversible methods—that is, hormonals or IUDs (odds ratio, 0.5 for each). No differences by race or ethnicity were found specifically for IUD use in the full model. Blacks and U.S.-born Hispanics were more likely than whites to choose female sterilization (1.9 and 1.7, respectively), while foreign-born Asians had reduced odds of such use (0.4). Finally, blacks and foreign-born Asians were less likely than whites to rely on male sterilization (0.3 and 0.1, respectively).
Socioeconomic factors did not explain the disparities in method choice among racial and ethnic groups. Intervention programs that focus on improving contraceptive choice among black and, particularly, Asian populations need to be developed, as such programs have the potential to reduce the number of unintended pregnancies that occur among these high-risk groups.
Grace Shih is assistant professor, Department of Family and Community Medicine; Eric Vittinghoff and Jody Steinauer are adjunct professors, Department of Biostatistics; and Christine Dehlendorf is assistant professor, Department of Obstetrics and Gynecology—all at the University of California, San Francisco.