In the United States, unintended pregnancies disproportionately affect minority populations. Persistent disparities in contraceptive use between black and Hispanic women and white women have been identified, but it is unclear whether racial and ethnic differences in use of the most effective methods have changed.
Data on 4,727 women from the 1995 National Survey of Family Growth and 5,775 women from the 2006–2010 cycle were used to examine the association between race and ethnicity and women’s choice of reversible contraceptives according to level of method effectiveness. Stepwise multinomial logistic regressions were used to identify changes in this association between cycles. Analyses controlled for demographic, socioeconomic, family, religious, behavioral and geographic characteristics.
The proportion of women using the most effective reversible contraceptive methods increased from 46% in 1995 to 53% in 2006–2010. In 1995, black and Hispanic women’s use of the most effective reversible contraceptives did not differ from that of white women. By 2006–2010, however, black women were substantially less likely than white women to use highly effective reversible contraceptive methods rather than no method (relative risk ratio, 0.6). An analysis that combined the two data sets and included a term for the interaction between survey year and race and ethnicity found that relative to white women, black women were less likely in 2006–2010 than in 1995 to use more effective methods rather than no method (0.6).
Further research is needed to identify factors that may be causing racial and ethnic disparities in contraceptive decisions to widen.
Josephine Jacobs is a doctoral candidate, Institute of Health Policy, Management, and Evaluation, University of Toronto. Maria Stanfors is associate professor, Centre for Economic Demography, Lund University, Sweden.