Race , Ethnicity and Diff erences in Contraception Among Low-Income Women : Methods

Christine Dehlendorf is assistant professor, Diana Greene Foster is associate professor, Heike Thiel de Bocanegra is academic coordinator, Claire Brindis and Philip Darney are professors, and Mary Bradsberry is senior statistician—all with the Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco. risk for unintended pregnancy persist in analyses that control for socioeconomic factors. Because contraceptive methods vary in their effectiveness, and because half of unintended pregnancies occur among women who are using contraceptives, differences by race and ethnicity in method choice may have an effect on racial and ethnic disparities in unintended pregnancy rates. Black and Latina women are more likely than whites to use the injectable and condoms, while whites are more likely than blacks or Latinas to use oral contraceptives. In addition, Latinas are more likely than either white or black women to use an IUD. A few studies have investigated the relationship between contraceptive use and race and ethnicity while controlling for socioeconomic status. In one study, black women were more likely than whites to have undergone tubal sterilization. In another, which controlled for education, income and insurance coverage, black women were less likely than whites to be using oral contraceptives, and more likely than whites to be using condoms and long-acting methods (the patch, ring, injectable, implant and IUD). In addition, U.S.-born Hispanics were more likely than whites to be using condoms, while foreign-born Hispanics were more likely than whites to be using long-acting methods. These fi ndings indicate that racial and ethnic differences Unintended pregnancy is a signifi cant health problem in the United States, where more than three million such pregnancies occur each year. The burden of unintended pregnancy falls disproportionately on ethnic minority women—69% of pregnancies among blacks and 54% of those among Latinas are unintended, compared with 42% of those among white women. These disparities contribute to substantial differentials in abortion rates—49 abortions per 1,000 black women of reproductive age and 30 abortions per 1,000 Latina women of reproductive age, compared with 13 per 1,000 among whites. In addition, low-income women have higher rates of unintended pregnancy and abortion than do women with higher incomes; the largest differences are between women with incomes below 200% of the federal poverty level and those with incomes above this threshold. Disparities in unintended pregnancy and abortion rates are driven in part by differences in contraceptive use. Many women at risk for unintended pregnancy do not use a contraceptive method, and the proportion varies by race and ethnicity. The 2006–2008 National Survey of Family Growth (NSFG) found that among women who were sexually active and did not desire pregnancy, 9% of whites, 16% of blacks and 9% of Latinas were not using contraceptives. Disparities in use between blacks and whites at Race, Ethnicity and Diff erences in Contraception Among Low-Income Women: Methods Received By Family PACT Clients, California, 2001–2007