title: Perceived racial, socioeconomic and gender discrimination and its impact on contraceptive choice.
abstract: BACKGROUND
  The study was conducted to determine whether perceived racial, economic and gender discrimination has an impact on contraception use and choice of method.
  
  
  METHODS
  We analyzed the first 2,500 women aged 14-45 years enrolled in the Contraceptive CHOICE Project, a prospective cohort study aimed to reduce barriers to obtaining long-acting reversible contraception. Items from the "Experiences of Discrimination" (EOD) scale measured experienced race-, gender- and economic-based discrimination.
  
  
  RESULTS
  Overall, 57% of women reported a history of discrimination. Thirty-three percent reported gender- or race-based discrimination, and 24% reported discrimination attributed to socioeconomic status (SES). Prior to study enrollment, women reporting discrimination were more likely to report any contraception use (61% vs. 52%, p<.001) but were more likely to use less effective methods (e.g., barrier methods, natural family planning or withdrawal; 41% vs. 32%, p<.001). In adjusted analyses, gender-, race- or SES-based discrimination were associated with increased current use of less effective methods [adjusted risk ratio (aRR) 1.22, 95% confidence interval (CI) 1.06-1.41; aRR 1.25, CI 1.08-1.45; aRR 1.23, CI 1.06-1.43, respectively]. After enrollment, 66% of women with a history of experience of discrimination chose a long-acting reversible contraceptive method (intrauterine device or implantable) and 35% chose a depo-medroxyprogesterone acetate or contraceptive pill, patch or ring.
  
  
  CONCLUSIONS
  Discrimination negatively impacts a woman's use of contraception. However, after financial and structural barriers to contraceptive use were eliminated, women with EOD overwhelmingly selected effective methods of contraception. Future interventions to improve access and utilization of contraception should focus on eliminating barriers and targeting interventions that encompass race-, gender- and economic-based discrimination.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, School of Medicine, St. Louis, MO 63110, USA.
authors.forename: Karla
authors.initials: K
authors.lastname: Kossler
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Kuroki
authors.forename: Jenifer E
authors.initials: JE
authors.lastname: Allsworth
authors.forename: Gina M
authors.initials: GM
authors.lastname: Secura
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Roehl
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Peipert
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D002755:Choice Behavior; D015331:Cohort Studies; D003267:Contraception / Q000379:methods* / Q000523:psychology*; D003268:Contraception Behavior / Q000523:psychology*; D003430:Cross-Sectional Studies; D004192:Discrimination, Psychological; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012306:Risk; D012959:Socioeconomic Factors; D044465:White People; D055815:Young Adult