Racial/ethnic disparities in contraceptive use: variation by age and women's reproductive experiences.
OBJECTIVE
Disparities in unintended pregnancy in the United States are related, in part, to black and Hispanic women being overall less likely to use effective contraceptive methods. However, the fact that these same groups are more likely to use female sterilization, a highly effective method, suggests there may be variability in disparities in contraceptive use across a woman's life course. We sought to assess the relationship between race/ethnicity and contraceptive use in a nationally representative sample and to approximate a life course perspective by examining effect modification on these disparities by women's age, parity, and history of unintended pregnancy.


METHODS
We conducted an analysis of the 2006 through 2010 National Survey of Family Growth to determine the association between race/ethnicity and: (1) use of any method; (2) use of a highly or moderately effective method among women using contraception; and (3) use of a highly effective method among women using contraception. We then performed analyses to assess interactions between race/ethnicity and age, parity, and history of unintended pregnancy.


RESULTS
Our sample included 7214 females aged 15-44 years. Compared to whites, blacks were less likely to use any contraceptive method (adjusted odds ratio, 0.65); and blacks and Hispanics were less likely to use a highly or moderately effective method (adjusted odds ratio, 0.49 and 0.57, respectively). Interaction analyses revealed that racial/ethnic disparities in contraceptive use varied by women's age, with younger women having more prominent disparities.


CONCLUSIONS
Interventions designed to address disparities in unintended pregnancy should focus on improving contraceptive use among younger women.
Departments of Family and Community Medicine; Obstetrics, Gynecology, and Reproductive Sciences; and Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine, San Francisco, CA.
Christine
C
Dehlendorf
Center for Research on Health Care Data Center and Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Seo Young
SY
Park
Center for Research on Health Care Data Center and Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Chetachi A
CA
Emeremni
Center for Research on Health Care Data Center and Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Diane
D
Comer
Amherst College, Amherst, MA.
Kathryn
K
Vincett
Center for Research on Health Care Data Center and Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Center for Health Equity Research, Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
Sonya
S
Borrero
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000208:ethnology* / Q000706:statistics & numerical data; D005260:Female; D006306:Health Surveys; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D016017:Odds Ratio; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000208:ethnology*; D012044:Regression Analysis; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data*
contraception; disparities; race/ethnicity