title: Reducing health disparities by removing cost, access, and knowledge barriers.
abstract: While the rate of unintended pregnancy has declined in the United States in recent years, unintended pregnancy among teens in the United States is the highest among industrialized nations, and disproportionately affects minority teens.
  
  
  
  Our objective of this secondary analysis was to estimate the risk of unintended pregnancy for both Black and White teens age 15-19 years when barriers to access, cost, and knowledge are removed. Our hypothesis was that the Black-White disparities would be reduced when access, education, and cost barriers are removed.
  
  
  
  We performed an analysis of the Contraceptive CHOICE Project database. CHOICE is a longitudinal cohort study of 9256 sexually active girls and women ages 14-45 years in the St Louis, MO, region from 2007 through 2013. Two measures of disparities were used to analyze teenage pregnancy rates and pregnancy risk from 2008 through 2013 among teens ages 15-19 years. These rates were then compared to the rates of pregnancy among all sexually active teens in the United States during the years 2008, 2009, 2010, and 2011. We estimated an absolute measure (rate difference) and a relative measure (rate ratio) to examine Black-White disparities in the rates of unintended pregnancy.
  
  
  
  While national rates of unintended pregnancy are decreasing, racial disparities in these rates persist. The Black-White rate difference dropped from 158.5 per 1000 in 2008 to 120.1 per 1000 in 2011; however, the relative ratio disparity decreased only from 2.6-2.5, suggesting that Black sexually active teens in the United States have 2.5 times the rate of unintended pregnancy as White teenagers. In the CHOICE Project, there was a decreasing trend in racial disparities in unintended pregnancy rates among sexually active teens (age 15-19 years): 2008 through 2009 (rate difference, 18.2; rate ratio, 3.7), 2010 through 2011 (rate difference, 4.3; rate ratio, 1.2), and 2012 through 2013 (rate difference, -1.5; rate ratio, 1.0).
  
  
  
  When barriers to cost, access, and knowledge were removed, such as in the Contraceptive CHOICE Project, Black-White disparities in unintended pregnancy rates among sexually active teens were reduced on both absolute and relative scales. The rate of unintended pregnancy was almost equal between Black and White teens compared to large Black-White disparities on the national level.
authors.affiliation: Department of Biostatistics, College of Global Public Health, New York University.
authors.forename: Melody
authors.initials: M
authors.lastname: Goodman
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO.
authors.forename: Ojiugo
authors.initials: O
authors.lastname: Onwumere
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Laurel
authors.initials: L
authors.lastname: Milam
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN. Electronic address: JPeipert@iu.edu.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Peipert
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D003274:Contraceptive Devices, Female; D016208:Databases, Factual; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics; D054624:Health Status Disparities; D006801:Humans; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control / Q000706:statistics & numerical data*; D049168:Pregnancy, Unplanned; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: contraception; health disparities; teenage girls; unintended pregnancy