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Socioeconomic Differences Persist in Use of Permanent versus Long-Acting Reversible Contraception: An Analysis of the National Survey for Family Growth, 2006-2010 versus 2015-2017. Contraception Beshar, I., So, J., Chelvakumar, M., Cahill, E. P., Shaw, K. A., Shaw, J. G. 2020

Abstract

OBJECTIVE: Permanent contraception has historically been more prevalent among non-White women with lower education and income. Given increasing popularity of long-acting reversible contraception (LARC), we examine changing sociodemographic patterns of permanent contraception and LARC.STUDY DESIGN: We performed a descriptive analysis of the National Survey of Family Growth (NSFG) from 2006-2017, with multivariable analyses of the 2006-2010 and 2015-2017 cohorts. Using multinomial logistic regression, we investigate predictors of contraceptive category (permanent contraception versus LARC, lower-efficacy contraception versus LARC) in reproductive-aged women.RESULTS: 8,161 respondents were included in two distinct but analogous regression analyses: 1) the most recent survey cohort, 2015-2017, and 2) the cohort a decade prior, 2006-2010. Over this period, the prevalence of LARC increased nearly three-fold (6.2% to 16.7%), while permanent contraception use trended downwards (22% to 18.6%). Yet, in adjusted models, we observed little change in the sociodemographic predictors of permanent contraception: from the early to recent cohort, use of permanent contraception (versus LARC) remained less likely among college graduates (multinomial odds ratio (OR) 0.45[95% CI 0.21, 0.97]) and Hispanic women (OR 0.41[0.21, 0.82]). In addition, high income (>$74,999) and metropolitan residence came to predict less use (OR 0.33[0.13, 0.84] and 0.47[0.23, 0.97]). Multiparity, advanced age (over =35), and marital status remained strong predictors of permanent contraception.CONCLUSION: Although use of LARC nearly equals that of permanent contraception in the most recent NSFG survey, socioeconomic differences persist. Continued effort is needed to detect and address structural barriers to accessing the most effective forms of contraception for women.IMPLICATIONS: Comparing 2006-2010 to 2015-2017, reliance on female permanent contraception decreased while LARC use increased, making prevalence more similar. However, significant socioeconomic differences persist in who chooses permanent contraception, with urban, educated, higher-income women more likely to use LARC. Ongoing efforts are needed to understand and reduce economic barriers to LARC.

View details for DOI 10.1016/j.contraception.2020.12.008

View details for PubMedID 33359509