Associations between perceived discrimination and contraceptive method use: why we need better measures of discrimination in reproductive healthcare

ABSTRACT

Discrimination has historically contributed to coercive contraceptive in the United States. We investigated associations between perceived discrimination, or the perception of unequal treatment in everyday life, and contraceptive method use among U.S. women. We analyzed population-based data from a 2013 study of U.S. women who were premenopausal, age 18–50, sexually active with a male partner in the last year and were not attempting pregnancy. Perceived discrimination was measured using the Everyday Discrimination Scale. Contraceptive method use was categorized into five method categories: permanent, highly effective reversible, moderately effective, barrier and no method. We analyzed relationships between perceived discrimination and contraceptive method use with several regression models, controlling for covariates. Among 539 women in our analytic sample, those with high perceived discrimination had lower incomes, less educational attainment and were less likely to be insured. Perceived discrimination was associated with a reduced odds of using any contraceptive method (aOR 0.43, CI 0.21–0.87, p < .001). Contraceptive method users with high perceived discrimination had an increased odds of using highly effective reversible methods versus moderately effective methods (aOR 5.28, CI 1.63–17.07 p = < .001). Women who perceived discrimination were at risk for contraceptive nonuse; however, among contraceptive users, perceived discrimination was associated with the use of more effective reversible methods.

KEYWORDS:

• Contraception
• reproductive health
• socioeconomic status

Disclosure statement

Vanessa Dalton is a paid expert witness for Bayer Corporation. The remaining authors declare that no competing interests exist.

Additional information

Funding

CL’s work was supported by the Society of Family Planning Research Fund [SFPRF16-30]. KSH received funding from the National Institute of Child Health and Human Development (NICHD) awards [K01 HD080722 (Emory University) and K12 HD001438 (University of Michigan, PI Johnson)]. The funding sources had no involvement in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.