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 to 2017, with multivariable analyses of the 2006 to 2010 and 2015 to 2017
cohorts. Using multinomial logistic regression, we investigate predictors of contraceptive
category (permanent contraception vs LARC, lower-efficacy contraception vs LARC) in
reproductive-aged women.
Results
Total 8161 respondents were included in 2 distinct but analogous regression analyses:
(1) the most recent survey cohort, 2015 to 2017 and (2) the cohort a decade prior,
2006 to 2010. Over this period, the prevalence of LARC increased nearly 3-fold (6.2%–16.7%),
while permanent contraception use trended downwards (22%–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 (vs
LARC) remained less likely among college graduates (multinomial odds ratio (OR) 0.45
[95% confidence interval 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.
Keywords
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Article info
Publication history
Published online: December 22, 2020
Accepted:
December 17,
2020
Received in revised form:
December 14,
2020
Received:
September 14,
2020
Footnotes
Prior presentation: Published following the American College of Obstetricians and Gynecologists Annual Clinical Meeting in Seattle, Washington (April 2020 presentation cancelled due to COVID-19) and the Annual Stanford Maternal and Child Health Research Institute Symposium in Stanford, California (November 2019).
Identification
Copyright
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