Contraceptive Care Disparities Among Sexual Orientation Identity and Racial/Ethnic Subgroups of U.S. Women: A National Probability Sample Study
Madina Agénor, Ashley E. Pérez, Amanda Wilhoit, Florence Almeda, Brittany M. Charlton, Megan L. Evans, Sonya Borrero, S. Bryn Austin
Abstract
Background: Sexual minority women may use contraception for various reasons but face notable barriers to contraceptive care, including stigma and discrimination. However, studies examining sexual orientation disparities in contraceptive care have largely relied on nonprobability samples of predominately White women and may thus not be generalizable to U.S. women overall or Black and Latina women in particular. Materials and Methods: Using data from the 2006 to 2017 National Survey of Family Growth, a large national probability sample of U.S. women 15–44 years of age ( N = 25,473), we used multivariable logistic regression to estimate adjusted odds ratios for receiving a contraceptive method or prescription and contraceptive counseling from a health care provider in the past year among sexual orientation identity and racial/ethnic subgroups of heterosexual, bisexual, and lesbian White, Black, and Latina women relative to White heterosexual women. Results: Among women overall, 33.9% had received contraception and 18.3% had obtained contraceptive counseling. Black (odds ratio [OR] = 0.73, 95% confidence interval [CI]: 0.65–0.82) and Latina (OR = 0.73, 95% CI: 0.64–0.82) heterosexual women, White (OR = 0.80, 95% CI: 0.65–0.99) and Black (OR = 0.43, 95% CI: 0.32–0.58) bisexual women, and White (OR = 0.23, 95% CI: 0.13–0.43), Black (OR = 0.19, 95% CI: 0.09–0.40), and Latina (OR = 0.08, 95% CI: 0.03–0.22) lesbian women had significantly lower adjusted odds of receiving contraception compared with White heterosexual women. White (OR = 0.36, 95% CI: 0.15–0.85), Black (OR = 0.42, 95% CI: 0.18–0.98), and Latina (OR = 0.22, 95% CI: 0.09–0.53) lesbian women also had significantly lower adjusted odds of obtaining contraceptive counseling relative to White heterosexual women. Conclusions: Policies, programs, and practices that facilitate access to person-centered contraceptive care among marginalized sexual orientation identity and racial/ethnic subgroups of U.S. women are needed to promote reproductive health equity.