Association of race and ethnicity with postpartum contraceptive method choice, receipt, and subsequent pregnancy

BMC Women's Health

David Ngendahimana¹  Emily Verbus²  Mary Montague²  Barbara Wilkinson²  Jessica Amalraj³  Kavita Shah Arora³  Jane Morris⁴ 

[1] Case Western Reserve University School of Medicine, Mary Ann Swetland Center for Environmental Health;Case Western Reserve University School of Medicine;Department of Bioethics, Case Western Reserve University School of Medicine;Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University;

关键词: Postpartum contraception;    Disparity;    Race/ethnicity;    Long-acting reversible contraception;    Implicit bias;    Contraceptive counseling;   

DOI  :  10.1186/s12905-020-01162-8

来源: DOAJ

【 摘 要 】

Abstract Background We sought to assess racial/ethnic differences in choice of postpartum contraceptive method after accounting for clinical and demographic correlates of contraceptive use. Methods This is a secondary analysis of a single-center retrospective cohort study examining postpartum women from 2012 to 2014. We determined the association between self-identified race/ethnicity and desired postpartum contraception, receipt, time to receipt, postpartum visit attendance, and subsequent pregnancy within 365 days of delivery. Results Of the 8649 deliveries in this study, 46% were by Black women, 36% White women, 12% Hispanic, and 6% by women of other races. Compared with White women, Black and Hispanic women were more likely to have a postpartum contraception plan for all methods. After multivariable analysis, Hispanic women (relative to White women) were less likely to receive their chosen method (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.64–0.87). Women of races other than Black or Hispanic were less likely to experience a delay in receipt of their desired highly-effective method compared to White women (hazard ratio [HR] = 0.70, 95% CI 0.52–0.94). There were no differences between racial/ethnic groups in terms of postpartum visit adherence. Black women were more likely to be diagnosed with a subsequent pregnancy compared to White women (OR 1.17, 95% CI 1.04–1.32). Conclusion Racial/ethnic variation in postpartum contraceptive outcomes persists after accounting for clinical and demographic differences. While intrinsic patient-level differences in contraceptive preferences should be better understood and respected, clinicians should take steps to ensure that the observed differences in postpartum contraceptive plan methods between racial/ethnic groups are not due to biased counseling.

【 授权许可】

Unknown