Racial, Ethnic Disparities in Contraceptive Use Not Explained by Women's Attitudes, Knowledge, Study Finds

October 25, 2012 — Summary of "Do Racial and Ethnic Differences in Contraceptive Attitudes and Knowledge Explain Disparities in Method Use?" Rocca/Harper, Perspectives on Sexual and Reproductive Health, September 2012.

Unintended pregnancy rates in the U.S. are particularly high among certain population groups, including black women, Latinas and socioeconomically disadvantaged women. Although effective, consistent contraceptive use reduces the risk of unintended pregnancy, the proportion of women who use the most effective methods -- long-acting reversible contraceptives, such as intrauterine devices and implants -- is low.

However, the reasons for variations in contraceptive use patterns are not well understood. For this study, Corinne Rocca -- an epidemiologist at the Bixby Center for Global Reproductive Health at the University of California-San Francisco School of Medicine -- and Cynthia Harper -- an associate professor at the center -- assessed whether women's knowledge about contraceptive methods and their attitudes about contraception, pregnancy, childbearing and fertility contribute to racial and ethnic disparities in unintended pregnancy and effective contraceptive use.

Methods

The study relied on data from the National Survey of Reproductive and Contraceptive Knowledge, which included 602 unmarried women ages 18 through 29 at risk for unintended pregnancy. The survey assessed the women's knowledge of contraceptive methods and their attitudes toward contraception, pregnancy, childbearing and fertility.

The researchers used mediation analysis and regression analysis to determine the contribution of racial and ethnic disparities to the women's responses.

Results

The study found that 32% of participants strongly or somewhat agreed with the idea that the government seeks to limit minority populations by encouraging contraceptive use. Blacks (42%) and Latinas (51%) were much more likely than whites (25%) to have this view.

In addition, most participants (79%) felt that avoiding pregnancy was very important, although this belief was more common among blacks (79%) and whites (80%) than among Latinas (71%). Compared with Latinas, significantly more blacks and whites said they would be upset or very upset if they found out they were pregnant.

In general, "[l]evels of fatalism were relatively high," the researchers found. Forty-one percent of women strongly or somewhat agreed that they would become pregnant when it is their time, including 58% of Latinas, 44% of black women and 35% of white women.

The researchers identified just one attitude -- fatalism about pregnancy -- that was associated with knowledge about effective contraception methods. They found that the less fatalistic women were about the timing of their pregnancy, the more knowledge they had about effective contraceptive methods.

Knowledge of effective methods was strongly associated with an increased likelihood of using effective methods. In regression analyses, Latinas had a lower level of knowledge about effective contraceptive methods than white women and black women, who had similar knowledge levels. About 27% of the difference in contraceptive method use among Latinas and whites was attributed to lower contraceptive knowledge among Latinas.

The researchers identified only one attitude that was associated with contraceptive method choice: skepticism that the government ensures contraceptive safety. Women who were the most skeptical tended to use less-effective methods. However, this attitude did not vary by race or ethnicity.

Discussion

The researchers found that women's attitudinal differences regarding effective contraceptive methods, pregnancy, childbearing and fertility did not explain racial and ethnic disparities in contraceptive use. They noted, "Only lower contraceptive knowledge among Latinas partly explained why [they] reported use of less effective methods than white women."

The study is the first "to indicate that Latinas may be as skeptical as black women about the promotion of contraceptives," the researchers wrote. However, overall, "[c]oncerns about the safety of and side effects from long-acting reversible contraceptives and hormonal methods were equally prevalent among black, Latina and white women, and were not associated with current method use," the study found. The findings "suggest that differences by race or ethnicity may not be as large as sometimes perceived," they added.

The researchers noted that "health system and provider factors" also influence racial and ethnic disparities in health care. "Research should examine other variables that might play a mediating role in racial and ethnic disparities in contraceptive use, including differential access to reproductive health care and supplies, insurance coverage of contraceptives and provider counseling techniques," they wrote.