To examine racial/ethnic disparities in contraceptive delivery for adolescent patients
within an adolescent medicine subspecialty clinical system before and during the COVID-19
pandemic. Secondarily we aimed to assess the relationship between race and contraceptive
delivery by telehealth.
Retrospective cohort study using electronic health record (EHR) data.
Three Adolescent Medicine subspecialty clinics in a large academic hospital system
including an urban location and two suburban locations.
Patients assigned female sex at birth prescribed hormonal contraception between January
1st, 2018 and May 31st, 2021.
Main Outcome Measures
Method type of contraceptive prescribed (short-acting, medium-acting, long-acting
There were 2,453 patients in the study, 47.5% were white and 36.0% Black, 8.1% identified
as Hispanic. After controlling for insurance and age, Black patients compared to non-Black
patients had a 2-fold higher odds of receiving LARC compared to a short acting method
across the study period (aOR: 2.0, 95% CI: 1.52-2.62). We identified effect modification
with significant interaction between Black race and the pandemic time period, with
evidence of a higher marginal probability of Black patients receiving LARC intra-pandemic.
Additionally intra-pandemic, patients receiving new contraceptive prescriptions via
telehealth were less likely to be Black (aOR=0.63, 95% CI: 0.41-0.94) or publicly
insured (aOR 0.56, 95% CI 0.38-0.81).
Our data show significantly higher prescribing of LARC to Black adolescents by clinicians,
which may suggest differences in physician contraceptive counseling with a bias toward
preferentially counseling Black patients toward LARC. Our data also show that Black
and publicly insured patients had decreased utilization of contraceptive care by telehealth
during the pandemic.