Research Article|Articles in Press

Racial Inequities in Adolescent Contraceptive Care Delivery: A Reproductive Justice Issue

Published:November 21, 2022DOI:


      Study Objective

      The objective of this study was 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 data


      Three adolescent medicine subspecialty clinics in a large academic hospital system, including an urban location and 2 suburban locations


      Patients assigned female sex at birth prescribed hormonal contraception between January 1st, 2018, and May 31st, 2021.

      Main Outcome Measures

      Method and type of contraceptive prescribed (short-acting, medium-acting, long-acting reversible contraception [LARC])


      There were 2453 patients in the study; 47.5% were White, 36.0% were Black, and 8.1% identified as Hispanic. After controlling for insurance and age, Black patients, compared with non-Black patients, had twofold higher odds of receiving LARC compared with 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 period, with evidence of a higher marginal probability of Black patients receiving LARCs during the pandemic. Additionally, during the 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 LARCs to Black adolescents by clinicians, which could suggest differences in physician contraceptive counseling with a bias toward preferentially counseling Black patients toward LARCs. Our data also show that Black and publicly insured patients had decreased utilization of contraceptive care by telehealth during the pandemic.

      Key Words

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