ABSTRACT
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.
Design
Retrospective cohort study using electronic health record data
Setting
Three adolescent medicine subspecialty clinics in a large academic hospital system,
including an urban location and 2 suburban locations
Participants
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])
Results
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).
Conclusion
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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric and Adolescent GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Outcomes of a rapid adolescent telehealth scale-up during the COVID-19 pandemic.J Adolesc Health. 2020; 67: 172-178
- Racial and ethnic health disparities related to COVID-19.JAMA. 2021; 325: 719-720
- Sexual activity and contraceptive use among teenagers in the United States, 2011-2015.Natl Health Stat Rep. 2017; : 1-23
- Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2006-2010 national survey of family growth.Vital Health Stat. 2011; 23: 1-35
- Racial/ethnic disparities in contraceptive use: variation by age and women's reproductive experiences.Am J Obstet Gynecol. 2014; 210 (e1-9): 526
- Condom and contraceptive use among sexually active high school students - Youth Risk Behavior Survey, United States, 2019.Morb Mortal Wkly Rep. 2020; 69: 11-18
- Black-White differences in sex and contraceptive use among young women.Demography. 2016; 53: 1399-1428
- Changes in use of long-acting reversible contraceptive methods among U.S. women, 2009–2012.Obstet Gynecol. 2015; 126: 917-927
- The relationship between insurance coverage and use of prescription contraception by race and ethnicity: lessons from the Affordable Care Act.Womens Health Issues. 2020; 30: 73-82
- Recommendations for intrauterine contraception: a randomized trial of the effects of patients’ race/ethnicity and socioeconomic status.Am J Obstet Gynecol. 2010; 203 (e1-8): 319
- Inequalities in health: definitions, concepts, and theories.Glob Health Action. 2015; 8: 27106
- Predictors of long-acting reversible contraception use among unmarried young adults.Am J Obstet Gynecol. 2012; 206 (e1-5): 526
- The impact of race and ethnicity on receipt of family planning services in the United States.J Womens Health Larchmt. 2009; 18: 91-96
- Under (implicit) pressure: young Black and Latina women's perceptions of contraceptive care.Contraception. 2017; 96: 221-226
- Provider bias in long-acting reversible contraception (LARC) promotion and removal: perceptions of young adult women.Am J Public Health. 2016; 106: 1932-1937
- Patient characteristics associated with telemedicine access for primary and specialty ambulatory care during the COVID-19 pandemic.JAMA Netw Open. 2020; 3e2031640
Sister Song: Sister Song. Available: https://www.sistersong.net. Accessed: 17 Jun 2021.
- Reproductive Justice: An Introduction.University of California Press, 2019 (. Available:)
- Undivided Rights: Women of Color Organizing for Reproductive Justice.Haymarket Books. Haymarket Books, United States2016
- A call to incorporate a reproductive justice agenda into reproductive health clinical practice and policy.Contraception. 2009; 79: 243-246
National Women's Health Network: LARC Statement of Principles. Available: https://nwhn.org/larc-statement-of-principles/. Accessed: 17 Jun 2021.
- Bridging the expertise of advocates and academics to identify reproductive justice learning outcomes.Teach Learn Med. 2020; 32: 11-22
Article info
Publication history
Published online: November 21, 2022
Accepted:
November 10,
2022
Received in revised form:
November 3,
2022
Received:
May 20,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
