Advertisement

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

Published:November 21, 2022DOI:https://doi.org/10.1016/j.jpag.2022.11.004

      Abstract

      Study Objective

      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 (EHR) data.

      Setting

      Three Adolescent Medicine subspecialty clinics in a large academic hospital system including an urban location and two suburban locations.

      Participants

      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 [LARC]).

      Results

      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).

      Conclusion

      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.

      Keywords

      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 access
      One-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 Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wood SM
        • White K
        • Peebles R
        • Pickel J
        • Alausa M
        • Mehringer J
        • et al.
        Outcomes of a Rapid Adolescent Telehealth Scale-Up During the COVID-19 Pandemic.
        J Adolesc Health. 2020; 67 (Aug 1): 172-178
        • Lopez III, L
        • Hart III, LH
        • Katz MH.
        Racial and Ethnic Health Disparities Related to COVID-19.
        JAMA. 2021 Feb 23; 325: 719-720
        • Abma JC
        • Martinez GM.
        Sexual Activity and Contraceptive Use Among Teenagers in the United States, 2011-2015.
        Natl Health Stat Rep. 2017 Jun; (2017/07/12 ed.): 1-23
        • Martinez G
        • Copen CE
        • Abma JC
        Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2006-2010 national survey of family growth.
        Vital Health Stat. 2011 Oct; 23 (2012/01/20 ed.): 1-35
        • Dehlendorf C
        • Park SY
        • Emeremni CA
        • Comer D
        • Vincett K
        • Borrero S.
        Racial/ethnic disparities in contraceptive use: variation by age and women's reproductive experiences.
        Am J Obstet Gynecol. 2014 Jun; 210 (2014/02/06 ed.e1-9): 526
        • Szucs LE
        • Lowry R
        • Fasula AM
        • Pampati S
        • Copen CE
        • Hussaini KS
        • et al.
        Condom and Contraceptive Use Among Sexually Active High School Students - Youth Risk Behavior Survey, United States, 2019.
        MMWR. 2020; 69 (Suppl. 2020/08/21 edAug 21): 11-18
        • Kusunoki Y
        • Barber JS
        • Ela EJ
        • Bucek A.
        Black-White Differences in Sex and Contraceptive Use Among Young Women.
        Demography. 2016 Oct; 53 (2016/09/15 ed.): 1399-1428
        • Kavanaugh ML
        • Jerman J
        • Finer LB.
        Changes in Use of Long-Acting Reversible Contraceptive Methods Among U.S. Women, 2009–2012.
        Obstet Gynecol. 2015 Nov; 126: 917-927
        • Johnston EM
        • McMorrow S.
        The Relationship Between Insurance Coverage and Use of Prescription Contraception by Race and Ethnicity: Lessons From the Affordable Care Act.
        Womens Health Issues. 2020 Mar; 30: 73-82
        • Dehlendorf C
        • Ruskin R
        • Grumbach K
        • Vittinghoff E
        • Bibbins-Domingo K
        • Schillinger D
        • et al.
        Recommendations for intrauterine contraception: a randomized trial of the effects of patients’ race/ethnicity and socioeconomic status.
        Am J Obstet Gynecol. 2010 Oct; 203 (2010/07/06 ed.e1-8): 319
        • Arcaya MC
        • Arcaya AL
        • Subramanian SV.
        Inequalities in health: definitions, concepts, and theories.
        Glob Health Action. 2015; 8 (Jun 24)https://doi.org/10.3402/gha.v8.27106
        • Dempsey AR
        • Billingsley CC
        • Savage AH
        • Korte JE.
        Predictors of long-acting reversible contraception use among unmarried young adults.
        Am J Obstet Gynecol. 2012 Jun; 206 (2012/03/20 ede1-5): 526
        • Borrero S
        • Schwarz EB
        • Creinin M
        • Ibrahim S.
        The impact of race and ethnicity on receipt of family planning services in the United States.
        J Womens Health Larchmt. 2009 Jan; 18 (2008/12/17 ed.): 91-96
        • Gomez AM
        • Wapman M.
        Under (implicit) pressure: young Black and Latina women's perceptions of contraceptive care.
        Contraception. 2017 Oct; 96 (2017/08/02 ed.): 221-226
        • Higgins JA
        • Kramer RD
        • Ryder KM.
        Provider Bias in Long-Acting Reversible Contraception (LARC) Promotion and Removal: Perceptions of Young Adult Women.
        Am J Public Health. 2016 Nov; 106 (2016/09/16 ed.): 1932-1937
        • Eberly LA
        • Kallan MJ
        • Julien HM
        • Haynes N
        • Khatana SAM
        • Nathan AS
        • et al.
        Patient Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care During the COVID-19 Pandemic.
        JAMA Netw Open. 2020 Dec 29; 3e2031640
      1. Sister Song [Internet].
        Sister Song. 2021; ([citedAug 13]. Available from:)
        • Ross L
        • Solinger R.
        Reproductive Justice: An Introduction [Internet].
        University of California Press, 2019 ([cited 2021 Aug 13]. Available from:)
        • Ross L
        • GutiŽrrez E
        • Gerber M
        • Silliman J
        Undivided Rights: Women of Color Organizing for Reproductive Justice.
        Haymarket Books. 2016; : 386
        • Gilliam ML
        • Neustadt A
        • Gordon R.
        A call to incorporate a reproductive justice agenda into reproductive health clinical practice and policy.
        Contraception. 2009 Apr; 79: 243-246
      2. LARC Statement Of Principles – National Women's Health Network [Internet]. 2021; ([citedAug 13]. Available from:)
        • Loder CM
        • Minadeo L
        • Jimenez L
        • Luna Z
        • Ross L
        • Rosenbloom N
        • et al.
        Bridging the Expertise of Advocates and Academics to Identify Reproductive Justice Learning Outcomes.
        Teach Learn Med. 2020 Jan 1; 32: 11-22