Contraceptive selection and practice: Associations with self-identified race and socioeconomic disadvantage

Abstract

Many researchers and policymakers have linked contraceptive programs to improvements in women's and children's socioeconomic outcomes. However, these studies have overlooked how socioeconomic status may be an initial driver of contraceptive choice and behavior. Here, I examine the relationship between a comprehensive measure of socioeconomic disadvantage, self-identified race, and contraceptive method selection at enrollment in a unique longitudinal study of contraceptive clients who received a new type of method at no cost. I then examine whether socioeconomic disadvantage has an association with contraceptive switching or discontinuation. I demonstrate that socioeconomic disadvantage decreases the chance of selecting any IUD, while Black racial membership increases the chance of selecting the 3-month injectable and Multiracial membership increases the chance of selecting the Vaginal Ring. I then demonstrate that socioeconomic disadvantage and self-identified race have intersectional and variable associations with switching, and, to a lesser extent, discontinuing methods. These findings offer an important insight for implementation in contraceptive programs: eliminating financial barriers to access contraceptive services does not eliminate the socioeconomic contexts that influence method selection and use that occur as part of everyday lived experiences. Taken cumulatively, these results suggest that contraceptive services should be offered to women in ways that ensure access to reproductive justice without obscuring the need for social changes in the institutions that create disadvantage and shape contraceptive use itself.

Keywords: Contraception; Contraceptive continuation; Contraceptive selection; Race; Socioeconomic disadvantage; Stratified reproduction.