Preferred use of contraceptive methods and reasons for non-use: a cross-sectional survey of a sample of Black, Indigenous, and people of color in the United States

Abstract

Use of preferred contraceptive methods is a measure of reproductive autonomy, yet barriers persist across the United States in accessing preferred methods of contraception, with disparities in access among communities of color. Using data from a 2021-2022 cross-sectional survey of 727 people aged 13-50 and living in the United States who identified as Asian American, Native Hawaiian, or Pacific Islander (29%); Black or African American (34%), Indigenous (13%), and Latina/Latinx (31%), we examined those who were not using their preferred contraceptive method(s), including the preferred method type and the reasons for not using this method(s). We ran an adjusted logistic regression to test the association between the quality of the last health care interaction related to contraception and the use of a non-preferred method. Thirty-seven percent of respondents preferred a contraceptive method they were not currently using. Among current contraceptive users, long-acting methods were preferred most often, while non-current contraceptive users desired long-acting and short-acting hormonal methods equally. Respondents most often cited concerns about side effects/health risks (65%) and financial/logistical reasons (42%) as the top reasons for not using their preferred method(s). Those who reported receiving higher quality care in a recent contraceptive visit were more likely to be using the method they wanted to be using. Use of a preferred contraceptive method may increase when receiving high-quality counselling and care. Strategies to improve access to preferred methods should address side effects and health concerns, as well as financial and logistical barriers among Black, Indigenous, and people of color.

Plain language summary

Use of preferred contraceptive methods is a measure of reproductive autonomy. But barriers persist across the United States in accessing contraception. There are disparities in access to contraception among communities of color. In 2021-22 we conducted a survey among a convenience sample of 727 people who identified as Asian American, Native Hawaiian, or Pacific Islander, Black or African American, Indigenous, and Latina/Latinx. Thirty-seven percent of respondents would rather use a different contraceptive method than the one currently used.

Most current contraceptive users preferred long-acting methods. People not currently using contraceptives desired long-acting and short-acting hormonal methods equally. Concerns about side effects, health risks, cost and logistics were the main reasons for not using a preferred method. Respondents who recently received higher quality contraceptive care were more likely to be using the method they wanted. High quality contraceptive counselling and care may mean more people use their preferred contraceptive method. Strategies to improve access to preferred methods should address side effects and health concerns, as well as financial and logistical barriers among Black, Indigenous, and people of color.