Do Racial and Ethnic Differences in Contraceptive Attitudes and Knowledge Explain Disparities In Method Use?

TLDR

Despite ongoing efforts, racial and ethnic disparities in unintended pregnancy and effective contraceptive use persist in the United States. The study aims to investigate additional factors, such as health system characteristics and provider behavior, that may explain contraceptive disparities. Using data from 602 unmarried women aged 18‑29 in the 2009 National Survey of Reproductive and Contraceptive Knowledge, the authors performed mediation analyses with regression models to examine how attitudes and knowledge influence contraceptive method use. The analysis found that while Blacks and Latinas held distinct attitudes toward pregnancy and government influence, these attitudes did not explain their lower use of effective contraceptive methods; instead, lower contraceptive knowledge partially accounted for Latinas’ disparities, suggesting that basic information provision could reduce ethnic gaps.

Abstract

Sustained efforts have not attenuated racial and ethnic disparities in unintended pregnancy and effective contraceptive use in the United States. The roles of attitudes toward contraception, pregnancy and fertility remain relatively unexplored.Knowledge of contraceptive methods and attitudes about contraception, pregnancy, childbearing and fertility were assessed among 602 unmarried women aged 18-29 at risk for unintended pregnancy who participated in the 2009 National Survey of Reproductive and Contraceptive Knowledge. The contribution of attitudes to racial and ethnic disparities in effective method use was assessed via mediation analysis, using a series of regression models.Blacks and Latinas were more likely than whites to believe that the government encourages contraceptive use to limit minority populations (odds ratio, 2.5 for each). Compared with white women, Latinas held more favorable attitudes toward pregnancy (2.5) and childbearing (coefficient, 0.3) and were more fatalistic about the timing of pregnancy (odds ratio, 2.3); blacks were more fatalistic about life in general (2.0). Only one attitude, skepticism that the government ensures contraceptive safety, was associated with contraceptive use (0.7), but this belief did not differ by race or ethnicity. Although blacks and Latinas used less effective methods than whites (0.3 and 0.4, respectively), attitudes did not explain disparities. Lower contraceptive knowledge partially explained Latinas' use of less effective methods.Providing basic information about effective methods might help to decrease ethnic disparities in use. Research should examine other variables that might account for these disparities, including health system characteristics and provider behavior.