Racial Differences in Contraception Encounters and Dispensing Among Female Medicaid Beneficiaries with Systemic Lupus Erythematosus

OBJECTIVE Black and Hispanic women with SLE have the highest rates of potentially avoidable pregnancy complications, yet racial disparities in family planning among reproductive-age women with SLE have not been well-studied. We examined whether there are racial differences in contraception encounters and dispensing among U.S. Medicaid-insured women with SLE. METHODS Using Medicaid claims data from 2000-2010, we identified women aged 18-50 with SLE. We examined contraception encounters and uptake over 24 months. We used multivariable logistic regression to estimate the odds (OR, 95% CI) by race/ethnicity of contraception encounters, any contraception dispensing, and highly effective contraception (HEC) use, adjusted for age, region, year, SLE severity, and contraindication to estrogen. We also compared contraception encounters and dispensing among women with SLE to the general population and women with diabetes. RESULTS We identified 24,693 reproductive-age females with SLE; 43% were Black, 35% White, 15% Hispanic, 4% Asian, 2% other race, and 1% American Indian/Alaska Native. Nine percent had a contraception visit, 10% received any contraception, and 2% received HEC. Compared to White women, Black and Asian women had lower odds of contraception dispensing, and Black women had lower odds of HEC use. Women with SLE were more likely to receive HEC than the general population and women with diabetes. CONCLUSION In this study of reproductive-age women with SLE, Black and Asian women had lower odds of contraception dispensing and Black women had lower odds of HEC use. Further study is needed to understand the factors driving these racial disparities among this population.