History of unintended pregnancy and patterns of contraceptive use among racial and ethnic minority women Veterans

Abstract Background Nearly half of all pregnancies in the United States each year are unintended, with the highest rates observed among non-Hispanic black and Hispanic women. Little is known about whether variations in unintended pregnancy and contraceptive use across racial and ethnic groups persist among women Veteran VA-users who have more universal access than other populations to health care and contraceptive services. Objectives The objectives of this study were to identify history of unintended pregnancy and describe patterns of contraceptive use across racial and ethnic groups among women Veterans accessing VA primary care. Study Design Cross-sectional data from a national random sample of women Veterans (n=2302) ages 18-44 who had accessed VA primary care in the previous 12 month were used to assess history of unintended pregnancy (pregnancies reported as either ‘unwanted’ or having occurred ‘too soon’). Any contraceptive use at last sex (both prescription and non-prescription methods) and prescription contraceptive use at last sex were assessed in the subset of women (n=1341) identified as being at risk for unintended pregnancy. Prescription contraceptive methods include long acting reversible contraceptive methods (intrauterine devices (IUDs) and subdermal implants), hormonal methods (pill, patch, ring, and injection), and female or male sterilization; non-prescription methods include barrier methods (e.g., condoms, diaphragm), fertility-awareness methods, and withdrawal. Multivariable logistic regression models were used to examine the relationship between race/ethnicity with unintended pregnancy and contraceptive use at last sex. Results Overall, 94.4% of women Veterans at risk of unintended pregnancy used any method of contraception at last sex. IUDs (18.9%), female surgical sterilization (16.9%), and birth control pills (15.9%) were the three most frequently used methods across the sample. IUDs were the most frequently used method for Hispanic, non-Hispanic White, and other non-Hispanic women, while female surgical sterilization was the most frequently used method among non-Hispanic black women. In adjusted models, Hispanic women (aOR=1.60, 95%CI:1.15,2.21) and non-Hispanic black women (aOR=1.84, 95%CI:1.44,2.36) were significantly more likely than non-Hispanic white women to report any history of unintended pregnancy. In the subcohort of 1341 women at risk of unintended pregnancy, there were no significant racial/ethnic differences in use of any contraception at last sex. However, significant differences were observed in the use of prescription methods at last sex. Hispanic women (aOR=0.51, 95%CI:0.35,0.75) and non-Hispanic black women (aOR=0.69, 95%CI:0.51,0.95) were significantly less likely than non-Hispanic white women to have used prescription contraception at last sex. Conclusions Significant racial and ethnic differences exist in unintended pregnancy and contraceptive use among women Veterans using VA care, suggesting the need for interventions to address potential disparities. Improving access to and delivery of patient-centered reproductive goals assessment and contraceptive counseling that can address knowledge gaps while respectfully considering individual patient preferences is needed to support women Veterans’ decision-making and ensure equitable reproductive health services across VA.