Patient race, class and ethnicity influence physician recommendations for contraception. Moreover, patient's perceived discrimination has been linked to health outcomes and healthcare utilization. We investigated associations between patients' perceived discrimination and contraceptive method use in premenopausal, sexually active U.S. women.
We used population-based data from the 2013 Women's Health Care Experiences and Preferences study of 18-55 year olds. The survey included items measuring health history and social wellbeing, including the Everyday Discrimination Scale (EDS). We focused on one EDS item, “People act as if they think you are not smart,” which we call “perceived discrimination based on intelligence” (PDI). We analyzed relationships between PDI and contraceptive method use (sterilization; highly effective methods [IUC/implant/injectable]; moderately effective methods [pill/patch/ring]; barrier; no method). We conducted multivariable binary logistic regression, controlling for sociodemographic characteristics.
We surveyed 730 premenopausal, sexually active women. Logistic regression models showed that PDI was positively associated with use of a highly effective contraceptive method compared to all other methods, controlling for race, ethnicity, marital status and education (OR 1.5, 95% CI 1.14-2.07, p=0.005). PDI was not associated with the use of any other category of contraceptive method.
Perceived discrimination based on intelligence is associated with use of highly effective contraceptive method use. Further research is needed to determine the reasons for these associations, and whether patient autonomy and/or provider bias influence this relationship.
Financial Disclosure: Vanessa Dalton disclosed the following-Bayer: Consultant/Advisory Board. The other authors did not report any potential conflicts of interest.
Received February 19, 2017
© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.