Contraceptive Use Among LowIncome and Ethnic Minority
Women Living in Three Urban
Underserved Neighborhoods
Adejoke B. Ayoola, PhD, RN1
Gail L. Zandee, MSN, RN1
Emily Johnson, BSN, RN2 &
Kendra Pennings, BSN1
1. Calvin College, Grand Rapids, MI, USA
2. Graduate student, University of Michigan, Ann Arbor, MI
Sigma Theta Tau International's 25th International Nursing
Research Congress, Hong Kong
July 24, 2014,
Acknowledgements
• Robert Wood Johnson Foundation Nurse
Faculty Scholar program (2012-2015)
• Calvin College Summer Research
Assistant Grant
• Calvin College Department of Nursing
Marian Peterson Fund
• Calvin Alumni Association
Unintended Pregnancy in the U.S.
• Nearly half of the 6.7
million pregnancies in
the United States in
2006 were unintended.
(Finer & Zolna, 2011)
• Unintended
pregnancies are
associated with
adverse outcomes
(Cheng, Schwarz, Douglas, & Horon, 2009;
Gipson, Koenig, & Hindin, 2008).
http://www.guttmacher.org/graphics/2012/01/31/Unintended-pregnancy-map2.gif
Unintended Pregnancy in the U.S.
• Associated with delayed
prenatal care, preterm births
and low birth weight
(Afable-Munsuz A, Braveman, 2008; Collier &
Hogue, 2007; Mohllajee, Curtis, Morrow, &
Marchbanks, 2007)
• Highest among low-income
women & among minorities
regardless of income
(Finer and Zolna, 2011)
Unintended Pregnancy in the U.S.
• Low-income and minority
women are at high risk of
having an unintended
pregnancy
(Finer & Henshaw, 2006).
• Unintended pregnancy is
highest among:
– African Americans (67%) and
– Hispanics (53%) compared to
– 40% among white women
(Finer & Zolna, 2011).
Unintended Pregnancy and
Contraceptive Use
• Of the 3.1 million unintended pregnancies in the
U.S.
– 52% of the women did not use contraception
– 43% were inconsistent users, and
– 5% were consistent in their usage
(Gold, Sonfield, Richards, & Frost, 2009).
• Ineffective and non–use of contraceptives could
increase the risk of unintended pregnancy among
minority and low-income women.
Unintended Pregnancy and
Contraceptive Use
• Nearly 1:4 women at risk of unintended
pregnancy in the U.S experience one or more
months of contraceptive non-use annually
(Frost, Singh, & Finer, 2007a).
• About 14% of women aged 35 to 44 years in
the U.S. reported not using any method of
contraception during their last intercourse
(Upson, Reed, Prager, & Schiff, 2010).
Unintended Pregnancy and
Contraceptive Use
• Contraceptive non-use and inconsistent use is
higher among:
– women with less education and lower income
– women who are on publicly funded health
insurance programs or have no health insurance
coverage
– women from ethnic minority groups
(Chandra, Martinez, Mosher, Abma, & Jones, 2005; Dehlendorf, Rodriguez, Levy,
Borrero, & Steinauer, 2010; Frost et al., 2007a; Upson et al., 2010; Wu, Meldrum,
Dozier, Stanwood, & Fiscella, 2008)
Unintended Pregnancy and
Contraceptive Use
• To achieve Healthy People 2020 goals¸ nurses
need to understand low-income women’s
current contraceptive practices to adequately
guide women through preconception
pregnancy planning.
Objectives
• This study examined the rate of
contraceptive use and types of
contraception used by lowincome women
Methods
• Pre-screening of women enrolled in a larger
study
• Data Collection
– Phone Interview
• Data Analysis
– Univariate & bivariate analysis using STATA 10
– Chi-squared and the Fisher exact test
– P = or < 0.05
Methods
• Measures- Contraceptive use
– Use of contraception 12 mths before the
interview.
•Effective contraceptive methods - long-acting methods
(i.e., intrauterine device (IUD), implant, and injectable)
•Moderately effective methods - patch, vaginal ring, and oral
contraceptives.
•Least effective methods - male/female condoms, withdrawal,
periodic abstinence, spermicides and other barrier methods,
natural family planning such as the rhythm method,
Creighton model
(Frost & Darroch, 2008; Mosher & Jones, 2010)
Results
• Initial sample of 131
• Women who were trying to get
pregnant (n=21, 16%)
• Final sample of 110 (84%) women
were included in this study.
Characteristics of the women in the study
Characteristic
n
%
30.95 years
SD = 8.38
18-55 years
7
6.4
20-24 years
20
18.2
25-29 years
24
21.8
30-34 years
28
25.5
35-39 years
15
13.6
40-44 years
9
8.2
7
6.4
Age
Mean
Range
19 years and below
45 years and above
Characteristics of the women in the study
Characteristic
Household income
Less than $10,000
n
%
44
40
$10,000 to $14,999
24
21.8
$15,000 to $19,999
13
11.8
$20,000 to $24,999
9
8.2
$25,000 to $34,999
4
3.6
$35,000 to $49,999
5
4.6
$50,000 or above
Not provided
3
8
2.7
7.3
Characteristics of the women in the study
Characteristics
n
%
Race/Ethnicity
Black or African American
White
Hispanic/Latino
Others
48
17
43
2
43.6
15.5
39.1
1.8
Women who were not currently
pregnant and not trying to get pregnant
Used a contraceptive in the last 12 months
n =110
23%
77%
Yes
No
Women who were not currently
pregnant and not trying to get pregnant
Currently use contraceptives (n =110)
36%
64%
Yes
No
Types of contraceptives used by the
women in the last 12 months
Types of contraceptive
used in the last 12
months* (n=110)
Yes
________________
No
______________
n
%
n
%
Male partner used
condom
Birth control pills
31
28.2
79
71.8
16
14.6
94
85.4
Contraceptive injection
14
12.7
96
87.3
Tubal Ligation
14
12.7
96
87.3
IUD
12
10.9
98
89.1
Hysterectomy
3
2.7
107
97.3
Types of contraceptives used by the
women in the last 12 months
Types of contraceptive
used in the last 12
months*
(n=110)
Yes
________________
No
______________
n
%
n
%
Menopause
1
0.9
109
99.1
Birth control patch
2
1.8
108
98.2
Vaginal ring
1
0.9
109
99.1
Vaginal sponge
1
0.9
109
99.1
No contraception
Other methods (n=12)
25
12
22.7
10.9
85
98
77.3
89.1
Types of contraceptives used by the
women in the last 12 months
Types of contraceptive
used in the last 12
months*
Yes
________________
No
______________
n
%
n
%
Other methods (n=12)
12
10.9
98
89.1
Natural Family
Planning
Contraceptive implants
3
25.0% of 12
9
75% of 12
3
25.0% of 12
9
75% of 12
Abstinence
1
8.33% of 12
11
91.67% of 12
Hysterectomy
3
25.0% of 12
9
75% of 12
Menopause
1
8.33% of 12
11
91.67% of 12
Women who were not currently
pregnant and not trying to get pregnant
Risk of pregnancy in the past 12 months
n = 95
43%
57%
No
Yes
Comparison of Contraceptive
Effectiveness among Racial Groups
n= 95
White
n
%
Black or
African
American
n
Effective
6 66.6 18
Moderately Effective
1 11.1
1
Ineffective
2 22.2
8
%
Hispanic
or Latino
Others
Total in
each
category
n
%
n
%
n
66.6 12
42.8
0
0
36
4
14.3
1
100
7
29.6 12
42.9
0
0
22
3.7
Contraceptive use and main
demographic variables
Variables
Race*
Current contraceptive use*
Contraceptive Effectiveness
Race*
Current contraceptive use*
Household Income*
Women not pregnant and not trying
to get pregnant (n=95)
Pearson chi2(27) =80.1 P<0.001
Fisher's exact <0.001
Pearson chi2(9) = 49.89 P<0.001
Fisher's exact <0.001
Pearson chi2(12) = 59.36 P<0.001
Fisher's exact = 0.038
Pearson chi2(2) = 20.9398 P <0.001
Fisher's exact <0.001
Pearson chi2(14) = 32.2839 P <0.001
Fisher's exact = 0.046
Contraceptive use and main
demographic variables
Variables
Women not pregnant and not trying
to get pregnant (n=95)
Use of any contraceptive in the
last 12 months
Maternal age*
Pearson chi2(6) = 11.4154 Pr = 0.076
Fisher's exact = 0.043
Household Income
Pearson chi2(7) = 6.0845 Pr = 0.530
Fisher's exact = 0.619
Strengths & Limitations of the Study
• The specific focus on contraceptive use among
women living in medically underserved areas.
• Survey only captured the rate and types of
contraceptives used.
• Did not measure women’s preferences/reasons
for choosing the least effective methods.
• Small sample size
Conclusion
• Rate of contraceptive use in this study
is less than the Healthy People 2020
goal
• Nearly a third of the women in this
study were using a least effective
contraceptive method, mostly
condoms.
Nursing Implications
• Educate women about the importance of
using more effective methods
• Promote consistent use of effective
methods of contraception among both
men and women
• Discuss condom negotiation skills
Nursing Implications
• Provide referrals for low-income women to
community resources and promote access to
health insurance programs which cover
contraception.
• Tailor contraceptive counseling to meet lowincome women’s needs, and not present a
“one-size-fits-all” approach when counseling
these women.
Recommendations and Future Research
• Analysis of consistency of contraceptive use/method
switching
• Use larger sample sizes to examine contraceptive use
among low-income women from ethnic minority
groups
• Examine the impact of the affordable care act on lowincome ethnic minority women’s use of effective
contraception
e-mail: [email protected]
Questions
[email protected]