Contraceptive Use by Women Across Multiple Components of Sexual Orientation: Findings from the 2011-2017 National Survey of Family Growth

Intrauterine device experience in lesbian, gay, bisexual, queer, pansexual, and asexual cisgender women

Providers should not overlook counseling LGBQPA cisgender women about the benefits of an IUD given their risk of unplanned pregnancy and desire for menstrual suppression.

Measurement and Operationalization of the Social Determinants of Health and Long-Acting Reversible Contraception Use in the U.S.: A Systematic Scoping Review

Introduction

The objective of this review was to conduct a systematic evaluation of the measurement and operationalization of the social determinants of health in research on long-acting reversible contraception use in the U.S. To contribute to the ongoing refinement of the quality of social determinants of health and long-acting reversible contraception use research, this systematic scoping review examines how social determinants of health are measured and operationalized in studies that examine long-acting reversible contraception initiation and usage at the patient level.

Methods

A detailed search of 5 electronic databases (PubMed, Embase, Web of Science, CINAHL, and PsycINFO) was conducted between December 2020 and January 2021 according to PRISMA guidelines. Determinants were assessed using the Dahlgren and Whitehead model. The protocol and data extraction template were developed a priori.

Results

A total of 27 articles representing 26 studies were included in our study. A total of 12 studies were retrospective and cross-sectional in design; the remaining studies were a combination of designs. Healthcare services and health insurance were identified as the most frequently researched categories of determinants. There was wide variation in reported operationalization of race and ethnicity, limited engagement with sexuality, and uneven geographic representation across studies.

Discussion

This systematic scoping review is the first, to the best of our knowledge, to focus on the measurement and operationalization of social determinants of health and on current long-acting reversible contraception use research. Future research on the impact of social determinants of health on long-acting reversible contraception use must explore the full range of factors shaping contraceptive decision making and use and focus on equity-informed data collection methods and reporting.

An intersectional analysis of contraceptive types chosen among sexual minority women: A nationally representative study

OBJECTIVE

The purpose of this study is to use an intersectional approach in which race, insurance, care setting, and disclosure of sexual orientation to a provider are used to assess patterns of contraceptive use in sexual minority women.

STUDY DESIGN

This study analyzes cross-sectional data from the 2011-2019 National Survey of Family Growth (NSFG). Sexual orientation of 21,075 respondents' data was used to investigate contraceptive use in sexual minority women, specifically lesbian and bisexual women, as compared to heterosexual women, controlling for variables such as race, age, and socioeconomic factors.

RESULTS

Black and Hispanic lesbian women (adjusted odds ratio [aOR] = 0.39 confidence interval [CI] 0.20-0.76 and aOR = 0.44 CI 0.23-0.82, respectively) and Hispanic and Other Race bisexual women use hormonal contraceptive methods less than their White lesbian and bisexual peers (aOR = 0.45 CI 0.29-0.69 and aOR = 0.43 CI 0.20-0.94). Care setting was not correlated with long-acting reversible contraceptive methods (LARC; such as intra-uterine device, hormonal implants) or prescription-based hormonal methods (such as oral contraceptive pills, injectables, vaginal rings, and patches) in lesbian women (aOR = 2.92 CI 0.60-14.2 and aOR = 1.43 CI 0.47-4.38, respectively) or bisexual women (aOR = 0.90 CI 0.48-1.58 and aOR = 0.83 CI 0.37-1.86), but it was for straight women (aOR = 1.28 CI 1.03-1.59 and aOR = 0.68 CI 0.53-0.86). Similarly, insurance status did not correlate with contraceptive patterns in sexual minority women. Importantly, adjusting for nationally representative data did not impact the results; in other words, the odds ratios after adjusting yielded the same results as before adjustment.

CONCLUSIONS

Insurance and care setting are important determinants of straight women's contraceptive use patterns with fewer effects seen among sexual minority women. These findings support previous work and indicate that known advantages of insurance coverage or use of public clinics may not positively impact sexual minority women as much as they do straight women. Provider awareness of sexual identity and sexual orientation is important for adequate contraceptive care.

IMPLICATIONS

While prior research has presented findings on sexual minority women contraceptive use, to our knowledge there are limited studies that address the social and demographic implications for contraceptive use in this population.

Factors Influencing Contraceptive Use Among Sexually Active U.S. Middle and High School Students, 2015 to 2019

Objective The objective of this study is to see whether factors including the age of first sexual intercourse, sexual orientation, age at the time of survey administration, race/ethnicity, and sex affect condom and other types of contraceptive usage among United States middle and high school students. Methods We analyzed data from the Centers for Disease Control's Youth Risk Behavior Surveys from the years 2015 to 2019. Students were asked questions about condom and specific type of contraceptive use (e.g. birth control pills, intrauterine device/implant, shot/patch/ring, withdrawal), age of first sexual intercourse, and sexual orientation, as well as demographic questions. Using a logistic regression model, we tested the linear effects on condom and contraception investigated variables. Results Differing sexual orientations had a significant relationship with both condom and contraceptive usage, with those who identified as lesbian or gay being least likely to use contraception as opposed to those who identified as straight, bisexual, or unsure. Female participants were 31.6% less likely to use contraception overall and 41.7% less likely to use condoms in comparison to male participants. With a one-year increase in the age of first sexual intercourse, contraceptive use overall increased by 23% and condom use specifically increased by 17%. With a one-year increase in a participant's age at the time of survey administration, contraceptive use decreased by 7.4% and condom use decreased by 21%. Between the years 2015 to 2019, there was an average decrease of 5.3% in the usage of condoms. Conclusion We found significant differences in contraceptive and/or condom usage between students of different sexual orientations, sex, age of first sexual intercourse, age at the time of survey administration, and between different years studied. These differences could be attributed to differences in sex education, cultural background, and availability of resources. Further investigations should be conducted to delineate these differences.