Contraception use and counseling among patients at increased risk for adverse pregnancy outcomes

Numerous studies indicate that non-White individuals and/or those who are of low socioeconomic status (SES) are preferentially prescribed long-acting reversible contraception more frequently than their white counterparts. This cohort is also more likely to have medical and obstetric complications that put them at high risk for adverse pregnancy outcomes due to the systematic racism within the medical system and its interaction with underlying conditions. Medical complications themselves may be a risk factor for contraceptive coercion. We looked to evaluate if contraceptive use and patient perception of contraceptive counseling is impacted by obstetric risk factors for adverse pregnancy outcomes, and if this varies by SES or race/ethnicity.

This is a retrospective analysis of the National Survey of Family Growth (NSFG) 2017-2019 cohort. Participants were grouped into categories of either high or low risk for adverse birth outcomes. The primary outcome was contraceptive choice. Bivariate comparison was performed using complex survey weighting. Secondary outcomes included participant ratings of provider counseling and respect. Multivariable regression was performed for use of long-acting reversible contraceptives, accounting for demographic variables that were significantly different between groups.

A total of 1655 participants met inclusion criteria for this analysis. Of these participants, 310 were at risk for adverse pregnancy outcomes as defined by study criteria. Participants at risk for adverse pregnancy outcomes were more likely to receive public assistance, have fewer years of formal education, and were less likely to report having "good" or "excellent health". There were no differences in the types of contraceptives used in the last 12 months between those at high risk for adverse pregnancy outcomes and those with low risk. Between groups, there were no differences of participant ratings of provider counseling and respect.

Participants in the NSFG reported no differences in contraceptive methods when comparing those at high risk for adverse pregnancy outcomes as compared to those with low risk.