Racial/Ethnic and Socioeconomic Disparities of Contraceptive Preference-Use Match in the United States

To examine factors associated with a contraceptive preference-use match, defined as alignment between an individual's stated contraceptive preference and actual use, in the USA, with a focus on disparities across demographic and socioeconomic groups.

The population-based study used the 2022 Behavioral Risk Factor Surveillance System (BRFSS). The key outcome was a match between contraceptive preference and actual use. Independent variables included demographic, socioeconomic, and health-related characteristics. Multivariable logistic regression was performed to investigate significant factors associated with contraceptive matches.

Of a total of 12,154 participants, the most preferred contraceptive method was short-acting reversible contraception (SAC) (29.5%), followed by long-acting reversible contraception (LARC) (25.0%), permanent (19.1%), and other/barrier methods (17.4%). Approximately 81.0% of participants were contraceptive users, and the overall contraceptive preference-use match was 45.8%. LARC showed the highest match rate (49.0%), followed by other/barriers (46.7%), SAC (38.3%), and permanent methods (33.7%). While Black individuals had a higher match rate with permanent methods (OR 1.83), they had a lower match rate with LARC (OR 0.65) and SAC (OR 0.42). In contrast, participants aged 40-44 years had 1.61 times greater odds of LARC matches. Individuals with higher education levels also showed a greater match than those with less than a high school diploma.

Findings highlight that racial/ethnic minorities and individuals with low socioeconomic status (SES) experience a lower preference-use match of LARC and SAC, while individuals with low SES show greater matches for other/barrier methods. Addressing these disparities may enhance reproductive autonomy and equitable access to contraceptives.