Associations between state abortion restrictions and contraceptive use among US-born and foreign-born women

Abortion restrictions undermine safe abortion, pregnancy care, and other reproductive health (RH) services, including contraceptive access. Foreign-born women may be particularly vulnerable, but there is limited information on this population. We examined associations between state abortion restrictions and contraceptive method use among US women, and assessed these differences by nativity.

Data were from a cross-sectional RH survey of 657 women. Analysis was limited to 562 non-pregnant, sexually active women with complete data on state of residence, nativity, and contraceptive use. Multinomial regression models estimated associations between state abortion restrictions and contraceptive use, in pooled and nativity-stratified analyses, adjusted for sociodemographic factors.

Women living in restrictive states were more likely to use permanent/LARC (RR=1.95, 95% CI:1.07-4.12), short-acting/hormonal (RR=2.40, 95% CI:1.09-6.75), and "other" methods (RR=2.75, 95% CI:1.49-5.17) compared to those in protective states. In nativity-stratified analyses, US-born women living in abortion restrictive states were more likely to use permanent/LARC methods (RR=1.43, 95% CI:1.08-2.94), and less likely to use short-acting/hormonal methods (RR=0.63, 95% CI:0.49-0.95) compared to those living in abortion protective states. Foreign-born women living in restrictive states were more likely to use "other" contraceptive methods (RR=5.50, 95% CI:2.16-11.00), and less likely to use permanent/LARC (RR=0.78, 95% CI:0.24-0.95) and short-acting/hormonal (RR=0.54, 95% CI:0.02-0.86) methods, compared to those living in protective states.

Abortion restrictions exacerbate contraceptive access disparities, disproportionately impacting foreign-born women. Addressing these disparities is crucial for mitigating the impacts of abortion restrictions on at-risk populations and ensuring equitable access to reproductive healthcare.