Socioeconomic status and discontinuation of long-acting reversible contraception in a population-based cohort study

To examine the association between socioeconomic status (SES) on long-acting reversible contraception (LARC) discontinuation.

We analyzed a national cohort of women born between 1980-1984 in the National Longitudinal Survey of Youth (NLSY97). We used 2005-2021 NSLY97 cycles, including the first cycle respondents were ≥18 years, sexually active, and using LARC. Respondents were tracked until they either reported using non-LARC contraception, were not using any contraceptives, became pregnant, or were lost to follow-up. SES characteristics were ascertained at respondents' first eligible cycle, including: Family income relative to the Federal Poverty Level (FPL), insurance, education, and employment. LARC discontinuation was categorized as stopping contraception, switching to non-LARC contraception, pregnancy, or continuing LARC throughout the study. Mixed-effects multinomial logistic regression with cluster-robust standard errors modeled continued LARC use as a function of SES.

Our cohort contained 435 women contributing 893 interviews. At the last interview, 23% of respondents still used LARC, 19% stopped contraception, 20% switched to another contraceptive, and 38% became pregnant. On multivariable regression, respondents between 300-399% FPL had an increased likelihood of stopping LARC (relative risk ratio [RRR]: 7.65; 95% confidence interval [CI]: 1.72, 33.93; p=0.007) while respondents between 100-199% FPL had a decreased likelihood of becoming pregnant (RRR: 0.28; 95% CI: 0.13, 0.61; p=0.001). There were no other significant associations between SES and LARC discontinuation.

Our analysis found no consistent relationship between SES and LARC discontinuation. While SES may influence the decision to initiate LARC, SES may not influence the decision to discontinue LARC.