Awareness and use of contraceptive methods


Awareness of most types of birth control was generally high among both white and non-white women, according to a prospective study that examined racial differences in contraceptive awareness and use among women seeking care at family health centers.

However, the study in the Journal of Women’s Health found that awareness of all types of contraceptives was significantly higher among white compared to non-white women (P < 0.001).

Unintended pregnancies continue to account for half of all pregnancies in the United States, according to the authors, mostly due to incorrect or inconsistent use of contraception methods. And although long-acting reversible contraception (LARC) methods are safe and highly effective, they are underused, perhaps due to inadequate education, misconceptions, and cultural factors such as race, ethnicity, or religion.

The study relied on focus groups to identify recurrent themes in contraceptive choice among participants and develop a survey that was completed by non-pregnant female patients, aged 18 to 45, from seven family health centers in Western Pennsylvania. Of the 465 participants, 46.2% were non-white.

For most types of contraceptives, use was significantly higher among white women than non-white women, with the exception of injectable hormones, which were used significantly more often by non-white women: 46.0% vs. 28.5% (P < 0.001).

The reasons for using LARC did not vary by type or by race, but reasons for not using LARC varied by race and by specific method.

For instance, the most common reason for not using IUDs was fear of insertion or removal (38%), whereas for injectable hormones it was not wanting to seek care every 3 months to receive a new treatment, and for an implant it was not wanting something left in her body.

For IUD, white women were more likely than non-white women to cite fear of insertion or removal and affordability as a barrier to use vs. non-white women who frequently cited ‘‘not knowing what an IUD is’’ as a barrier.

For injectable hormones, white women more often than non-white women cited concern and inconvenience of needing treatment every 3 months as barriers to use, but non-white women more likely cited having had a ‘‘bad experience’’ with injectable hormones than white women.

White women, more often than non-white women, also cited fear of side effects, not wanting something left in her body and safety concerns about implantable hormones, while non-white women more frequently believed that implantable hormones would make it more difficult to become pregnant in the future.

After adjusting for all cultural factors, race and religious affiliation had the greatest impact on using any group of contraceptive methods.

White women were 2.12 to 2.57 times more likely to report use of short-acting, behavioral and barrier methods than non-white women.

Similarly, women reporting no religious affiliation were 2.27 to 3.48 times more likely to use short-acting, barrier or LARC methods than women who reported an affiliation with a faith tradition.

“By understanding factors that influence contraceptive awareness, use, and perceptions, clinicians can better address the contraceptive needs and concerns of their female patients,” wrote the authors.


  1. Lin C J, Maier J, Nwankwo C, et al. Awareness and use of contraceptive methods and perceptions of long-acting reversible contraception among white and non-white women. J Womens Health. Published online December 9, 2020. doi:10.1089/jwh.2020.8642
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