Reducing Racial Disparities in the US by Increasing Contraception Coverage

On October 6, the Trump Administration rolled back the federal requirement that all employers must include birth control coverage in their health insurance plans. As a result, some employees will be asked to pay for contraceptives on their own. By making contraceptives less affordable and accessible, this policy decision may lead to significant negative consequences for millions of women across the country. In particular, it may have a disproportionately negative impact on poor women and women of color. A recently published review by Andrea Jackson, Lin-Fan Wang, and Jessica Morse outlines disparities in the accessibility and use of contraception among white, Latina, and black women. Additionally, they examined the relationships between contraception use, unintended pregnancies, and health outcomes for both mothers and their children.

The authors note that unintended pregnancy—a mistimed pregnancy that is usually a result of non-use or failure of contraceptives—is more common among black women. The rate of unintended pregnancy among black women is almost two and a half times higher than it is among white women, even after controlling for differences in income level. The unintended pregnancy rate among poor black women is even higher—triple the national average. The authors note that pregnancy intention is associated with childbirth outcomes. As a recent Essence article highlights, the United States is the only industrialized country with increasing rates of maternal mortality, and these rates are alarmingly high among black women. The power to better plan a pregnancy with the use of contraceptives could help curb this trend.

According to data that the authors collected between 2011 and 2013, 65 percent of white women surveyed were using contraceptives, compared to only 58 percent of black and Latina women. There was also a notable difference in the use of long-acting reversible contraceptives (LARC), which are known to be the most effective forms of reversible birth control on the market. While 9 percent of Latina women and 7 percent of white women were using LARC methods, only 5 percent of black women were using this more effective method of birth control. The most common LARC method, an intrauterine device (IUD), can cost up to $1,300 and require an office visit and a prescription. Limiting contraceptive coverage in health insurance plans will only make it more difficult for low-income women to access this more effective form of birth control.

Although cost can be a significant barrier to contraceptive use, especially when it is not covered by health insurance, it is not the only barrier. The authors carefully outline alternate explanations for the failure and misuse of birth control. Low-income women, for example, may find it financially unsustainable to become a parent in a long-term relationship and, therefore, planning a pregnancy is infeasible. Structural and historical racism also play a role, as black women tend to be less trusting toward contraceptives because sterilization has been used as a tool by the U.S. government to decrease reproduction among women of color. Financial, cultural, and structural barriers to contraceptive use have led to a state of reproductive inequality in which low-income women and women of color have unequal access to the tools that would enable them to better plan for pregnancy and to experience better outcomes for both mothers and children.

In the United States, black mothers experience higher rates of pre-term birth, fetal loss, and maternal morbidity, while Latina women experience high rates of neural tube defects, obesity, and diabetes—key indicators of negative birth outcomes. When women are not equipped with the tools to plan for and control their pregnancies, they are less likely to experience positive birth outcomes. While expanding access to effective contraceptives will not address the core issue of reproductive inequality, it is most certainly an important first step in improving birth outcomes of black and Latina women.

Article source: Jackson, Andrea V., Lin-Fan Wang, and Jessica Morse. “Racial and ethnic differences in contraception use and obstetric outcomes: A review.” Seminars in Perinatology 41, No. 5. (2017): 273-77.

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