3044 — Racial/ethnic Differences in Contraceptive Knowledge among Women Veterans

Rosenfeld EA, Postdoctoral Fellow, Women's Health, VA Pittsburgh Healthcare System; Schwarz EB, Department of Medicine, University of California, Davis; Callegari LS, Staff Gynecologist, VA Puget Sound Health Care System; Zhao X, Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System; Mor MK, Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System; Borrero S, Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System;

Objectives:
Over 50% of pregnancies in the US are unintended, with the highest rates occurring among women of color. Women of reproductive age are a growing segment of the VA population; and nearly 40% of women Veterans are women of color. The purpose of this study was to examine racial/ethnic differences in contraceptive knowledge among women Veterans.

Methods:
We analyzed preliminary data from an ongoing telephone-based survey of a national sample of 1,150 female Veterans aged 18-45 years who had received primary care within the VA Healthcare System in the 12 months prior to interview. Knowledge questions assessed women's understanding of contraceptive efficacy, safety and correct use. Multivariable logistic regression was used to examine racial/ethnic variation in contraceptive knowledge after adjusting for age, marital status, income, military branch, and education level.

Results:
In our sample, 55% were white, 29% black, and 13% Hispanic. Overall, contraceptive knowledge was low. For example, 53% of women Veterans did not know that intrauterine devices (IUDs) did not need to be replaced annually, 60% incorrectly thought it was unsafe to use birth control that caused women to skip periods, and nearly 50% overestimated the effectiveness of condoms in preventing pregnancy. In addition, black and Hispanic women had particularly low levels of knowledge about various contraceptive methods. For example, compared to whites, black and Hispanic women were less likely to know that tubal sterilization cannot be easily reversed [57% vs. 32% and 42%; aOR(95%CI):0.37(0.28-0.50) and 0.56(0.39-0.81)] and that the Nuvaring does not need to be inserted by a doctor [56% vs. 41% and 46%; aOR(95%CI):0.60(0.45-0.79) and 0.63(0.43-0.91)]. Blacks were less likely than whites to know that spermicides do not provide protection against sexually transmitted infections [88% vs. 79%; aOR(95%CI):0.58(0.40-0.84)] ,that nulliparous women can use IUDs [72% vs. 63%; aOR(95%CI):0.71(0.53-0.96)],and that IUDs do not need to be replaced yearly [52% vs. 39%; aOR(95%CI):0.65(0.49-0.86)].

Implications:
Women Veterans, especially black and Hispanic women Veterans, have low levels of knowledge about contraception.

Impacts:
There is ample opportunity to improve women Veterans' knowledge about important aspects of available contraceptive methods, which may help enhance effective contraceptive use and reduce risk for unintended pregnancy.