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2019 HSR&D/QUERI National Conference Abstract

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4053 — Racial and ethnic differences in women Veterans' history of unintended pregnancy and contraceptive use

Lead/Presenter: Deirdre Quinn,  COIN - Pittsburgh/Philadelphia
All Authors: Quinn DA (Center for Health Equity Research and Promotion, Pittsburgh), Sileanu, FE (Center for Health Equity Research and Promotion, Pittsburgh), Zhao, X (Center for Health Equity Research and Promotion, Pittsburgh) Mor, MK (Center for Health Equity Research and Promotion, Pittsburgh) Judge-Golden, C (University of Pittsburgh School of Medicine) Callegari, LS (Health Services Research and Development, VA Puget Sound Health Care System; Department of Obstetrics & Gynecology, University of Washington School of Medicine) Borrero, S (Center for Health Equity Research and Promotion, Pittsburgh; Center for Research on Health Care, University of Pittsburgh School of Medicine)

Objectives:
Nearly half of all pregnancies in the United States each year are unintended, with the highest rates observed among non-Hispanic black and Hispanic women. This study's objective is to improve our understanding of variations in unintended pregnancy and contraceptive use among women Veterans across racial and ethnic groups.

Methods:
Data were collected via a telephone-based, cross-sectional survey of a national random sample of women Veteran VA users (n = 2302) ages 18-44 who had accessed VA primary care in the previous 12 months. We assessed any history of unintended pregnancy (pregnancies reported as either ‘unwanted' or having occurred ‘too soon') in the full cohort. Use of prescription contraception at last sex was assessed in the subset of women (n = 1341) identified as being at risk for unintended pregnancy (sexually active with a male partner in the past year; no history of hysterectomy or infertility; not pregnant, within 6 weeks postpartum, or currently trying to get pregnant). Prescription contraceptive methods include long-acting reversible contraception (LARC; i.e. intrauterine devices (IUDs) and subdermal implants), hormonal methods (pill, patch, ring, and injection), and female or male sterilization. Multivariable logistic regression models were used to assess the adjusted association between race/ethnicity and the outcomes of interest, controlling for age, marital status, education, income, parity, non-VA insurance, and history of medical or mental illness.

Results:
In the full cohort of 2,302 women, the experience of unintended pregnancy was common across racial and ethnic groups - 66.8% of non-Hispanic black women, 60.0% of Hispanic women, and 50.8% of non-Hispanic white women had any history of unintended pregnancy (p < 0.001). In adjusted models, Hispanic women (aOR = 1.60, 95%CI:1.15,2.21) and non-Hispanic black women (aOR = 1.84, 95%CI:1.44,2.36) were significantly more likely than non-Hispanic white women to have any history of unintended pregnancy. In the subcohort of 1341 women at risk of unintended pregnancy, Hispanic women (aOR = 0.51, 95%CI:0.35,0.75) and non-Hispanic black women (aOR = 0.69, 95%CI:0.51,0.95) were significantly less likely than non-Hispanic white women to have used prescription contraception at last sex.

Implications:
Significant racial and ethnic differences exist in unintended pregnancy and contraceptive use among women Veterans using VA care.

Impacts:
Additional research is needed to elucidate underlying mechanisms for these observed differences to inform interventions that can address potential disparities and ensure equitable reproductive health services in VA.