Date

May 2008

Document Type

Thesis

Degree Name

M.S.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Objective: To identify risk factors for contraception non-use and identify any new populations or changes in risk factors over time that explain the observed increase in sexually active, reproductive age (15-44 years) women who do not use contraception and do not desire pregnancy. Methods: Data collected by the National Survey of Family Growth in 1995 and 2002 are used to determine if demographic, socioeconomic, or family history predictors influence contraception non-use. Significant risk factors for non-use between survey periods are determined using multivariate logistic regression that is adjusted for the complex survey design. Results: An increase in contraception non-use among at risk women is observed, from 5.2% in 1995 to 7.4% in 2002 (p=<0.001). The proportion of women living in a suburban environment increased between 1995 and 2002 (30.8% to 49.0%). The significant risk factors associated with increased odds of contraception non-use, in a multivariate model controlling for the year, were identified as age 15-19 (OR 1.79 [1.39-2.30], p<0.001), non-Hispanic black ethnicity (OR 1.33 [1.04-1.71], p=0.03), high school education (OR 1.31 [1.03-1.65], p=0.03), unemployment (OR 1.18 [1.02-1.37], p=0.03), uninsurance (OR 1.26 [1.02-1.56], p=0.03), and Catholic faith (OR 1.29 [1.04-1.60], p=0.02). Three predictors were also identified in this same model as being significantly protective against non-use: cohabitating with a male partner (OR 0.57 [0.48-0.69], p<0.001), mother's age 20-24 at first birth (OR 0.79 [0.66-0.95], p=0.01), and living in a rural setting (OR 0.78 [0.62-0.98], p=0.03). Interestingly, income was not a significant predictor of non-use in the model (p=0.75). Controlling for significant predictors, at risk women are 47% more likely to be non-users in 2002 than in 1995 (OR 1.47 [1.26-1.72], p<0.001). Of the year*predictor interaction terms entered in the model, the greatest change in deviance was observed with the insurance predictor, showing that the odds of non-use was 55% greater among uninsured women in 2002 compared to 1995 (OR 1.55 [1.2-2.0], p<0.05). Conclusion: Despite the fact that a greater proportion of women in the United States are using highly-effective, female-controlled methods of contraception, there continues to be a concerning, paradoxical increase in contraception non-use among sexually active women not desiring pregnancy. This study confirmed known high-risk characteristics for women not using contraception: teens, non-Hispanic black ethnicity, high school equivalent educations only, uninsured, unemployed, and self-identifying as Catholic. Funding and legislative barriers to contraceptive access exist for women seeking care at public clinics as well as women with private insurance. The funding deficit for public clinics is represented in the greater non-use among uninsured women in 2002. A fluctuation in the geographic distribution of reproductive age women from rural to suburban areas may be a barrier to access for family planning if there are not sufficient services available in these areas. Abstinence-only education also threatens informed decision-making by women about contraceptive choice and the consequences of unprotected sex. Greater understanding of the behavioral, structural, and socio-cultural factors influencing contraception non-use is ongoing and needs to be considered along with known socio-demographic risk factors in formulating future public health and policy interventions.

Identifier

doi:10.6083/M4CJ8BFR

School

School of Medicine

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