EXPLORING BARRIERS TO CONTRACEPTION USE AMONG LOW-INCOME WOMEN USING THE 2016 NATIONAL INPATIENT SAMPLE DATA

Abstract

Background: There are patterns in contraceptive use among religious denominations, socioeconomic status, race, ethnicity, and many other factors. These trends in contraceptive use are due to hundreds of years of discrimination, forced sterilization, and structural racism. Contraceptive access is influenced by social determinants of health (SDoH), specifically education level, health insurance coverage, and socioeconomic status. Our study compared the odds of contraceptive use between women living in low-income and those in high-income zip codes and adjusted for key SDoH. Methods: This study used the 2016 Nationwide Inpatient Sample data from the Healthcare Cost and Utilization Project. The unweighted dataset includes over 1.3 million hospital inpatient stays by patients classified as women ages 18-44. We performed hierarchical mixed-effect logistic regression models and calculated the odds ratios and 95% confidence intervals. The models were adjusted by age, race/ethnicity, insurance type, and hospital location. Results: We identified 4,189 hospitalizations where contraceptive use was documented. We found that low-income women were 1.12 (95% CI: 1.04-1.20) times more likely to be using contraceptives than medium-income women. When adjusted by age, race/ethnicity, insurance type, and hospital location, there was no longer a difference by income level (aOR: 1.01; 95% CI: 0.93-1.09). Low-income women that self-paid for their visit (0.67; 0.55-0.81) or lived in micropolitan counties had lower odds of using contraceptives (0.74; 0.62-0.88). Conclusion: Our findings indicate that one’s ability to pay for a healthcare visit and living in rural counties seems to influence contraceptive use differences between low-income and high-income reproductive age women.