Department of Obstetrics and Gynecology, Washington University in St. Louis, School of Medicine, St. Louis, MO 63110, USA.
Contraception. 2011 Sep;84(3):273-9. doi: 10.1016/j.contraception.2011.01.004. Epub 2011 Feb 21.
The study was conducted to determine whether perceived racial, economic and gender discrimination has an impact on contraception use and choice of method.
We analyzed the first 2,500 women aged 14-45 years enrolled in the Contraceptive CHOICE Project, a prospective cohort study aimed to reduce barriers to obtaining long-acting reversible contraception. Items from the "Experiences of Discrimination" (EOD) scale measured experienced race-, gender- and economic-based discrimination.
Overall, 57% of women reported a history of discrimination. Thirty-three percent reported gender- or race-based discrimination, and 24% reported discrimination attributed to socioeconomic status (SES). Prior to study enrollment, women reporting discrimination were more likely to report any contraception use (61% vs. 52%, p<.001) but were more likely to use less effective methods (e.g., barrier methods, natural family planning or withdrawal; 41% vs. 32%, p<.001). In adjusted analyses, gender-, race- or SES-based discrimination were associated with increased current use of less effective methods [adjusted risk ratio (aRR) 1.22, 95% confidence interval (CI) 1.06-1.41; aRR 1.25, CI 1.08-1.45; aRR 1.23, CI 1.06-1.43, respectively]. After enrollment, 66% of women with a history of experience of discrimination chose a long-acting reversible contraceptive method (intrauterine device or implantable) and 35% chose a depo-medroxyprogesterone acetate or contraceptive pill, patch or ring.
Discrimination negatively impacts a woman's use of contraception. However, after financial and structural barriers to contraceptive use were eliminated, women with EOD overwhelmingly selected effective methods of contraception. Future interventions to improve access and utilization of contraception should focus on eliminating barriers and targeting interventions that encompass race-, gender- and economic-based discrimination.
本研究旨在探讨感知到的种族、经济和性别歧视是否会影响避孕措施的使用和方法选择。
我们分析了“避孕选择项目”中前 2500 名年龄在 14-45 岁的女性，该项目旨在减少获得长效可逆避孕措施的障碍。“歧视经历”（EOD）量表中的项目衡量了经历的基于种族、性别和经济的歧视。
总体而言，57%的女性报告有歧视经历。33%的女性报告了基于性别或种族的歧视，24%的女性报告了归因于社会经济地位（SES）的歧视。在研究入组前，报告歧视的女性更有可能报告使用任何避孕措施（61% vs. 52%，p<.001），但更有可能使用效果较差的方法（如屏障方法、自然计划生育或退出；41% vs. 32%，p<.001）。在调整分析中，基于性别、种族或 SES 的歧视与当前使用效果较差的方法的风险增加相关[调整后的风险比（aRR）1.22，95%置信区间（CI）1.06-1.41；aRR 1.25，CI 1.08-1.45；aRR 1.23，CI 1.06-1.43]。入组后，66%有歧视经历的女性选择了长效可逆避孕方法（宫内节育器或植入物），35%选择了醋酸甲羟孕酮避孕针或避孕药、贴剂或环。
歧视对女性的避孕措施使用产生负面影响。然而，在消除了避孕使用的经济和结构性障碍后，经历 EOD 的女性绝大多数选择了有效的避孕方法。未来改善避孕措施获取和利用的干预措施应侧重于消除障碍，并针对基于种族、性别和经济的歧视进行干预。
