University of Wisconsin, Sewell Social Sciences, 1180 Observatory Drive Madison, Madison 4471, WI, 53706, USA.
Soc Sci Med. 2020 Dec;266:113366. doi: 10.1016/j.socscimed.2020.113366. Epub 2020 Sep 13.
Many researchers and policymakers have linked contraceptive programs to improvements in women's and children's socioeconomic outcomes. However, these studies have overlooked how socioeconomic status may be an initial driver of contraceptive choice and behavior. Here, I examine the relationship between a comprehensive measure of socioeconomic disadvantage, self-identified race, and contraceptive method selection at enrollment in a unique longitudinal study of contraceptive clients who received a new type of method at no cost. I then examine whether socioeconomic disadvantage has an association with contraceptive switching or discontinuation. I demonstrate that socioeconomic disadvantage decreases the chance of selecting any IUD, while Black racial membership increases the chance of selecting the 3-month injectable and Multiracial membership increases the chance of selecting the Vaginal Ring. I then demonstrate that socioeconomic disadvantage and self-identified race have intersectional and variable associations with switching, and, to a lesser extent, discontinuing methods. These findings offer an important insight for implementation in contraceptive programs: eliminating financial barriers to access contraceptive services does not eliminate the socioeconomic contexts that influence method selection and use that occur as part of everyday lived experiences. Taken cumulatively, these results suggest that contraceptive services should be offered to women in ways that ensure access to reproductive justice without obscuring the need for social changes in the institutions that create disadvantage and shape contraceptive use itself.
许多研究人员和政策制定者将避孕项目与妇女和儿童社会经济成果的改善联系起来。然而，这些研究忽视了社会经济地位可能是最初推动避孕选择和行为的因素。在这里，我在一项独特的纵向研究中检查了综合社会经济劣势衡量标准、自我认同的种族以及在获得免费新型避孕方法时的避孕方法选择之间的关系，该研究对接受新避孕方法的避孕客户进行了研究。然后，我检查了社会经济劣势是否与避孕方法的转换或停止使用有关。我证明社会经济劣势降低了选择任何宫内节育器的机会，而黑人种族成员增加了选择三个月注射避孕针的机会，而多种族成员增加了选择阴道环的机会。然后，我证明社会经济劣势和自我认同的种族与转换有交叉和可变的关联，并且在较小程度上与方法的停止使用有关。这些发现为避孕项目的实施提供了一个重要的见解：消除获得避孕服务的经济障碍并不能消除影响方法选择和使用的社会经济背景，这些背景是日常生活经验的一部分。综上所述，这些结果表明，应该以确保获得生殖公正的方式向妇女提供避孕服务，而不会掩盖在造成劣势的机构中进行社会变革以及塑造避孕本身使用的必要性。
