Stanford School of Medicine, Stanford University, Stanford, CA, United States.
Stanford School of Medicine, Stanford University, Stanford, CA, United States.
Contraception. 2021 Apr;103(4):246-254. doi: 10.1016/j.contraception.2020.12.008. Epub 2020 Dec 23.
Permanent contraception has historically been more prevalent among non-White women with lower education and income. Given increasing popularity of long-acting reversible contraception (LARC), we examine changing sociodemographic patterns of permanent contraception and LARC.
We performed a descriptive analysis of the National Survey of Family Growth (NSFG) from 2006 to 2017, with multivariable analyses of the 2006 to 2010 and 2015 to 2017 cohorts. Using multinomial logistic regression, we investigate predictors of contraceptive category (permanent contraception vs LARC, lower-efficacy contraception vs LARC) in reproductive-aged women.
Total 8161 respondents were included in 2 distinct but analogous regression analyses: (1) the most recent survey cohort, 2015 to 2017 and (2) the cohort a decade prior, 2006 to 2010. Over this period, the prevalence of LARC increased nearly 3-fold (6.2%-16.7%), while permanent contraception use trended downwards (22%-18.6%). Yet, in adjusted models, we observed little change in the sociodemographic predictors of permanent contraception: from the early to recent cohort, use of permanent contraception (vs LARC) remained less likely among college graduates (multinomial odds ratio (OR) 0.45 [95% confidence interval 0.21, 0.97]) and Hispanic women (OR 0.41 [0.21, 0.82]). In addition, high income (>$74,999) and metropolitan residence came to predict less use (OR 0.33 [0.13, 0.84] and 0.47 [0.23, 0.97]). Multiparity, advanced age (over ≥35), and marital status remained strong predictors of permanent contraception.
Although use of LARC nearly equals that of permanent contraception in the most recent NSFG survey, socioeconomic differences persist. Continued effort is needed to detect and address structural barriers to accessing the most effective forms of contraception for women.
Comparing 2006-2010 to 2015-2017, reliance on female permanent contraception decreased while LARC use increased, making prevalence more similar. However, significant socioeconomic differences persist in who chooses permanent contraception, with urban, educated, higher income women more likely to use LARC. Ongoing efforts are needed to understand and reduce economic barriers to LARC.
在接受医学专业学术文献翻译为简体中文服务时，我们发现，历史上，永久性避孕措施在受教育程度和收入较低的非白种女性中更为普遍。鉴于长效可逆避孕（LARC）越来越受欢迎，我们研究了永久性避孕和 LARC 的社会人口统计学模式的变化。
我们对 2006 年至 2017 年的全国家庭增长调查（NSFG）进行了描述性分析，并对 2006 年至 2010 年和 2015 年至 2017 年的队列进行了多变量分析。使用多项逻辑回归，我们调查了生殖年龄妇女中避孕类别的预测因素（永久性避孕与 LARC、低效能避孕与 LARC）。
在两个不同但类似的回归分析中，共有 8161 名受访者被纳入：（1）最近的调查队列，2015 年至 2017 年；（2）十年前的队列，2006 年至 2010 年。在此期间，LARC 的使用率几乎增加了两倍（6.2%-16.7%），而永久性避孕的使用率呈下降趋势（22%-18.6%）。然而，在调整后的模型中，我们观察到永久性避孕的社会人口统计学预测因素几乎没有变化：从早期到近期队列，大学毕业的女性（多项优势比（OR）0.45 [95%置信区间 0.21，0.97]）和西班牙裔女性（OR 0.41 [0.21，0.82]）使用永久性避孕的可能性较小。此外，高收入（>$74999）和大都市居住成为使用较少的预测因素（OR 0.33 [0.13，0.84]和 0.47 [0.23，0.97]）。多胎、高龄（≥35 岁）和婚姻状况仍然是永久性避孕的强有力预测因素。
尽管在最近的 NSFG 调查中，LARC 的使用率与永久性避孕相当，但仍存在社会经济差异。需要继续努力发现和解决妇女获得最有效避孕措施的结构性障碍。
将 2006-2010 年与 2015-2017 年进行比较，永久性避孕的依赖减少，而 LARC 的使用增加，使流行率更为相似。然而，在选择永久性避孕的人群中，仍然存在显著的社会经济差异，城市、受过教育、高收入的女性更有可能使用 LARC。需要继续努力了解和减少 LARC 的经济障碍。
