Milkowski Carly M, Ziller Erika C, Ahrens Katherine A
Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, ME, United States.
Contracept X. 2021 Feb 8;3:100061. doi: 10.1016/j.conx.2021.100061. eCollection 2021.
To estimate differences in emergency contraception (EC) use, access, and counseling by rural-urban residence among reproductive age women in the United States.
We examined respondent data (2006-2017) from the National Survey of Family Growth for women ages 15-44 ( 28,448) to estimate EC use, access, and counseling by rural-urban county of residence. Rural-urban prevalence ratios for EC outcome measures were estimated using predicted margins from logistic regression models, which were adjusted for demographic differences and current contraceptive method use. Changes in ever-use of EC over time were estimated for rural and urban respondents, separately, using Chi-square tests and trends were estimated using inverse variance weighted linear regression models.
During 2006 to 2017, 10% of rural and 19% of urban women who had ever had sex reported ever using EC pills. Among rural women, ever-use increased from 6% in 2006-2008 to 15% in 2015-2017 (Chi-square 0.01; trend -value < 0.01); among urban women, ever-use increased from 11% to 27% (Chi-square 0.01; trend -value < 0.01). Rural and urban women were similarly likely to have obtained EC without a prescription and from a drug store. Rural women were less likely to have received EC counseling than urban women; however, counseling rates were low among all women.
We observed differences in EC ever-use and receipt of EC counseling by rural-urban residence among US women ages 15 to 44, adding to the evidence that rural-urban residence is an important factor in reproductive health. More research is needed to explore factors contributing to rural-urban differences in EC use.
Our key finding that EC use varied by rural-urban county residence offers additional evidence that rural-urban residence should be considered in reproductive health practice and policy. We discuss areas for future research into potential barriers to EC use in rural populations.
评估美国城乡育龄女性在紧急避孕（EC）的使用、获取及咨询方面的差异。
我们分析了全国生育状况调查（2006 - 2017年）中15 - 44岁女性（28448人）的应答者数据，以评估按城乡居住县划分的紧急避孕使用、获取及咨询情况。紧急避孕结果指标的城乡患病率比值通过逻辑回归模型的预测边际进行估计，并针对人口统计学差异和当前避孕方法的使用进行了调整。分别使用卡方检验估计农村和城市应答者随时间推移紧急避孕使用情况的变化，并使用逆方差加权线性回归模型估计趋势。
在2006年至2017年期间，有过性行为的农村女性中有10%报告曾使用过紧急避孕药，城市女性中有19%。在农村女性中，曾使用比例从2006 - 2008年的6%增至2015 - 2017年的15%（卡方值=0.01；趋势值<0.01）；在城市女性中，曾使用比例从11%增至27%（卡方值=0.01；趋势值<0.01）。农村和城市女性在无需处方从药店获取紧急避孕方面可能性相似。农村女性接受紧急避孕咨询的可能性低于城市女性；然而，所有女性的咨询率都较低。
我们观察到15至44岁美国女性在紧急避孕的使用及咨询接受情况上存在城乡差异，这进一步证明城乡居住情况是生殖健康的一个重要因素。需要更多研究来探索导致城乡紧急避孕使用差异的因素。
我们的关键发现是紧急避孕使用因城乡居住县而异，这为生殖健康实践和政策中应考虑城乡居住情况提供了更多证据。我们讨论了未来针对农村人群紧急避孕使用潜在障碍的研究领域。
