Contraceptive care experiences and preferences among Black women in Mississippi: A qualitative study.

OBJECTIVES

Sexual and reproductive health (SRH) equity requires engagement with anti-Black racism's impact on contraceptive care experiences, and prioritization of Black women's needs in program and policy design. To date, such efforts have been limited. We explored contraceptive care experiences and preferences of Black women in Mississippi.

STUDY DESIGN

We conducted 34 in-depth interviews and 6 focus group discussions (with a total of 35 participants) with adult Black women who had used contraception in the last 2 years. We recruited in community settings throughout Mississippi and used the Person-Centered Contraceptive Care Framework as a guide to explore experiences and preferences. We applied the 4 Person-Centered Contraceptive Care Framework elements - Outreach and trust building, Access, Quality, and Follow-up support - to identify and interpret themes.

RESULTS

Schools and churches as sources of support for adolescent SRH was the most salient theme within Outreach and trust building. Cost and difficulties obtaining appointments without private insurance were identified as barriers to Access. The need for more comprehensive contraceptive counseling, including side effect information, and the experience of racism and other discrimination by providers and clinic staff emerged as prominent themes around Quality. Finally, desire for more proactive clinical outreach and respect for discontinuation emerged related to Follow-up support.

CONCLUSIONS

Barriers and facilitators to high quality contraceptive care and information identified among Black women in this study offer insights for interventions to improve access to high quality contraceptive care and address historical and ongoing inequities.

IMPLICATIONS

In an era of increasing prioritization of person-centeredness and equity in contraceptive access efforts, our findings suggest the critical need to expand information and support through churches and schools, develop an anti-racist, trustworthy health care workforce, improve counseling, and address appointment and follow-up care barriers.