Differences in Contraceptive Discontinuation Among Black and White Women: Evidence from the Contraceptive CHOICE Project

Abstract

Objective: We sought to evaluate whether differences in rates of contraceptive discontinuation exist among black and white women receiving contraceptive counseling and no-cost contraception among users of long-acting reversible contraceptive (LARC; intrauterine devices or subdermal implant) and non-LARC (oral contraceptive pills, contraceptive vaginal ring, patch, or injection) methods.

Materials and methods: We analyzed data from a prospective cohort study of 7546 non-Hispanic black and white women who participated in the Contraceptive CHOICE Project. Among women who initiated their method within 12 weeks of enrollment, discontinuation was defined as any break in use longer than 1 month. Using Cox proportional hazards regression analysis, we estimated discontinuation stratified by use of LARC methods.

Results: There were no statistically significant differences in contraceptive discontinuation between black and white women at 12, 24, or 36 months among both LARC [12-month adjusted hazard ratio (HR_adj-12M) 1.01 (95% confidence interval or 95% CI 0.86-1.18); HR_adj-24M 1.10 (95% CI 0.97-1.24); and HR_adj-36M 1.10 (95% CI 0.98-1.23)] and non-LARC users [HR_adj-12M 1.08 (95% CI 0.92, 1.26); HR_adj-24M 1.07 (95% CI 0.94, 1.23); and HR_adj-36M 1.08 (95% CI 0.95, 1.23)] adjusting for confounders. Secondary analyses found no significant differences in discontinuation of LARC and non-LARC methods among black and white women at highest risk of pregnancy or those receiving public assistance at baseline.

Conclusions: At 12, 24, and 36 months there were no differences in contraceptive discontinuation of both LARC methods and non-LARC methods when comparing white and black women.

Keywords: discontinuation; family planning; long-acting reversible contraception; race.