Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 16:26:e44.
doi: 10.1017/S1463423625000325.

Social determinants of health and family planning: impact of food and financial insecurity on contraceptive use and pregnancy intention

Breanna Sharp  1 , Covenant Elenwo  1 , Jordan Lowrimore  1 , Caroline Markey  2   3 , Micah Hartwell  1   4
Affiliations

Social determinants of health and family planning: impact of food and financial insecurity on contraceptive use and pregnancy intention

Breanna Sharp et al. Prim Health Care Res Dev. .

Abstract

Aim: In the United States, roughly one million pregnancies occur every year from the misuse and discontinuation of oral contraceptives - which may be affected by an individual's exposure to social determinants of health (SDOH). For those experiencing poorer SDOH, significant barriers may exist when family planning. Thus, our primary objective is to examine associations between domains of SDOH and contraceptive use as well as pregnancy intention using the Behavior Risk Factor Surveillance System (BRFSS).

Methods: A cross-sectional analysis of 2017 BRFSS was conducted using the SDOH module to examine differences in family planning. We used bivariate and multivariable logistic regression models to measure associations, via odd ratios, between SDOHs and contraceptive use and pregnancy intention controlling for other sociodemographic variables.

Results: We found that individuals experiencing negative SDOH who reported running out of food (AOR: 0.65; CI: 0.50-0.86), were unable to afford balanced meals (AOR: 0.64; CI:0.49-0.84), or had no money left at the end of the month (AOR: 0.45; CI: 0.32-0.64) were less likely to have used contraceptive methods compared to those not experiencing challenges within these SDOH domains. Among women not utilizing contraceptive methods, individuals not intending to get pregnant were more likely to report difficulty affording balanced meals or having financial stability compared to women attempting to become pregnant.

Conclusions: Our study found that the SDOH domains of monthly financial instability and food insecurity are significantly associated with women not using contraceptive measures but not wanting to become pregnant. Addressing barriers to contraceptive access and FP is becoming more important with shifting policies regarding women's reproductive healthcare. For women seeking contraceptive and FP advice, increased funding may help provide a solution.

Keywords: SDOH; contraceptive use; family planning; financial instability; food insecurity; pregnancy intention.

PubMed Disclaimer

Conflict of interest statement

Dr. Hartwell receives research support through the National Institutes for Justice unrelated to the current work and the Health Resources Services Administration.

References

    1. About BRFSS (2019. a). Available at: https://www.cdc.gov/brfss/about/index.htm (accessed 13 June 2022).
    1. Amjad S, MacDonald I, Chambers T, et al. (2019) Social determinants of health and adverse maternal and birth outcomes in adolescent pregnancies: a systematic review and meta-analysis. Paediatric and Perinatal Epidemiology 33 (1). Paediatr Perinat Epidemiol. DOI: 10.1111/ppe.12529. - DOI - PubMed
    1. Attacks on Access to Care at Planned Parenthood (2023). Available at: https://www.plannedparenthoodaction.org/issues/attacks-access-planned-pa... (accessed 28 July 2022).
    1. Behavioral Risk Factor Surveillance System (2021). Available at: https://www.healthypeople.gov/2020/data-source/behavioral-risk-factor-su... (accessed 13 June 2022).
    1. Black KI, Gupta S, Rassi A, et al. (2010) Why do women experience untimed pregnancies? areview of contraceptive failure rates. Best Practice & Research. Clinical Obstetrics & Gynaecology 24 (4), 443–455. - PubMed