Reproductive Health Disparities: Does Immigration Status Predict a Difference in Coverage and Use of Contraceptives?

Background and Purpose: While the importance of contraception in preventing unintended pregnancies has been reported in numerous studies, evidence on immigrant women’s contraceptive behaviors is unassertive and conflicting. Literature suggests that foreign-born women have a “health advantage” compared to U.S.-born women, specifically related to better maternal outcomes. At the same time, certain factors, such as lower rates of health insurance coverage, restrict immigrant women’s access to healthcare services. The impact of these factors on immigrant women’s reproductive health behaviors, such as contraceptive use, has not been well-documented. Despite the growing body of evidence on the prevalence of contraceptive use among U.S-born women, the literature is fragmented, limited, and sparse on trends in contraceptive utilization among foreign-born women. This study will focus on analyzing contraceptive use among immigrant women in the U.S. and how these associations vary by marital status.

Methods: Generated from the 2015-2017 National Survey of Family Growth (NSFG), the sample consists of women at risk of unintended pregnancy between the ages of 15 and 44; women at risk are those that are sexually active with men, not pregnant or seeking to become pregnant, and not clinically sterile (N = 2,979). We examined the likelihood of immigrant and U.S.-born women to utilize contraceptive methods of varying effectiveness [0= no method, 1=low effectiveness, 2=moderate effectiveness, 3=high effectiveness]. A series of ordinal logit and logit regression models were analyzed controlling for socio-demographic factors such as age, parity, place of residence, health insurance coverage, and marital status.

Results: Differences in contraceptive use persisted in analyses after controlling for socioeconomic and demographic characteristics. Immigrant women were less likely to use highly effective contraceptive methods [OR:0.62, p<0.001] or any other contraceptive methods (OR: 0.73, p < 0.005) compared to U.S. born women. Our analysis reveals that the association between women’s marital status and their use of highly effective contraceptive methods is significant (p<0.001); however, this effect was not significant for other contraceptive methods of lower effectiveness (p>0.05). Women are more likely to utilize contraceptives in the presence of a health insurance coverage (OR: 1.3; p<0.01) compared to women who were not using any methods; however, this association was not found to be significantly associated with immigration status or highly effective contraceptive methods.

Conclusion and Implications: Immigrant women use contraceptive methods at lower rates than U.S.-born women. The associations between immigration and the use of contraceptive methods vary by marital status. The complex relationships among contraceptive methods, immigration, and marital status may be further complicated by accessibility to health care, reproductive knowledge, and family planning decisions. Reducing unintended pregnancy rates requires a greater understanding of fundamental socioeconomic inequities affecting contraceptive behaviors. Further research exploring ethnic differences contributing to variance in contraceptive use is critical to improving the reproductive outcomes and quality of life among foreign-born women.