Family Planning Service Use and Health-Literacy Needs Among Low-Income Women in the United States

Background and Purpose
Unintended pregnancy outcomes remain a persistent public health challenge in the United States, disproportionately affecting low-income and immigrant women. Yet, limited national data exist examining how nativity and income intersect to shape pregnancy wantedness. This study investigates differences in pregnancy wantedness by nativity (U.S.-born vs. foreign-born) and income status.

Methods
We analyzed data from the 2013–2019 National Survey of Family Growth (NSFG) (n = 23,079) of women aged 15–44. The primary outcome was pregnancy wantedness, categorized as mistimed, unwanted, or right-time pregnancy outcome. The key independent variables were nativity, low-income status (≤300% of the federal poverty level), and their interaction. Covariates included age, race, Hispanic ethnicity, primary language, education, insurance status, number of children, metropolitan residence, religious beliefs, and having a usual source of care. Multinomial logistic regression modelling was used to estimate relative risk ratios (RRRs) for each category of pregnancy wantedness.

Results
Foreign-born women reported significantly lower mistimed (RRR = 0.75, p < .001) and unwanted (RRR = 0.59, p < .001) pregnancy outcomes compared to U.S.-born women. However, low-income status was associated with higher risk across both mistimed (RRR = 1.2, p < .001) and unwanted (RRR = 1.7, p < .001) pregnancy outcomes. Additional predictors of higher risk for unintended pregnancy included reporting Hispanic ethnicity, speaking a language other than English, having more than one child, lower educational attainment, and reporting weaker religious affiliations were significantly associated with unintended pregnancy outcomes.

Conclusions and Implications
These findings support the need for culturally responsive and linguistically accessible reproductive health services. They also reinforce the importance of tailoring public health efforts, such as Title X-funded programs, to address structural barriers that persist for immigrant and low-income populations. Social workers are uniquely positioned to lead health literacy initiatives, advocate for policy change, and deliver culturally responsive care to reduce reproductive health disparities among marginalized populations.