The October issue of the American Journal of Obstetrics and Gynecology includes a study conducted by the University of California, San Francisco, examining contraceptive recommendations based on race and socioeconomic status factors. The study found that health care providers recommend IUDs--one of the longest-acting and most effective methods of birth control available today--less frequently to poor white women than to other groups of women.
In other words, clinicians' recommendations for IUDs were affected by both the patient's class and her race/ethnicity. For example:
- Clinicians were less likely to recommend IUDs to white women of low socioeconomic status than to white women of high socioeconomic status.
- Socioeconomic status had no significant effect on recommendations for IUDs for Latinas and black women.
- But when the researchers evaluated the groups by race/ethnicity, clinicians were more likely to recommend IUDs to Latinas and black women of low socioeconomic status than to white women of low socioeconomic status.
Previous research on the effect of patient race/ethnicity and class on clinicians' recommendations has focused on patient-provider interactions involving medical decisions about diseases, such as coronary artery disease, for which there is general consensus about appropriate treatments. Decisions about family planning are obviously a different animal altogether. The most effective option will depend not on race or socioeconomic status, but on the patient herself--is she comfortable with the IUD as a birth control method? Does she use condoms to prevent STIs? Is there another long-acting method (Implanon or Depo, for example) more appropriate for her lifestyle? These are obviously factors that cannot be sussed out without a detailed conversation between provider and patient.
The bottom line is that access to contraception--particularly contraception as effective as the IUD--should never come down to race, ethnicity, or socioeconomic status. In fact, according to another Pregnant Pause post by my colleague Lisa Shuger, "nearly three-fourths of American voters (71 percent) believe insurers should be required to fully cover the birth control pill and other forms of prescription contraception as they will be required to do for other preventive health care services under the new health care reform law" (read the full post here). In other words, of the million factors that go into choosing a method of birth control, cost shouldn't be one of them.
Jody Steinauer, senior study author and associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences sums it up nicely: "This is an especially important area of research given the high rate of unintended pregnancy in the US. It is critical that we provide comprehensive contraceptive counseling and equitable access to highly effective long-acting reversible contraceptives such as the IUD to all women."