Review
General gynecology
Disparities in family planning

https://doi.org/10.1016/j.ajog.2009.08.022Get rights and content

Prominent racial/ethnic and socioeconomic disparities in rates of unintended pregnancy, abortion, and unintended births exist in the United States. These disparities can contribute to the cycle of disadvantage experienced by specific demographic groups when women are unable to control their fertility as desired. In this review we consider 3 factors that contribute to disparities in family planning outcomes: patient preferences and behaviors, health care system factors, and provider-related factors. Through addressing barriers to access to family planning services, including abortion and contraception, and working to ensure that all women receive patient-centered reproductive health care, health care providers and policy makers can substantially improve the ability of women from all racial/ethnic and socioeconomic backgrounds to make informed decisions about their fertility.

Section snippets

Cultural and historical context

Although the epidemiology of family planning disparities is similar to disparities in other areas of health, with poor and minority women experiencing worse outcomes, the unique historical and cultural context of family planning provides added complexity. Specifically, consideration of disparities in unintended pregnancy and adolescent pregnancy requires consideration of a broad range of social and cultural issues, ranging from sexuality to attitudes toward pregnancy to sex relations to beliefs

Disparities in family planning outcomes

All adverse family planning outcomes–unintended pregnancy, unintended births, abortions, and teen pregnancies–occur more commonly among minority and low socioeconomic status (SES) women. Although how best to measure unintended pregnancy is debated in the literature, with concern that standard survey questions used may not adequately assess intention,20 and with some evidence that this construct may have variable meanings across cultural and socioeconomic groups,21, 22 the National Survey of

Disparities in family planning outcomes are related to disparities in patterns of contraceptive use

Given the consistent finding that race/ethnicity and SES factors are associated with higher levels of unwanted fertility, it is not surprising to find that studies have found strong relationships between these demographic factors and less effective use of contraception. There is evidence that minority and low SES women are less likely to use contraception overall, use different contraceptive methods, and have higher rates of contraceptive failure than white and higher SES women.

The 2002

What causes these disparities in family planning outcomes?

Following the framework of Kilbourne et al41 in their seminal work on health disparities research, we consider 3 major factors that have been identified in the literature as likely contributors to these disparities: patient preferences and behaviors, health care system factors, and provider-related factors. Although we review each of these factors individually, in accordance with the available literature, we encourage the reader to consider the complex and multifaceted ways in which these

Next steps: addressing disparities in family planning

The concentration of undesired and adolescent pregnancies among poor and minority women in the United States has important implications for the ability of these women to choose their life paths and to experience equal opportunity in our society. Although the etiologies of these disparities are embedded in a complex historical and cultural framework, providers and policy makers have several opportunities for change that could dramatically affect the reproductive health of these populations.

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    Supported by National Institutes of Health (NIH)/NCRR/OD UCSF-CTSI Grant no. KL2 RR024130. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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