Abstract
Introduction
Low-income and young women experience disproportionately high rates of unintended
pregnancy. Traditional measures of socioeconomic status may not be appropriate indicators
of financial status, particularly during emerging adulthood. This study investigates
the relationship between financial strain and contraceptive use, focusing on the differential
effects by age group.
Methods
Multinomial logistic regression analyses assessed the relationship between financial
strain and contraceptive use in a national sample of U.S. women ages 18–39 years (N = 932). Models were adjusted for income, employment status, and other sociodemographic
characteristics and tested the interaction of financial strain and age group.
Results
Women with high financial strain were less likely to use short-acting methods (compared
with using no method) in the adjusted model; when the age and financial strain interaction
was included, associations held only for women ages 18–24 and 25–29 years of age.
Relative to contraceptive nonuse, women ages 18–24 years with high financial strain
were less likely to use long-acting reversible (relative risk ratio [RRR], 0.10; 95%
confidence interval [CI], 0.01–0.99) and short-acting hormonal (RRR, 0.03; 95% CI,
0.00–0.18) methods. Women ages 25–29 with high financial strain were less likely to
use short-acting hormonal (RRR, 0.20; 95% CI, 0.05–0.87) and coital-specific (RRR,
0.11; 95% CI, 0.02–0.51) methods.
Implications for Practice and/or Policy
Young women may be vulnerable to the effect of high financial strain on contraceptive
nonuse. Providers working with this group should consider incorporating financial
strain into screening tools to identify patients who may need extra attention in contraceptive
decision-making conversations. Antipoverty programs could also have a positive effect
on effective contraceptive use.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Women's Health IssuesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Socioeconomic status and health. The challenge of the gradient.American Psychologist. 1994; 49: 15-24
- Emerging adulthood: A theory of development from the late teens through the twenties.American Psychologist. 2000; 55: 469
- Emerging adulthood: What is it, and what is it good for?.Child Development Perspectives. 2007; 1: 68-73
- The role of financial strain and self-control in explaining health behaviours: The GLOBE study.European Journal of Public Health. 2017; 28: 597-603
- Multiple roles, multiple lives: The protective effects of role responsibilities on the health functioning of African American Mothers.Women & Health. 2009; 49: 144-163
- “It just happens”: A qualitative study exploring low-income women’s perspectives on pregnancy intention and planning.Contraception. 2015; 91: 150-156
- Socioeconomic status in health research: One size does not fit all.JAMA. 2005; 294: 2879-2888
- Addressing potential pitfalls of reproductive life planning with patient-centered counseling.American Journal of Obstetrics & Gynecology. 2017; 216: 129-134
- Sexually transmitted disease surveillance 2016.U.S. Department of Health and Human Services, Atlanta, GA2017 (Available:)www.cdc.gov/std/stats16/CDC_2016_STDS_Report-for508WebSep21_2017_1644.pdfDate accessed: March 21, 2018
- Current contraceptive status among women aged 15-44: United States, 2011-2013. (NCHS Data Brief No. 173).National Center for Health Statistics, Hyattsville, MD2014
- Current contraceptive use and variation by selected characteristics among women aged 15-44: United States, 2011-2013. (National Health Statistics Reports No. 86).National Center for Health Statistics, Hyattsville, MD2015
- A qualitative analysis of approaches to contraceptive counseling.Perspectives on Sexual and Reproductive Health. 2014; 46: 233-240
- Women’s preferences for contraceptive counseling and decision making.Contraception. 2013; 88: 250-256
- Associations of financial strain and income with depressive and anxiety disorders.Journal of Epidemiology and Community Health. 2015; 69: 660-665
- Financial strain, social capital, and perceived health during economic recession: A longitudinal survey in rural Canada.Anxiety, Stress, & Coping. 2014; 27: 422-438
- Does contraceptive use in the United States meet global goals?.Perspectives on Sexual and Reproductive Health. 2017; 49: 197-205
- It’s not planned, but is it okay? The acceptability of unplanned pregnancy among young people.Women’s Health Issues. 2018; 28: 408-414
- Associations between financial strain and the diurnal salivary cortisol secretion of long-term unemployed individuals.Integrative Physiological & Behavioral Science. 2001; 36: 205-219
- Contraceptive use in the United States (Fact Sheet).2016 (Available:)www.guttmacher.org/fact-sheet/contraceptive-use-united-statesDate accessed: February 6, 2018
- Longitudinal trends in race/ethnic disparities in leading health indicators from adolescence to young adulthood.Archives of Pediatrics & Adolescent Medicine. 2006; 160: 74-81
- Research on clinical preventive services for adolescents and young adults: Where are we and where do we need to go?.Journal of Adolescent Health. 2017; 60: 249-260
- Single mothers in low-wage jobs: Financial strain, parenting, and preschoolers’ outcomes.Child Development. 2000; 71: 1409-1423
- Current contraceptive use in the United States, 2006–2010, and changes in patterns of use since 1995 (National Health Statistics Reports No. 60).National Center for Health Statistics, Hyattsville, MD2012 (Available:)www.cdc.gov/nchs/data/nhsr/nhsr060.pdfDate accessed: February 26, 2018
- Are uncertain fertility intentions a temporary or long-term outlook? Findings from a panel study.Women’s Health Issues. 2017; 27: 21-28
- Contraceptive method use in the United States: Trends and characteristics between 2008, 2012 and 2014.Contraception. 2018; 97: 14-21
- Pregnancy motivations and contraceptive use: Hers, his, or theirs?.Women’s Health Issues. 2010; 20: 234-241
- Black-White differences in sex and contraceptive use among young women.Demography. 2016; 53: 1399-1428
- Financial strain and medication adherence among diabetes patients in an integrated health care delivery system: The Diabetes Study of Northern California (DISTANCE).Health Services Research. 2016; 51: 610-624
- Predictors of health behaviors after the economic downturn: A longitudinal study.Social Science & Medicine. 2013; 89: 8-15
- Relationship characteristics and contraceptive use among young adults.Perspectives on Sexual and Reproductive Health. 2011; 43: 119-128
- Relationship types and contraceptive use within young adult dating relationships.Perspectives on Sexual and Reproductive Health. 2014; 46: 41-50
- The relationship context of contraceptive use at first intercourse.Family Planning Perspectives. 2000; 32: 104-110
- Exploring the relationship between socioeconomic factors, method of contraception and unintended pregnancy.Reproductive Health. 2016; 13
- Financial strain and birth weight: The mediating role of psychological distress.Archives of Women’s Mental Health. 2017; 20: 201-208
- Pregnant womens perspectives on intendedness of pregnancy.Women s Health Issues. 1997; 7: 385-392
- Nonuse of contraception among women at risk of unintended pregnancy in the United States.Contraception. 2015; 92: 170-176
- Scarcity: Why having too little means so much.Times Books, Henry Holt and Company, New York2013
- The new adolescents: An analysis of health conditions, behaviors, risks, and access to services among emerging young adults.University of Southern California, Los Angeles2013
- Young adults remain worse off than adolescents.Journal of Adolescent Health. 2013; 53: 559-561
- The measurement of SES in health research: Current practice and steps toward a new approach.Social Science & Medicine. 2003; 56: 769-784
- Young adult preventive health care guidelines: There but can’t be found.Archives of Pediatrics & Adolescent Medicine. 2012; 166: 240-247
- Adolescent and young adult health in the United States in the past decade: Little improvement and young adults remain worse off than adolescents.Journal of Adolescent Health. 2014; 55: 3-16
- Financial strain and self-rated health among black adults.American Journal of Health Behavior. 2014; 38: 340-350
- Accumulated financial strain and women’s health over three decades.Journals of Gerontology Series B Psychological Sciences and Social Sciences. 2012; 67: 585-594
- Unintended pregnancy: Worldwide levels, trends, and outcomes.Studies in Family Planning. 2010; 41: 241-250
- Subjective social status: Its determinants and its association with measures of ill-health in the Whitehall II study.Social Science & Medicine. 2003; 56: 1321-1333
- Documentation for human subject review committees: GfK company information, past external review, confidentiality, and privacy protections for panelists.GfK Custom Research, LLC, New York2014
- Effectiveness of family planning methods.2011 (Available:)www.cdc.gov/reproductivehealth/contraception/unintendedpregnancy/pdf/contraceptive_methods_508.pdfDate accessed: July 18, 2018
Biography
Sophie Lyons, MPH, MSW, began this work as a graduate student at the University of California, Berkeley. Her interests include how social determinants affect sexual and reproductive health among adolescents and women and how research is translated into programs and policy.
Biography
Jennet Arcara, MPH, MPP, is a PhD candidate, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Her research focuses on the roles of gender, autonomy, and power in reproductive health in U.S. and global contexts.
Biography
Julianna Deardorff, PhD, is Associate Professor, Maternal and Child Health program, University of California, Berkeley. Her research focuses on antecedents/consequences of girls' early puberty. She examines sexual behaviors/condom use during adolescence and related risk and protective factors, particularly among young Latinas.
Biography
Anu Manchikanti Gomez, PhD, is Assistant Professor and Director, SHARE Program, University of California, Berkeley. A health equity researcher, her scholarship advances the understanding/promotion of sexual/reproductive health equity, emphasizing social, relational, and structural determinants of health.
Article info
Publication history
Published online: February 02, 2019
Accepted:
December 27,
2018
Received in revised form:
December 27,
2018
Received:
July 23,
2018
Identification
Copyright
© 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.
