Shortcomings and disparities in contraception counseling and use by hypertensive individuals at risk for unintended pregnancy: a comparative analysis of the National Survey of Family Growth

• Published in: American journal of obstetrics and gynecology 2024-03, Vol.230 (3), p.350.e1-350.e11
• Main Authors: Danvers, Antoinette A., Gurney, Elizabeth G., Panushka, Katherine A., Peskin, Melissa, Evans, Thomas A.
• Format: Article
• Language: English
• Subjects: Contraception - methods; Contraception Behavior; contraception counseling; Contraceptive Agents; Counseling; Diabetes Mellitus; Family Planning Services; Female; Humans; hypertension; Hypertension - epidemiology; maternal morbidity; maternal mortality; Pregnancy; Pregnancy, Unplanned
• ISSN: 0002-9378; 1097-6868; 1097-6868
• DOI: 10.1016/j.ajog.2023.10.032

Hypertension is a leading cause of adverse pregnancy outcomes. These outcomes disproportionately affect Black individuals. Reproductive life planning that includes patient-centered contraception counseling could mitigate the impact of unintended pregnancy. The primary objective of the study is to compare contraception counseling and use between hypertensive and nonhypertensive individuals at risk for unintended pregnancy. Our secondary objectives are the following: (1) to evaluate the effect of race on the probability of counseling and the use of contraception, and (2) to evaluate the methods used by individuals with hypertension. Data from the 2015–2017 and 2017–2019 National Survey of Family Growth Female Respondent Files were used to analyze whether individuals who reported being informed of having high blood pressure within the previous 12 months received counseling about contraception or received a contraceptive method. Covariates considered in the analysis included age, race, parity, educational attainment, body mass index, smoking, diabetes, and experience with social determinants of health. The social determinants of health covariate was based on reported experiences within 5 social determinants of health domains: food security, housing stability, financial security, transportation access, and childcare needs. Linear probability models were used to estimate the adjusted probability of receiving counseling and the use of a contraceptive. Using difference-in-difference analyses, we compared the change in counseling and use between hypertensive and nonhypertensive respondents by race, relative to White respondents. Of the 8625 participants analyzed, 771 (9%) were hypertensive. Contraception counseling was received by 26.2% (95% confidence interval, 20.4–31.9) of hypertensive individuals and 20.7% (95% confidence interval, 19.3–22.2) of nonhypertensive individuals. Contraception use was reported by 39.8% (95% confidence interval, 33.2–46.5) of hypertensive and 35.3% (95% confidence interval, 33.3–37.2) of nonhypertensive individuals. The linear probability model adjusting for age, parity, education attainment, body mass index, smoking, diabetes, and social determinants of health indicated that hypertensive individuals were 8 percentage points (95% confidence interval, 3–18 percentage points) more likely to receive counseling and 9 percentage points (95% confidence interval, 3–16 percentage points) more likely to use contraception. Hypertensive Black in