176 - Racial and Socioeconomic Inequities in Contraceptive Care Delivery and the Impact of COVID-19

Poster Number: 176
Publication Number: 176.412

Sarah Rowley, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Caroline A. Broomfield, Children's Hospital of Philadelphia, PHILADELPHIA, PA, United States; Jungwon Min, Children's hospital of Philadelphia, Philadelphia, PA, United States; Kenisha Campbell, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Sarah M. Wood, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

Background: Prior to the COVID-19 pandemic, disparities in adolescent contraceptive care existed. Pandemic-related disruptions in care led to uncertainties about access to contraceptive services for adolescent women. It is unknown whether disparities were magnified during the pandemic.

Objective: To examine how contraceptive care delivery for adolescent patients differed by race/ethnicity and socioeconomic status and how the pandemic affected contraceptive care delivery.

Design/Methods: Retrospective cohort study using electronic health record data of adolescent patients prescribed hormonal contraceptives at three academic adolescent specialty clinics, January 1st, 2018-May 31st, 2021. Characteristics of patients first prescribed hormonal contraceptives pre-pandemic were compared to those first prescribed contraceptives intra-pandemic using Chi2 testing for categorical variables and t-testing for continuous variables. Multinomial logistic regression and generalized linear and latent mixed models assessed associations between contraceptive type and exposure variables, accounting for random effects by patient and site. An interaction term was added to assess the effect of the pandemic on the relationship between Black race and contraceptive type.

Results: Over the study period, 2453 adolescents received contraceptive care. Comparing patient characteristics in the pre- and intra-pandemic periods, the proportion of non-Black versus Black patients (77.5% vs. 58.6%, p< 0.001) as well as privately vs publicly insured (70.6% vs 59.7%, p=0.009) patients was higher intra-pandemic compared to pre-pandemic. After controlling for time period, insurance type, and age, providers had 1.9 higher adjusted odds of prescribing LARC, compared to a short acting method, to Black patients than to non-Black patients (95% CI: 1.49-2.54). Although Black patients before and intra-pandemic were more likely than non-Black patients to be prescribed LARC, the magnitude of this effect decreased intra-pandemic (aOR=1.24, 95% CI: 0.94-1.65).Conclusion(s): Our data suggests the importance of finding an equitable balance in delivering contraceptive care. The pandemic impacted access to contraceptive care in a disparate manner as Black and publicly insured patients were significantly less likely to be prescribed new hormonal contraceptives intra-pandemic compared to pre-pandemic. At the same time our data shows higher LARC prescription by providers to Black adolescents that persisted intra-pandemic which may suggest differences in provider counseling due to racial biases leading to preferential counseling of Black patients to start long acting methods.
Rowley_Sarah CV Jan 2022.pdf
Association of patient characteristics and the type of hormonal contraceptive prescribed