Effective Contraception Use by Usual Source of Care: An Opportunity for Prevention

Introduction: Women using emergency departments (ED) or urgent care facilities for their usual care may lack access to contraception. This study examined the relationship between effectiveness of current contraception use (highly effective/effective methods vs. less effective/no method) and usual source of care in the clinic (referent group), urgent care, ED, or none among U.S. reproductive-aged females at risk for unintended pregnancy. Methods: Using the National Survey of Family Growth, we conducted logistic regression analyses using pooled, as well as age-and insurance-stratified, data. Results: Less effective/no contraception was associated with ED (odds ratio [OR] = 1.9 [95% CI = 1.3, 3]) and no usual source of care (OR = 1.5 [95% CI = 1.3, 1.8]) in the unadjusted logistic regression. Adjusting for confounders, no usual care source was marginally associated with less effective/no contraception use (OR = 1.2 [95% CI = 1.0, 1.4]; p = .041). Adjusted age-and insurance-stratified analyses revealed that less effective/no contraception was associated with the following: no usual care source for 15 to 19-year-olds (OR = 2.5, [95% CI = 1.5, 4.1]); ED usual care source for 20 to 25-year-olds (OR = 2.2, [95% CI = 1.0, 4.5]; p = .038); ED usual care source for Medicaid/Children's Health Insurance Program-insured (OR = 2.0, [95% CI 1/4 1.0, 3.7]; p = .042); and ED usual care source for any publicly-funded insurance (adjusted OR = 2.1, [95% CI = 1.1, 3.8]). Conclusion: Overall, use of less effective/no contraception did not vary substantially by usual source of care. Stratified analyses showed some groups of women with ED usual source of care (20 to 25-year-olds, Medicaid/Children's Health Insurance Program insurance, or any publicly-funded insurance) and no usual care source (15 to 19-year-olds) had higher odds of using less effective/no contraception. (C) 2018 Jacobs Institute of Women's Health. Published by Elsevier Inc.