Neighborhood-level racialized socioeconomic deprivation and contraceptive use in the us, 2011-2019

Objectives The social and structural environments where people live are understudied in contraceptive research. We assessed if neighborhood measures of racialized socioeconomic deprivation are associated with contraceptive use in the US. Methods We used restricted geographic data from four waves of the National Survey of Family Growth (2011–2019) limited to non-pregnant women ages 15-44 who had sex in the last 12 months. We characterized respondent neighborhoods (census tract) with the Index of Concentration at the Extremes (ICE), a measure of spatial social polarization into areas of concentrated privilege (predominantly high-income White residents) and deprivation (predominantly low-income people of color). We used multivariable binary and multinomial logistic regression with year fixed effects to estimate adjusted associations between ICE tertile and contraceptive use and method type. We assessed for moderation by health insurance type. Results Of the 14,396 respondents, 88.4% in neighborhoods of concentrated deprivation used contraception, compared to 92.7% in the most privileged neighborhoods. In adjusted models, the predicted probability of using any contraception in neighborhoods of concentrated deprivation was 2.8 percentage points lower than in neighborhoods of concentrated privilege, 5.0 percentage points higher for barrier/coital dependent methods, and 4.3 percentage points lower for short-acting methods. Those with private health insurance were significantly more likely to use any contraception than those with Medicaid, irrespective of their neighborhood deprivation or privilege. Conclusions This study highlights the salience of structural factors for contraceptive use and the need for continued examination of structural factors to inform health policy interventions. The social and structural environments where people live are understudied in contraceptive research. We assessed if neighborhood measures of racialized socioeconomic deprivation are associated with contraceptive use in the US. We used restricted geographic data from four waves of the National Survey of Family Growth (2011–2019) limited to non-pregnant women ages 15-44 who had sex in the last 12 months. We characterized respondent neighborhoods (census tract) with the Index of Concentration at the Extremes (ICE), a measure of spatial social polarization into areas of concentrated privilege (predominantly high-income White residents) and deprivation (predominantly low-income people of color). We used multivariable binary and multinomial logistic regression with year fixed effects to estimate adjusted associations between ICE tertile and contraceptive use and method type. We assessed for moderation by health insurance type. Of the 14,396 respondents, 88.4% in neighborhoods of concentrated deprivation used contraception, compared to 92.7% in the most privileged neighborhoods. In adjusted models, the predicted probability of using any contraception in neighborhoods of concentrated deprivation was 2.8 percentage points lower than in neighborhoods of concentrated privilege, 5.0 percentage points higher for barrier/coital dependent methods, and 4.3 percentage points lower for short-acting methods. Those with private health insurance were significantly more likely to use any contraception than those with Medicaid, irrespective of their neighborhood deprivation or privilege. This study highlights the salience of structural factors for contraceptive use and the need for continued examination of structural factors to inform health policy interventions.