Racial Inequities in Adolescent Contraceptive Care Delivery: A Reproductive Justice Issue.

ABSTRACT

STUDY OBJECTIVE: To examine racial/ethnic disparities in contraceptive delivery for adolescent patients within an adolescent medicine subspecialty clinical system before and during the COVID-19 pandemic. Secondarily we aimed to assess the relationship between race and contraceptive delivery by telehealth. DESIGN: Retrospective cohort study using electronic health record (EHR) data. SETTING: Three Adolescent Medicine subspecialty clinics in a large academic hospital system including an urban location and two suburban locations. PARTICIPANTS: Patients assigned female sex at birth prescribed hormonal contraception between January 1st, 2018 and May 31st, 2021. MAIN OUTCOME MEASURES: Method type of contraceptive prescribed (short-acting, medium-acting, long-acting [LARC]). RESULTS: There were 2,453 patients in the study, 47.5% were white and 36.0% Black, 8.1% identified as Hispanic. After controlling for insurance and age, Black patients compared to non-Black patients had a 2-fold higher odds of receiving LARC compared to a short acting method across the study period (aOR 2.0, 95% CI 1.52-2.62). We identified effect modification with significant interaction between Black race and the pandemic time period, with evidence of a higher marginal probability of Black patients receiving LARC intra-pandemic. Additionally intra-pandemic, patients receiving new contraceptive prescriptions via telehealth were less likely to be Black (aOR=0.63, 95% CI 0.41-0.94) or publicly insured (aOR 0.56, 95% CI 0.38-0.81). CONCLUSION: Our data show significantly higher prescribing of LARC to Black adolescents by clinicians, which may suggest differences in physician contraceptive counseling with a bias toward preferentially counseling Black patients toward LARC. Our data also show that Black and publicly insured patients had decreased utilization of contraceptive care by telehealth during the pandemic.