Original research articleUnder (implicit) pressure: young Black and Latina women's perceptions of contraceptive care
Introduction
There is longstanding recognition that healthcare disparities — differences in quality of healthcare experienced by members of minority groups — are a barrier to improving health, particularly for racial/ethnic minorities [1], [2], [3]. A small body of research has described practices perpetuating healthcare disparities in family planning settings [4], [5], [6], [7], as well as women's perceptions of discrimination, coercion and bias in contraceptive counseling [8], [9], [10], [11]. Moreover, qualitative research has surfaced important insights into the ways that providers' beliefs — implicit or explicit — about appropriate childbearing can impact healthcare provision [12], [13], [14]. The most recent national data indicate that Black, Latina, young and low-income women experience the highest rates of unintended pregnancy in the United States [15]. At face value, these differences in population-level rates of unintended pregnancy by race/ethnicity, income level and age may provide justification for differential interventions for “at-risk” populations. Such approaches neglect the highly personal nature of contraceptive decision making and the long history of reproductive oppression impacting these same groups [16], [17].
Indeed, the role of family planning providers in promoting and constraining reproductive autonomy has been the subject of increasing focus in recent years [9], [13], [17], [18]. In particular, the benefits and limitations of various methods of contraceptive counseling, including directive, informed choice and shared decision-making approaches, have been highlighted [19], [20]. With the rise of patient-centered care, some scholars argue that preference-sensitive decisions, such as contraceptive method choice, require counseling that is engaged, nondirective and interactive and that acknowledges patients' preferences and priorities [20], [21]. Notably, two studies found an association between non-patient-centered care and earlier contraceptive discontinuation [22], [23]. Given the high levels of contraceptive discontinuation and dissatisfaction in the United States, interventions and practices that support patients in accessing and using methods that best fit their situations are critically important [24].
Despite the well-established tensions between contraceptive counseling approaches and respect for reproductive autonomy, scant research examines young women of color's experiences with family planning care within this context. Accordingly, the objective of the present qualitative analysis was to understand the impact of feeling pressured during contraceptive care on contraceptive decision making and reproductive autonomy among young Black and Latina women.
Section snippets
Methods
This analysis drew on qualitative data collected in 2013 regarding contraceptive decision making and attitudes toward intrauterine devices (IUDs) among 38 young Black and Latina women in the San Francisco Bay Area. Women were eligible to participate in the study if they were between the ages of 18 and 24; identified as Black, African–American, Latina or Hispanic; had vaginal sex in the last 3 months and were not pregnant or trying to conceive. We recruited participants via Craigslist and flyers
Results
The majority of women in the study (71%) recounted experiences of pressure in contraceptive care. Demographics for both the full sample (n=38) and analytic subsample (n=27) experiencing pressure are presented in Table 1. While the subsample was demographically similar to the full sample, all participants with children (n=11) relayed experiences of pressure. Among the subsample, the mean age was 21.7 years (range 18–24). Fifteen participants identified as Latina or Hispanic, and 13 identified as
Discussion
In our sample of 38 young Latina and Black women, the majority had experienced pressure from a healthcare provider regarding contraception. While a number of our participants agreed to providers' directive recommendations, several discontinued these methods shortly after their appointments if they felt pressured, did not receive enough information about side effects or only initiated the method as means of interrupting directive counseling. Notably, the maximum age of study participants was 24
Acknowledgments
This work was supported by an individual investigator grant from the Office of Sponsored Research and Programs at San Francisco State University. We gratefully acknowledge Stephanie Arteaga, Kelly Bermudes, Vanessa Cardona, Airial Clark and Vanessa Torres for their work facilitating data collection, recruiting and interviewing participants, and cleaning the data. Additionally, we thank Jennet Arcara, Stephanie Arteaga, Lauren Caton, Maggie Downey, Bridget Freihart, Alvaro Gómez, Elizabeth
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