Does universal healthcare coverage ensure equal access to contraception? Socioeconomic inequalities on contraceptive use in a young-adult population in Porto, Portugal.

Abstract

Introduction: Access to effective and safe contraception is important to women, individually, and to the population's health and well-being. Universal free access to family planning is provided in Portugal, yet it is unknown if socioeconomic inequalities remain in access and use of contraceptives.

Purpose: To study the association between socioeconomic status and use of contraceptives by young Portuguese women, and whether healthcare use contributes to socioeconomic inequalities.

Material and methods: We analysed data from 552 young-adult women from the EPITeen cohort. We regressed use and method of contraception against individual net monthly income, education level, and the number of medical appointments in the past year.

Results: Most women (84.1%) currently used contraceptives. Though, contraceptive use was less frequent among women with lower incomes [adjusted OR (aOR) = 0.340, p < 0.005] especially the vaginal ring or contraceptive patch (aOR = 0.164, p < 0.05). Women with lower education status were less likely to use contraceptives (aOR = 0.402, p < 0.05). The number of medical appointments in the last year was not associated with the use and method of contraception. Similar results were found for the ever use of contraceptives.

Conclusions: Despite universal health coverage policies in Portugal, contraceptive use is still socioeconomically patterned. To achieve their full potential, family planning programs and policies must be revised, ensuring equitable access for all.