Disparities in perceptions of long-acting reversible contraceptives among patients in Delaware Title X clinics.

Objectives: We examined whether there were racial/ethnic and insurance status differences in patients reporting a sense of relief with the idea of using long-acting reversible contraceptives (LARCs) and whether these differences were attenuated by provider trust and fertility concerns among Title X patients.

Study design: We analyzed two waves of data from a repeated cross-sectional patient survey designed to capture a representative sample of Title X patient health encounters in Delaware (N = 797), fielded in the context of a larger study designed to evaluate a statewide intervention to improve patient access to highly effective contraceptive methods.

Results: We found that a majority of patients reported a sense of relief associated with the idea of using LARCs and differences by race/ethnicity and insurance status. Insurance coverage differences were attenuated by adjusting for reversibility concerns, fertility concerns, and patient-provider trust, but racial/ethnic disparities remained. Fifty-nine percent (95% CI, 55%-63%) of Black respondents reported a sense of relief at the idea of having an LARC, compared with 67% (95% CI, 63%-71%) and 65% (95% CI, 62%-67%) of White and Hispanic/Latinx patients, respectively. Patients who did not trust their provider to remove an IUD on request had a predicted probability of 50% (95% CI, 43%-57%) of viewing LARC with a sense of relief compared with 70% (95% CI, 64%-76%) of patients who reported trust in their provider to do so.

Conclusions: This study contributes to the growing body of research on reproductive autonomy by shedding further light on how decisions regarding contraceptive usage are made in the context of perceived agency constraints in health care settings.

Implications: This study underscores the importance of efforts to improve equitable access to long-acting reversible contraceptives by promoting patient-provider trust, addressing patient concerns regarding the short- and long-term effects of LARCs, and ensuring patients have continued access to healthcare treatment.