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21. Neighborhood‐level racialized socioeconomic deprivation and contraceptive use in the United States, 2011–2019.

Author

Cartwright, Alice F., Wallace, Maeve, Su, Jessica, Curtis, Siân, Angeles, Gustavo, and Speizer, Ilene S.

Subjects
MEDICAL care use, WOMEN of color, RESEARCH funding, SOCIOECONOMIC factors, HUMAN sexuality, LOGISTIC regression analysis, HEALTH insurance, PROBABILITY theory, HEALTH policy, DESCRIPTIVE statistics, SOCIAL context, RACE, SEX customs, SURVEYS, CONTRACEPTION, MEDICAID, NEIGHBORHOOD characteristics, SOCIAL isolation, POVERTY
Abstract

Introduction: 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 United States. 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 tracts) with the Index of Concentration at the Extremes (ICE), a measure of spatial social polarization, into areas of concentrated privilege (predominantly white residents living on high incomes) and deprivation (predominantly people of color living on low incomes). 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 also assessed for an interactive effect of ICE and health insurance type. Results: Of the 14,396 respondents, 88.4% in neighborhoods of concentrated deprivation used any 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 Medicaid were less likely to use any contraception than those with private insurance irrespective of neighborhood classification. Conclusions: This study highlights the salience of structural factors for contraceptive use and the need for continued examination of structural oppressions to inform health policy. [ABSTRACT FROM AUTHOR]

Published
2024
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44. The Effect of the Removal of User Fees for Delivery at Public Health Facilities on Institutional Delivery in Urban Kenya

Author

Calhoun, Lisa M., Speizer, Ilene S., Guilkey, David, and Bukusi, Elizabeth

Subjects
Public health -- Laws, regulations and rules, User fees -- Laws, regulations and rules, Health care services accessibility, Government regulation, Health care industry
Abstract

Objectives In 2013, Kenya removed delivery fees at public health facilities in an effort to promote equity in access to health services and address high maternal mortality. This study determines the effect of the policy to remove user fees on institutional delivery in a population-based sample of women from urban Kenya. Methods Longitudinal data were collected from a representative sample of 8500 women from five cities in Kenya in 2010 with a follow-up interview in 2014 (response rate 58.9%). Respondents were asked about their most recent birth since 2008 at baseline and 2012 at endline, including the delivery location. Multinomial logistic regression is used, controlling for the temporal time trend and background characteristics, to determine if births which occurred after the national policy change were more likely to occur at a public facility than at home or a private facility. Results Multivariate findings show that women were significantly more likely to deliver at a public facility as compared to a private facility after the policy. Among the poor, the results show that poor women were significantly more likely to deliver in a public facility compared to home or a private facility after policy change. Conclusions for Practice These findings show Kenya's progress towards achieving universal access to delivery services and meeting its national development targets. The removal of delivery fees in the public sector is leading to increased use of facilities for delivery among the urban poor; this is an important first step in reducing maternal death., Author(s): Lisa M. Calhoun [sup.1] , Ilene S. Speizer [sup.1] [sup.2] , David Guilkey [sup.1] [sup.3] , Elizabeth Bukusi [sup.4] Author Affiliations: (Aff1) 0000000122483208, grid.10698.36, Carolina Population Center, The University [...]

Published
2018
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