Health care provider bias in the Appalachian region: The frequency and impact of contraceptive coercion

Abstract

Objective: To investigate the frequency and impact of contraceptive coercion in the Appalachian region of the United States.

Data sources and study setting: In fall 2019, we collected primary survey data with participants in the Appalachian region.

Study design: We conducted an online survey including patient-centered measures of contraceptive care and behavior.

Data collection/extraction methods: We used social media advertisements to recruit Appalachians of reproductive age who were assigned female at birth (N = 622). After exploring the frequency of upward coercion (pressure to use contraception) and downward coercion (pressure not to use contraception), we ran chi-square and logistic regression analyses to explore the relationships between contraceptive coercion and preferred contraceptive use.

Principal findings: Approximately one in four (23%, n = 143) participants reported that they were not using their preferred contraceptive method. More than one-third of participants (37.0%, n = 230) reported ever experiencing coercion in their contraceptive care, with 15.8% reporting downward coercion and 29.6% reporting upward coercion. Chi-square tests indicated that downward (χ² (1) = 23.337, p < 0.001) and upward coercion (χ² (1) = 24.481, p < 0.001) were both associated with a decreased likelihood of using the preferred contraceptive method. These relationships remained significant when controlling for sociodemographic factors in a logistic regression model (downward coercion: Marginal effect = -0.169, p = 0.001; upward coercion: Marginal effect = -0.121, p = 0.002).

Conclusions: This study utilized novel person-centered measures to investigate contraceptive coercion in the Appalachian region. Findings highlight the negative impact of contraceptive coercion on patients' reproductive autonomy. Promoting contraceptive access, in Appalachia and beyond, requires comprehensive and unbiased contraceptive care.

Keywords: contraceptive care; contraceptive coercion; health care access; provider bias; reproductive autonomy.