Available online 21 November 2022

To examine racial/ethnic disparities in contraceptive delivery for adolescent patients within an adolescent medicine subspecialty clinical system before and during the COVID-19 pandemic. Secondarily we aimed to assess the relationship between race and contraceptive delivery by telehealth.

Retrospective cohort study using electronic health record (EHR) data.

Three Adolescent Medicine subspecialty clinics in a large academic hospital system including an urban location and two suburban locations.

Patients assigned female sex at birth prescribed hormonal contraception between January 1st, 2018 and May 31st, 2021.

Method type of contraceptive prescribed (short-acting, medium-acting, long-acting [LARC]).

There were 2,453 patients in the study, 47.5% were white and 36.0% Black, 8.1% identified as Hispanic. After controlling for insurance and age, Black patients compared to non-Black patients had a 2-fold higher odds of receiving LARC compared to a short acting method across the study period (aOR: 2.0, 95% CI: 1.52-2.62). We identified effect modification with significant interaction between Black race and the pandemic time period, with evidence of a higher marginal probability of Black patients receiving LARC intra-pandemic. Additionally intra-pandemic, patients receiving new contraceptive prescriptions via telehealth were less likely to be Black (aOR=0.63, 95% CI: 0.41-0.94) or publicly insured (aOR 0.56, 95% CI 0.38-0.81).

Our data show significantly higher prescribing of LARC to Black adolescents by clinicians, which may suggest differences in physician contraceptive counseling with a bias toward preferentially counseling Black patients toward LARC. Our data also show that Black and publicly insured patients had decreased utilization of contraceptive care by telehealth during the pandemic.

contraception

adolescents

health equity

© 2022 Published by Elsevier Inc. on behalf of North American Society for Pediatric and Adolescent Gynecology.