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INTRODUCTION: Across the United States, mortality rates for black infants are twice as high as those for white, and in Kalamazoo County they are four times higher. Among many factors that contribute to infant mortality, rapid repeat pregnancies (RRP) are associated with higher rates of poor birth outcomes. RRP are more likely in African American women and those of lower socioeconomic status. Contraception is a vital aspect of postpartum care that assists women to avoid RRP. This study investigates the impact of race on birth control choices for postpartum mothers in Kalamazoo County.

METHODS: A prospective study was conducted to assess the health experiences of mothers in Kalamazoo County, Michigan. Of the 471 eligible women, 244 completed a survey, collected between April and November of 2017. Variables collected included demographic information (race, income, age and insurance), social determinants of health (transportation and childcare), and reproductive health (birth control). A bivariate analysis with Chi-squared tests was conducted to evaluate the impact of these variables on utilization of postpartum birth control, stratified by race.

RESULTS: By the second postpartum month, 85.6% of 243 surveyed women report having a birth control method. Reasons for not having a birth control method include not yet having a postpartum visit (31.4%), ambivalence about becoming pregnant (25.7%) or not wanting to use birth control (22.9%). These reasons do not vary by race or by income. Among women who reported using birth control postpartum the three leading methods were: condoms (21.3%), abstinence (18.4%) and birth control pills (16.4%). Interestingly, there were differences in the use of each of these methods between white women and women of color; condoms (23.6% vs. 17.7%), birth control pills (21.6% vs. 8.3%), or abstinence (14.2% vs. 25%). Both postpartum visit and use of a medically prescribed birth control method were significantly lower among women of color compared to white women (p=.003 and p=.021, respectively). Furthermore, significantly fewer women of color report having a medical home compared to white women (88.4% and 95.9%, respectively p=.032), and even fewer report having a primary doctor (one they could name) (34.7% and 54.7%, respectively, p=.002). Women of color are significantly more likely to report the following socioeconomic barriers compared to white women: lack of reliable transportation (11.5% vs 0%, p<.001), non-private insurance (62.5% vs 25.7%, p<.001), or poverty (42.7%, 16.2%, p<.001).

CONCLUSION: Our data suggests there are differences in birth control choice between white women and women of color in Kalamazoo county. In addition, women of color experience more barriers that may impact contraception choice. Abstinence only sexual education has been shown to be one of the least effective means to prevent unintended pregnancies, interestingly, this is one of the leading postpartum birth control methods chosen by women in this study and is emphasized in the sexual education provided students in Michigan. Further investigation into the factors that impact postpartum birth control choice by women may address the race-related and socioeconomic disparities seen in infant mortality.

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