Socioeconomic status and discontinuation of long-acting reversible contraception in a population-based cohort study.

OBJECTIVE: To examine the association between socioeconomic status (SES) on long-acting reversible contraception (LARC) discontinuation. METHODS: We analyzed a national cohort of women born between 1980-1984 in the National Longitudinal Survey of Youth (NLSY97). We used 2005-2021 NSLY97 cycles, including the first cycle respondents were ≥18 years, sexually active, and using LARC. Respondents were tracked until they either reported using non-LARC contraception, were not using any contraceptives, became pregnant, or were lost to follow-up. SES characteristics were ascertained at respondents' first eligible cycle, including: Family income relative to the Federal Poverty Level (FPL), insurance, education, and employment. LARC discontinuation was categorized as stopping contraception, switching to non-LARC contraception, pregnancy, or continuing LARC throughout the study. Mixed-effects multinomial logistic regression with cluster-robust standard errors modeled continued LARC use as a function of SES. RESULTS: Our cohort contained 435 women contributing 893 interviews. At the last interview, 23% of respondents still used LARC, 19% stopped contraception, 20% switched to another contraceptive, and 38% became pregnant. On multivariable regression, respondents between 300-399% FPL had an increased likelihood of stopping LARC (relative risk ratio [RRR]: 7.65; 95% confidence interval [CI]: 1.72, 33.93; p=0.007) while respondents between 100-199% FPL had a decreased likelihood of becoming pregnant (RRR: 0.28; 95% CI: 0.13, 0.61; p=0.001). There were no other significant associations between SES and LARC discontinuation. CONCLUSIONS: Our analysis found no consistent relationship between SES and LARC discontinuation. While SES may influence the decision to initiate LARC, SES may not influence the decision to discontinue LARC.