Barriers to Contraception: The Effect of Obesity Bias on Women's Contraceptive Practices

Background
Societal stigma and provider bias against obesity have been shown to have an overall negative impact on obese individuals’ health status.  These influences may impair an obese women’s ability to access effective methods of contraception as many methods are available by prescription only. 

Methods
A conceptual model was designed based on a review of relevant literature and theories to predict the influence of societal and physician bias on obese women’s contraceptive decision-making.  Quantitative analysis utilized the National Survey of Family Growth (NSFG), Cycle 2006-2010, to analyze reproductive health behaviors and contraceptive choice among women ages 20-44 that are sexually active and do not desire pregnancy. Both descriptive analyses and multivariate logistic regression were conducted for each proposed hypothesis from the conceptual model.

Results
Even though obese women are just as likely to be sexually active as non-obese women, fewer are using contraception (83.7% vs. 90.2% using contraception, p-value <.000.)  Of those that are using contraception, obese women are choosing less effective methods such as condoms, with the percentage increasing as women’s BMI increase (BMI over 35: 41% used only condoms; BMI less than 25: 34.2% used only condoms.)  When controlling for socio-economic factors in regression analysis, obese women are still significantly less likely to use contraception than non-obese women (OR: 1.31, p-value: .003).

Conclusions
Obese women are at higher risk for unprotected intercourse, even after controlling for socio-economic factors.  Societal and physician bias could contribute to unintended pregnancies by limiting access to effective contraception.