Contraceptive Use Disparities in Asian American Women in 2015–2016: California Health and Interview Survey

Abstract

Background: Consistent use of effective contraceptives is directly associated with a lower risk of unintended pregnancies, a significant public health burden in the U.S. The Asian American population is heterogeneous and fast-growing. However, patterns and disparities in contraceptive use among Asian American women, particularly within racial/ethnic subgroups, have been understudied, hindering effective family planning. Objectives: This study aimed to identify the prevalence of contraceptive use and its pattern in Asian American women using the 2015–2016 California Health and Interview Survey (CHIS) data, with a focus on different Asian ethnic subgroups. Study Design: A composite score of acculturation level (0–5) was created based on place of birth, years in the U.S., and language spoken at home. Data on demographics, self-rated health, contraceptive use, and related information were collected from women aged 18–44 years who were at risk of unintended pregnancy. Adjusted multivariable logistic regressions were conducted to examine contraceptive use and patterns in relation to race/ethnicity and other factors. Results: Over 18.20% of the overall sample (pop estimated N = 16,177,759) were Asian Americans, and among them, 24.62% were Chinese, followed by other Asian subgroups (28.83%), Filipina (25.49%), Korean (11.25%), and Vietnamese (9.80%). Overall, Filipina, Korean, and Vietnamese women were less likely to use contraception compared to their non-Hispanic White (NHW) peers, whereas acculturation level was positively associated with contraceptive use. Among different types of contraceptives, Filipina, Korean, and Vietnamese women were less likely to use long-acting reversible contraceptives compared to NHW. Such racial/ethnic disparities were not observed with less or moderately effective contraceptives. Conclusions: Patterns of contraceptive use and associated disparities varied among Asian American subgroups. Providers working with Asian American women should be aware of these racial disparities in contraceptive use and seek ways to address barriers to effective contraception use in this diverse population in order to provide culturally competent family planning services.

1. Introduction

Consistent use of effective contraceptives is crucial in reducing the risk of unintended pregnancies, which correlate with adverse birth outcomes such as preterm birth, low-birth-weight infants, and other obstetric complications [1,2,3]. The U.S. Department of Health and Human Services has prioritized the reduction in unintended pregnancies as a goal in the Healthy People 2030 family planning objectives [4]. Between 2017 and 2019, 38% of births reported by women aged 15–49 years in the U.S. were unintended [5]. Factors influencing unintended pregnancy rates include age, socioeconomic status, racial or ethnic minority background, and variations across states with differing social welfare policies [1,2,6,7]. Despite these associations, the relationship between these factors and effective contraceptive use remains unknown. Given the prevailing political atmosphere in the U.S., where access to abortion may not be universally available, the consequences of unintended pregnancies can be even more significant for individuals and their families.

Prior studies have indicated racial/ethnic disparities in unintended pregnancies due to various factors, including logistical, cultural, and structural barriers [6,7]. According to the 2006–2010 National Health Statistics Report, the percentages of unintended birth among ever-married women were 34% and 35% for Hispanics and non-Hispanic Black (NHB) individuals, respectively, compared to 22% for non-Hispanic White (NHW) individuals [6]. Limited information is available on Asian American women due to insufficient data collection. An earlier study by Guzman et al., which included 9100 mothers from a cohort of children born in 2001, found that Asian women faced an 18% higher risk of unintended birth than NHW individuals [7]. These disparities are noteworthy and in need of updating with more recent data, particularly given the low failure rate (<1%) of highly effective contraceptives [1]. Therefore, investigating patterns of contraceptive use and their relation to racial/ethnic minorities is crucial for enhancing our understanding of the risks associated with unintended pregnancies.

The Asian American population is the fastest-growing racial/ethnic minority in the U.S., having nearly doubled from 2000 to 2019, and is estimated to be 46 million by 2060 [8]. Historically, Asian Americans have been marginalized in health literature and research due to factors such as limited funding, small sample size, homogeneity, or methodological issues [9,10]. This population encompasses a diverse range of genetic factors, socioeconomic statuses, immigration histories, cultural/religious backgrounds, and health behaviors [8,9,10,11]. Some studies have reported that Asian Americans, particularly those who are foreign-born, are less likely to utilize sexual health services due to cultural barriers (e.g., sexual knowledge, stigma, and attitude) and logistical challenges (e.g., language barriers, health insurance coverage, and resources) [12,13,14]. Despite the large size of this population, there is a dearth of research on contraceptive use among Asian American women, particularly within distinct racial/ethnic subgroups. The perception of conservative attitudes toward sex among certain Asian Americans may contribute to the assumption that they are at low risk for engaging in unprotected sex or may opt for alternative methods, further hindering their access to sexual and reproductive health services [15,16,17].

To address this knowledge gap, this study aimed to identify the prevalence and patterns of contraceptive use among Asian American women. To achieve this, data from the 2015–2016 California Health and Interview Survey (CHIS) were utilized to compare the contraceptive practices of Asian American women with those of NHW women.

2. Methods

2.1. Data and Participants

This study utilized cross-sectional data from the 2015–2016 CHIS (https://healthpolicy.ucla.edu/our-work/california-health-interview-survey-chis, accessed on 2 December 2023), which was designed with a two-stage geographically stratified sampling approach to gather health data from diverse populations living in California through web and telephone surveys. The CHIS offers multiple language options, and further methodological details are available elsewhere [18,19,20].

During 2015–2016, the overall response rate for adults participating in the CHIS was 41.80%. To address potential methodological concerns related to nonresponse and noncoverage biases, the CHIS researcher conducted thorough data quality studies. These studies consistently affirmed that the data effectively represented California’s household population [21]. The choice to use the 2015–2016 CHIS data was based on the availability of Asian American subgroups and contraceptive methods.

Eligible participants for this study were females assigned at birth, aged 18–44 years, not planning to become pregnant in the next 12 months, and having male sex partner(s). Listwise deletion was employed in cases of missing data for any of the measures. After adjusting for the survey design, analyses were conducted on a weighted population of 16,177,759 participants (raw sample n = 7630) based on public-accessed, de-identified CHIS data. Institutional Review Board approval was not required due to the use of de-identified public data. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

2.2. Measures

2.2.1. Independent Variables

The level of acculturation, indicating the adoption of dominant U.S. cultural norms, was computed using information from three items: birthplace, duration of U.S. residence, and language spoken at home in this study [18]. Participants received a score of 0–3 based on their place of birth and duration of U.S. residence (0 = foreign-born, resided in the U.S. less than 5 years; 1 = foreign-born, resided in the U.S. for 5–9 years; 2 = foreign-born, resided in the U.S. for 10+ years; and 3 = U.S.-born) and language spoken at home (0 = speaks a non-English language only, 1 = speaks English and another language, and 2 = speaks English only). The total acculturation score ranged from 0 (least acculturated) to 5 (most acculturated).

Baseline demographics included race/ethnicity, age, marital status, education, health insurance, employment status, federal poverty level (FPL), and self-rated health. Asian ethnicity was further divided into Chinese, Filipina, Korean, Vietnamese, and other Asians. In our analysis, the “other Asians” category included Japanese, Asian Indian, and Pakistani individuals, combined into a single group due to limited sample sizes in these groups.

Four items related to access to birth control information and sexual health services were captured: received birth control information from a doctor in the past year (yes, no), received birth control methods/prescription from a doctor in the past year (yes, no), main type of birth control received from a doctor in the past year, and place received main birth control methods/prescription in the past year.

2.2.2. Outcome Variables

Two outcome variables were analyzed: current use of birth control (yes, no) and types of birth control (long-acting, reversible contraception (LARC), moderately effective contraception, and less effective contraception) [19,20]. In our study, LARC was defined as intrauterine devices (e.g., Mirena or ParaGard) and implants (e.g., Implanon or Nexplanon). Moderately effective contraception included oral contraceptive pills or a hormone injection (e.g., Depo-Provera), a transdermal patch (e.g., OrthoEvra), or a vaginal birth control ring (e.g., NuvaRing). Less effective contraceptive methods included condoms to prevent pregnancy, withdrawal, or some other methods.

2.3. Data Analysis

The preliminary analysis involved comparing population characteristics, types of birth control use, and access to birth control information and services across different racial/ethnic groups (NHW, NHB, Latina, Chinese, Filipina, Korean, Vietnamese, and other Asian women) using ANOVA or chi-squared tests. Missing and nonresponse data for independent variables were excluded from the final analyses. Multi-variable logistic regressions were then conducted to examine the odds ratios (ORs) and 95% confidence intervals (CIs) between race/ethnicity and current contraceptive use after adjusting for confounding variables. Next, four adjusted binary logistic regression models were conducted to examine each type of contraceptive use across racial/ethnic groups in comparison to non-use. All analyses were weighted to accommodate the complex CHIS design and generate representative estimates of the Californian population [18]. Data cleaning and analyses were performed using STATA 18.0 software (Stata Corp., College Park, TX, USA), with significance set at an alpha level of 0.05 or less, two-sided.

3. Results

3.1. Descriptive Characteristics

The demographic characteristics of Californian women aged 18–49 years, who were considered at risk for unintended pregnancy, are shown by race/ethnicity in

Table 1. Baseline characteristics in women aged 18–44, CHIS 2015–2016 ^a,b.

Variable	Overall (N = 7630; pop N = 16,177,759)	Latina (N = 3302; pop N = 7,103,508)	NHW (N = 3012; pop N = 5,158,211)	NHB (N = 475; pop N = 972,346.67)	Chinese (N = 283; pop N = 762,406.9)	Filipina (N = 176; pop N = 789,043.29)	Korean (N = 89; pop N = 348,391.97)	Vietnamese (N = 95; pop N = 303,495.96)	Other Asians c (N = 299; pop N = 892,730.65)	p
	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)
Age										<0.001
18–29	37.47 (35.59–39.39)	39.81 (37.02–42.67)	31.71 (28.95–34.60)	36.16 (29.37–43.55)	50.14 (39.26–61.01)	39.41 (28.76–51.18)	57.56 (41.11–72.49)	27.43 (16.36–42.20)	36.42 (28.28–45.43)
30–39	31.37 (29.62–33.18)	30.92 (28.42–33.54)	34.22 (31.30–37.26)	37.36 (30.28–45.03)	27.76 (19.21–38.31)	28.80 (18.97–41.14)	11.81 (5.31–24.20)	23.94 (13.52–38.80)	27.29 (19.88–36.21)
40–44	31.16 (29.46–32.91)	29.27 (26.91–31.75)	34.07 (31.27–36.99)	26.48 (21.09–32.67)	22.10 (15.49–30.50)	231.78 (2.62–42.62)	30.63 (18.26–46.61)	48.63 (32.59–64.96)	36.29 (27.20–46.48)
Marital status										<0.001
Married	44.56 (42.66–46.47)	42.10 (39.38–44.86)	48.63 (45.57–51.70)	22.19 (16.60–29.00)	40.34 (30.61–50.90)	52.58 (49.95–63.93)	49.76 (33.29–66.29)	54.87 (38.75–70.03)	55.91 (46.61–64.81)
Domestic partner	10.27 (9.27–11.38)	12.90 (11.23–14.78)	10.30 (8.70–12.15)	10.08 (6.26–15.84)	4.70 (2.09–10.23)	5.69 (2.33–13.25)	0.37 (0.05–2.66)	5.32 (1.89–14.09)	3.86 (2.00–7.32)
Separated d	8.88 (7.88–10.00)	9.89 (8.46–11.52)	9.40 (7.75–11.35)	12.76 (7.99–19.77)	1.42 (0.45–4.39)	7.34 (2.23–21.56)	3.15 (0.97–9.78)	5.28 (1.62–15.89)	4.93 (2.48–9.55)
Single	36.29 (34.42–38.19)	35.12 (32.36–37.98)	31.68 (28.86–34.63)	54.97 (47.45–62.27)	53.55 (42.92–63.86)	34.39 (24.21–46.23)	46.72 (30.81–63.32)	34.53 (21.35–50.61)	35.30 (27.16–44.40)
Educational attainment										<0.001
≤High school	36.11 (34.37–37.89)	57.57 (54.68–60.41)	19.57 (17.34–22.00)	31.45 (25.19–38.46)	9.48 (5.51–15.83)	14.24 (8.51–22.87)	9.45 (4.45–18.96)	51.64 (35.48–67.46)	13.26 (8.89–19.34)
Some college	23.94 (22.34–25.62)	22.73 (20.44–25.19)	26.73 (24.12–29.51)	30.71 (24.54–37.65)	14.24 (7.34–25.84)	29.15 (19.44–41.22)	22.58 (11.52–39.51)	10.28 (4.72–20.95)	19.01 (12.69–27.50)
College	28.23 ( 26.40–30.14)	16.10 (13.73–18.80)	35.69 (32.74–38.74)	23.56 (18.06–30.12)	58.03 (47.32–68.03)	41.67 (31.09–53.08)	48.41 (31.97–65.20)	25.24 (13.38–42.44)	42.64 (33.29–52.54)
≥Graduate school	11.71 (10.53–13.00)	3.60 (2.71–4.77)	18.02 (15.81–20.47)	14.29 (9.00–21.93)	18.24 (12.43–25.96)	14.94 (7.59–27.30)	19.56 (10.62–33.22)	12.84 (5.55–26.95)	25.09 (18.34–33.31)
Health insurance coverage										<0.001
Insured	90.37 (89.12–91.49)	84.47 (82.06–86.61)	94.90 (93.65–95.91)	94.75 (91.12–96.94)	92.19 (83.08–96.60)	95.03 (88.77–97.88)	97.44 (91.82–99.23)	96.99 (92.39–98.85)	95.64 (89.35–98.29)
Not insured	9.63 (8.51–10.88)	15.53 (13.39–17.94)	5.10 (4.09–6.35)	5.25 (3.06–8.88)	7.81 (3.40–16.92)	4.97 (2.12–11.23)	2.56 (0.77–8.18)	3.01 (1.15–7.61)	4.36 (1.71–10.65)
Employment status										0.001
Employed	71.08 (69.34–72.77)	67.13 (64.55–69.60)	77.15 (71.39–77.05)	78.83 (72.90–83.74)	78.83 (69.19–86.06)	79.50 (69.28–86.96)	68.03 (50.59–81.56)	72.39 (57.20–83.73)	62.10 (52.14–71.13)
Unemployed	28.92 (27.23–30.66)	32.87 (30.40–35.45)	25.68 (22.95–28.61)	21.17 (16.26–27.10)	21.17 (13.94–30.81)	20.50 (13.04–30.72)	31.97 (18.44–49.41)	27.61 (16.27–42.80)	37.90 (28.87–47.86)
Poverty level										<0.001
> = 100.00%FPL	56.63 (54.75–58.50)	36.63 (33.85–39.50)	77.15 (74.63–79.48)	52.46 (44.93–59.46)	71.37 (61.47–79.57)	74.88 (64.63–82.94)	61.76 (43.18–77.43)	52.68 (36.28–68.53)	72.71 (64.71–79.48)
<100.00% FPL	43.37 (41.50–45.25)	63.37 (60.50–66.15)	22.68 (20.52–25.37)	47.76 (40.54–55.07)	21.17 (0.43–38.53)	25.12 (17.06–35.37)	38.44 (22.57–56.82)	47.32 (31.47–63.72)	27.29 (02.52–35.29)
Self-rated health										<0.001
Good or above	83.26 (81.91–84.53)	76.60 (74.31–78.74)	89.43 (87.72–90.93)	85.88 (81.29–89.49)	71.37 (76.44–92.76)	88.77 (80.55–93.78)	61.76 (71.02–93.06)	86.72 (73.01–94.03)	88.25 (80.47–93.19)
Fair or poor	16.74 (15.47–18.09)	23.40 (21.26–25.69)	10.57 (9.07–12.28)	14.12 (10.51–18.71)	28.63 (7.24–23.56)	11.23 (6.22–19.45)	38.24 (6.94–28.98)	13.28 (5.96–26.99)	11.75 (6.81–19.53)
Acculturation level, mean (SD)	3.80 (0.03)	3.28 (0.04)	4.68 (0.03)	4.77 (0.05)	2.87 (0.18)	3.74 (0.13)	2.84 (0.26)	2.82 (0.18)	3.34 (0.11)	<0.001

Note: CI: confidence interval; FPL: federal poverty level; NHB: non-Hispanic Black; NHW: non-Hispanic White; SD: standard deviation. ^a Data are reported as weighted percent (standard error of percent) unless noted otherwise. ^b The model weights for complex study design were derived from the CHIS dataset. ^c Other Asians include Japanese, Asian Indian, and Pakistani. ^d Separated include widowed, divorced, and separated.

. Notably, over 50% of Chinese and Korean women in the 18–29 age group, compared to approximately 30% of NHW and Vietnamese women, were in the same category (p < 0.001). Marital status varied significantly, with 22.19% of NHB women being married, compared to 40–50% in other racial groups. Latinas exhibited low health insurance coverage, with their uninsured rate being 4–5 times higher than other racial groups (p < 0.001). Latinas also had the lowest educational attainment, reflected by the lowest rate of holding a college degree and the highest poverty rate. Furthermore, Korean women reported the highest rate of self-reported fair or poor health (38.24%) compared to all other groups (p < 0.001). Chinese, Vietnamese, and Korean women demonstrated significantly lower acculturation levels than other racial/ethnic groups (p < 0.001).

3.2. Types of Birth Control Use and Sexual Health Services by Race/Ethnicity

Table 2. Birth control and related information among women aged 18–44, CHIS 2015–2016.

Variable	Overall (N = 7630; pop N = 16,177,759)	Latina (N = 3302; pop N = 7,103,508)	NHW (N = 3012; pop N = 5,158,211)	NHB (N = 475; pop N = 972,346.67)	Chinese (N = 283; pop N = 762,406.9)	Filipina (N = 176; pop N = 789,043.29)	Korean (N = 89; pop N = 348,391.97)	Vietnamese (N = 95; pop N = 303,495.96)	Other Asians a (N = 299; pop N = 892,730.65)	p
	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)
Use of birth control										<0.001
Yes	54.33 (52.09–56.55)	51.13 (7.89–54.36)	62.73 (59.20–66.14)	51.29 (42.76–59.74)	60.35 (47.93–71.56)	44.90 (31.51–59.07)	33.66 (16.38–56.79)	35.93 (20.80–54.49)	53.35 (42.88–63.53)
No	45.67 (43.45–47.91)	48.87 (45.64–52.11)	37.27 (33.86–40.80)	48.71 (40.26–57.24)	39.65 (28.44–52.07)	55.10 (40.93–68.49)	66.34 (43.21–83.62)	64.07 (45.51–79.20)	46.65 (36.47–57.12)
Birth control method										0.006
LARC b	40.88 (37.85–43.99)	45.29 (40.78–49.88)	42.50 ( 37.87–47.26)	29.07 (19.26–41.33)	20.54 (8.65–41.35)	35.46 (18.62–56.88)	28.00 (7.98–63.56)	19.32 (6.69–44.43)	40.57 (25.32–57.89)
Moderately effective c	24.03 (21.34–26.95)	20.45 (17.18–24.15)	26.58 (22.53–31.07)	27.68 (15.74–43.94)	24.86 (13.87–40.47)	45.15 (23.39–68.94)	36.64 (7.90–79.59)	40.54 (18.90–66.61)	9.84 (4.77–19.23)
Less effective d	35.08 (32.11–38.17)	34.26 (29.72–39.11)	30.92 (26.80–35.36)	43.25 (30.97–56.42)	54.60 (37.24–70.91)	19.39 (9.14–36.52)	35.36 (11.58–69.56)	40.14 (18.38–66.63)	49.58 (34.29–64.95)
Received birth control information from doctor past year										0.003
Yes	38.37 (35.31–41.54)	32.64 (28.63–36.92)	43.60 (38.93–48.39)	30.00 (20.09–42.21)	61.29 (45.35–75.14)	51.81 (30.04–72.92)	41.00 (10.69–80.13)	38.29 (18.51–62.89)	25.09 (15.44–38.05)
No	61.63 (58.46–64.69)	67.36 (63.08–71.37)	56.40 (51.61–61.07)	70.00 (57.79–79.91)	38.71 (24.86–54.65)	48.19 (27.08–69.96)	59.00 (19.87–89.31)	61.71 (37.11–81.49)	74.91 (61.95–84.56)
Received birth control method/prescription from doctor, past year										0.040
Yes	39.31 (36.19–42.51)	35.25 (30.71–40.06)	44.15 (39.51–48.89)	34.43 (23.71–47.00)	47.40 (30.88–64.51)	55.52 (33.75–75.36)	45.14 (13.53–81.22)	50.98 (26.84–74.68)	21.60 (12.64–34.41)
No	60.69 (57.49–63.81)	64.75 (59.94–69.29)	55.85 (51.11–60.49)	65.57 (53.00–76.29)	52.60 (35.49–69.12)	44.48 (24.64–66.25)	54.86 (18.78–86.47)	49.02 (25.32–73.16)	78.40 (65.59–87.36)
Main type birth control received from doctor, past year										----
IUD	16.91 (13.80–20.55)	19.31 (14.00–26.01)	15.55 (11.41–20.83)	17.25 (8.22–32.68)	5.63 (1.49–19.04)	10.43 (2.50–34.65)	12.52 (1.09–65.05)	24.91 (6.13–62.75)	38.21 (16.91–65.27)
Birth control pills	58.86 (53.76–63.78)	50.07 (41.36–58.78)	62.29 (55.23–68.87)	46.27 (27.87–65.76)	73.99 (4.65–90.31)	85.39 (60.25–95.75)	83.46 (32.96–98.11)	61.99 (28.40–87.02)	51.10 (26.92–74.77)
Other control pills	13.56 (10.83–16.86)	13.28 (9.50–18.27)	15.81 (11.18–21.89)	27.53 (15.02–44.95)	9.47 (2.01–34.74)	0.34 (0.04–2.72)	0	3.13 (0.40–20.76)	9.15 (3.11–24.01)
Other birth control and hysterectomy	10.67 (8.21–13.75)	17.34 (12.52–23.51)	6.35 (4.07–9.77)	8.95 (3.58–20.64)	10.91 (1.71–46.28)	3.83 (0.48–24.69)	4.02 (0.35–33.45)	9.97 (1.46–45.32)	1.54 (0.23–9.44)
Place received main birth control method/prescription										----
Private doctor’s office/HMO facility	49.82 (44.41–55.24)	37.61 (30.13–45.73)	61.22 (53.83–68.13)	37.42 (22.61–55.03)	37.82 (18.03–62.72)	50.82 (18.95–82.04)	93.71 (64.02–99.20)	49.10 (19.02–70.84)	79.72 (61.05–90.79)
Hospital/hospital/Clinic	12.82 (9.89–16.47)	20.35 (15.50–26.26)	4.93 (3.00–8.02)	17.55 (7.83–34.78)	24.56 (6.23–61.47)	6.70 (0.86–37.27)	0	11.17 (1.64–48.72)	5.47 (1.74–15.94)
Planned parenthood/County health department	21.28 (16.63–26.81)	30.94 (21.82–41.84)	16.24 (12.08–21.47)	29.51 (12.66–54.73)	11.17 (1.83–45.94)	5.81 (0.90–29.57)	0	36.00 (10.17–73.64)	4.94 (1.34–16.64)
Other	16.07 (12.23–20.84)	11.09 (7.41–16.28)	17.61 (11.99–25.11)	15.51 (6.94–31.16)	26.45 (10.49–52.45)	36.67 (9.98–75.14)	6.25 (0.80–35.98)	3.74 (0.62–19.44)	9.86 (3.13–27.06)

Note: CI: confidence interval; HMO: health maintenance organization; LARC: long-acting, reversible contraception; NHB: non-Hispanic Black; NHW: non-Hispanic White; IUD: intrauterine device. ^a Other Asians include Japanese, Asian Indian, and Pakistani. ^b LARC includes intrauterine devices (e.g., Mirena or ParaGard) and implants (e.g., Implanon or Nexplanon). ^c Moderately effective contraceptive methods include oral contraceptive pills or a hormone injection (e.g., Depo-Provera), a transdermal patch (e.g., OrthoEvra), or a vaginal birth control ring (e.g., NuvaRing). ^d Less effective contraceptive methods include condoms to prevent pregnancy, withdrawal, or some other method.

presents information on contraceptive use and related aspects among the study population. Overall, 54.33% (95% CI: 52.09–56.55) of participants used contraception, with almost twice the prevalence in NHW women (62.73%; 95% CI: 59.20–66.14) compared to Korean women (33.66%; 95% CI: 16.38–56.79). When categorized by contraceptive methods, 40.88% (95% CI: 37.85–43.99) reported using LARC, ranging from 19.32% (95% CI: 6.69–44.43) in Vietnamese women to 45.29% (95% CI: 40.78–49.88) in Latinas (p = 0.006). Substantial differences in receiving clinical guidance for contraception use were also observed, with Chinese women having the highest proportion of receiving contraceptive information (61.29%) and Filipinas receiving most contraceptive interventions and prescriptions (55.52%) from their doctors. Meanwhile, the highest proportion of IUD receipt (38.21%) was observed in the “Other Asian” group, while more Filipinas reported having received contraceptive pills (85.39%). NHB, Chinese, and Latina women were less likely to receive prescribed contraceptives in a private doctor’s office/HMO facility compared to NHW women.

3.3. Regression Results on Birth Control Use by Race/Ethnicity

Table 3. Multivariable logistic regression of contraceptive use and its covariates among women aged 18–44, CHIS 2015–2016 ^a,b.

	Whether Use Birth Control c (F(22,5614) = 9.37; p < 0.001)
Variable	OR (95% CI)	p Value
Race/ethnicity
NHW	REF
Hispanic	0.98 (0.76–1.27)	0.91
NHB	0.82 (0.55–1.23)	0.34
Chinese	1.09 (0.62–1.89)	0.77
Filipino	0.49 (0.26–0.92)	0.03
Korean	0.39 (0.16–0.90)	0.03
Vietnamese	0.43 (0.20–0.92)	0.03
Other Asians d	0.80 (0.48–1.34)	0.41
Health insurance coverage
Insured	REF
Not insured	0.76 (0.56–1.03)	0.08
Self-rated health
Good or above	REF
Fair or poor	0.90 (0.70–1.14)	0.37
Received birth control information from a doctor, past year
Yes	REF
No	0.94 (0.72–1.23)	0.67
Received birth control method/prescription from a doctor, past year
Yes	REF
No	0.39 (0.29–0.51)	<0.001
	Coeff. (std. error)	p value
Acculturation level	1.10 (0.05)	0.05

Note: CI: confidence interval; NHB: non-Hispanic Black; NHW: non-Hispanic White; OR: odds ratio; REF: reference; Coeff.: coefficient; STD error: standardized error. ^a The model adjusts for age, education, employment status, marital status, and poverty level. ^b The model weights for complex study design derived from the CHIS dataset. ^c Outcome variable is that “Are you or your male sex partner currently using a birth control method to prevent pregnancy”. ^d Other Asians include Japanese, Asian Indian, and Pakistani.

displays the associations between contraceptive usage and race/ethnicity after adjusting for confounding factors such as age, education, employment status, marital status, and poverty level. In summary, Filipinas (OR: 0.49; 95% CI: 0.26–0.92), Koreans (OR: 0.39; 95% CI: 0.16–0.90), and Vietnamese (OR: 0.43; 95% CI: 0.20–0.92) were less likely to use contraception compared to their NHW peers. Also, women who did not receive birth control prescriptions from the doctor’s office in the past year (OR: 0.39; 95% CI: 0.29–0.51) were less inclined to use contraception, while highly acculturation levels were positively associated with birth control use (p = 0.050).

Table 4. Multivariable logistic regression of types of contraceptive use in women aged 18–44, CHIS 2015–2016 ^a,b.

	Currently Using a Birth Control Method c
	LARC d (F(223,848) = 7.95; p < 0.001)		Moderately Effective e (F(223,234) = 17.27; p < 0.001)		Less effective f (F(223,556) = 4.17; p < 0.001)
Race/Ethnicity	OR (95% CI)	p Value	OR (95% CI)	p Value	OR (95% CI)	p Value
NHW	REF		REF		REF
Hispanic	0.95 (0.69–1.32)	0.77	0.96 (0.65–1.43)	0.85	1.01 (0.72–1.42)	0.95
NHB	0.57 (0.34–0.95)	0.03	1.04 (0.39–2.79)	0.94	1.04 (0.64–1.67)	0.87
Chinese	0.57 (0.18–1.85)	0.35	1.41 (0.59–3.37)	0.44	1.56 (0.82–2.97)	0.18
Filipino	0.37 (0.16–0.83)	0.02	0.92 (0.34–2.46)	0.87	0.33 (0.15–0.73)	<0.01
Korean	0.22 (0.06–0.79)	0.02	1.32 (0.36–4.85)	0.67	0.44 (0.16–1.26)	0.13
Vietnamese	0.16 (0.04–0.59)	<0.01	1.14 (0.36–3.62)	0.83	0.68 (0.22–2.07)	0.50
Other Asians g	0.71 (0.34–1.48)	0.36	0.36 (0.13–0.98)	0.03	1.18 (0.68–2.05)	0.56

Note: CI, confidence interval; LARC = long-acting, reversible contraception; NHB: non-Hispanic Black; NHW: non-Hispanic White; OR: odds ratio; REF: reference. ^a The models adjust for age, marital status, education, health insurance coverage, employment status, poverty level, self-related health, received birth control information from the doctor’s in the past 12 months, received birth control method/prescription from the doctor’s in the past 12 months, and acculturation. ^b The models’ weight for complex study design derived from the CHIS dataset. ^c Outcome variable is that “If you use birth control methods, which birth control method(s) are you using”. ^d LARC includes intrauterine devices (e.g., Mirena or ParaGard) and implants (e.g., Implanon or Nexplanon). ^e Moderately effective contraceptive methods include oral contraceptive pills or a hormone injection (e.g., Depo-Provera), a transdermal patch (e.g., OrthoEvra), or a vaginal birth control ring (e.g., NuvaRing). ^f Less effective contraceptive methods include condoms to prevent pregnancy, withdrawal, or some other method. ^g Other Asians include Japanese, Asian Indian, and Pakistani.

shows the racial/ethnic disparities in the utilization of different types of contraceptives. The analyses controlled for confounding factors including age, marital status, education, health insurance coverage, employment status, poverty level, self-related health, received birth control information from the doctor’s office, received birth control prescription, and acculturation. The findings reveal that, compared to non-use, NHB (OR: 0.57; 95% CI: 0.34–0.95), Filipina (OR: 0.37; 95% CI: 0.16–0.83), Korean (OR: 0.22; 95% CI: 0.06–0.79), and Vietnamese (OR: 0.16; 95% CI: 0.04–0.59) women were less likely to use LARC compared to NHW. The “Other Asian” subgroup was also less likely to use moderately effective contraceptive methods (OR: 0.36; 95% CI: 0.13–0.98), while Filipinas were less likely to use less effective contraceptive methods (OR: 0.33; 95% CI: 0.15–0.73) compared to their NHW peers.

4. Discussion

This study addresses the research gap in contraceptive use disparities among racially/ethnically diverse women in California, with a particular focus on Asian subgroups. The significance of this research lies in challenging the dispelling myths and addressing stereotypes surrounding sex and safe sex practices among Asian American women. For instance, Asian cultural values that promote conservative attitudes toward sex might lead some health professionals to mistakenly assume that Asian Americans are at low risk for risky sexual behaviors. Additionally, cultural norms and misconceptions may contribute to lower rates of seeking birth control or sexual health services among Asian American women [15]. Our findings reveal that in contrast to the overall contraceptive use rate of 54.33% among California women, Filipina, Korean, and Vietnamese women report lower rates and lower odds of contraceptive use compared to their NHW peers. Additionally, there is notable variation in contraceptive use patterns, preferred methods, and healthcare utilization across different Asian American subgroups.

The study also found that single women were less likely to use contraceptives, potentially heightening their vulnerability to unintended pregnancy. Factors such as financial stability, family planning, and potential discomfort may limit single women’s access to sexual and reproductive health services compared to their married counterparts. In our study, women with less educational attainment exhibited reduced contraceptive usage, consistent with previous literature highlighting the positive influence of knowledge and education on employment, access to healthcare, and reproductive care [21,22]. It is noteworthy that the contraceptive usage rate in our study was slightly lower than the national level (65.3%) among women aged 15–49 years based on the 2017–2019 U.S. National Survey of Family Growth data [2]. This discrepancy could be attributed to the unique demographic composition of California, where Latinos constitute the largest ethnic group facing challenges in socioeconomic status, such as low health insurance coverage, educational attainment, employment rate, and high poverty, alongside lower self-assessed health [22]. Additionally, the absence of adolescence data may contribute to the variation in contraceptive use rates [2].

In contrast to prior findings [23,24], our results did not reveal significant differences in contraceptive use between NHW, Latina, and NHB women. This suggests that racial/ethnic disparities in contraceptive use may be mitigated by demographic and socioeconomic factors, such as the low marriage rate in NHB women, and the socioeconomic disadvantages faced by NHB women and Latinas, as mentioned earlier [1,2,6,7].

Asian women, on the other hand, exhibited similar rates of healthcare access, such as receiving birth control information and obtaining contraceptive prescriptions from the doctor’s office, compared to NHW women. Despite these comparable rates of healthcare access, contraceptive use among most Asian women remained significantly lower than that of their NHW peers. Specifically, Filipina, Korean, and Vietnamese subgroups within the Asian population exhibited lower contraceptive usage rates compared to their NHW counterparts. These findings emphasize the necessity of future studies to discover specific needs for these Asian subgroups and to develop targeted interventions that leverage established resources to enhance access to and utilization of reproductive health services.

We observed a positive association between acculturation level and contraceptive use, with lower acculturation levels noted among Vietnamese and Korean women. Acculturation, defined as the integration of immigrants into mainstream society while retaining some heritage cultural beliefs and values, played a significant role in contraceptive behaviors [25]. Moreover, nearly three-quarters of Asian American adults in our study were born abroad, highlighting a substantial presence of immigrants and their adult children in this demographic. Our finding indicated that foreign-born women were less likely to use effective methods, including spermicide, sponge, gel, cream, and withdrawal. This echoes the results of a study by Farid et al., which suggested that cross-continental migration does not diminish the impact of culture on contraceptive use [26]. Additionally, research has shown that Chinese women in Australia may be less willing to seek medical advice about contraceptive use, believing that family planning does not require medical intervention [27]. Concerns about side effects, including reduced or absent menstrual bleeding, primarily drive reluctance to use hormonal methods [27]. A qualitative study of Korean women living in Canada showed deep-seated beliefs that hormonal contraceptive methods cause permanent harm [28]. Thus, the lower contraceptive usage in Asian subgroups may be explained by family opposition, pressure from spouses or in-laws to have children, cultural prohibitions, lack of education/knowledge about contraceptives, fear of side effects, misinformation, and infrequent use of oral contraceptive pills and other devices [25,26,28]. Prior studies also suggest a significant correlation between education level, sex education, and contraceptive use in different Asian subgroups [26,29,30]. The notable absence of sex education within Asian American families and infrequent discussions about family planning contribute to this trend. Asian American adolescents, across subgroups including Vietnamese, Filipinas, Koreans, and Chinese, often considered school as their primary source of family planning-related education, with family being the least reported source [12]. The National Longitudinal Study of Add Health Wave I and II data indicated that a substantial percentage (89.0% and 57.3%) of Asian American adolescents and young adults perceived maternal disapproval of sexual activities and contraceptive use [31].

Our study underscores a complex interplay of cultural, personal, and societal biases against hormonal contraception in Asian women, laying the foundation for future research to explore barriers (e.g., acculturation), cultural contexts (e.g., immigrant family or culture), and determinants of contraceptive use across different Asian subgroups, beyond access to healthcare services and information.

The use of LARC has increased significantly across all racial/ethnic groups over the past decade, rising from 6.5% in 2008 to 15.0% in 2014, and further to 17.3% in 2018 in the U.S., largely due to the Affordable Care Act [32]. However, our findings reveal that Filipina, Korean, and Vietnamese women are significantly less likely to use LARC than NHW peers. A study showed that Asian or Pacific Islander obstetrician–gynecologists were significantly less likely to provide same-day IUD placement (OR = 0.26; 95% CI: 0.11–0.61) [33], suggesting potential disparities rooted in “statistical discrimination”, where providers may rely on general clinical experience or epidemiological evidence rather than individualized information to guide clinical decisions for specific sociodemographic groups [34]. Also, patients’ concerns about LARC might be influenced more by information from media, partner(s), family, or peers than by providers’ knowledge [35]. While some discussions exist about the relationships between LARC use, delayed pregnancies, and personal contraceptive preferences over time; there is limited information, especially regarding Asian American women [36]. Nevertheless, when barriers related to access and cost are removed, and women receive unbiased and accurate contraceptive counseling, LARC often becomes the preferred method of contraception [37].

To address racial/ethnic disparities in contraceptive use, integrating cultural sensitivity training into medical education and workplaces is essential. Such training enhances providers’ knowledge and communication styles, supporting immigrant women and women of color. Our study found that Filipina women reported higher percentages of receiving birth control from a doctor in the past year; however, they showed lower utilization rates of IUDs. This pattern was not observed among Vietnamese women. Contraceptive method preferences varied significantly across different Asian groups. It is important to implement anti-oppressive sex education and health practices, recognizing that the Asian population is not homogeneous. Understanding these diverse needs and identifying unmet family planning requirements are crucial for making informed healthcare decisions and preventing sexually transmitted infections. Culturally tailored, patient-centered contraceptive counseling is vital for all women’s health encounters, emphasizing the need for tailored health education for diverse racial/ethnic groups. Future national studies should focus on collecting data from specific Asian subgroups, incorporating surrounding attitudes and cultural norms to explore the relationships between acculturation, culture, immigration, and contraceptive use.

5. Limitations

The results of this study should be interpreted with caution due to several limitations. First, the CHIS data analyzed here are subject to self-report and selection bias (due to the study design), potentially leading to over- or underestimation of contraceptive use due to social desirability. Also, the Asian Americans in CHIS may be more acculturated, possessing higher levels of health literacy or knowledge. The absence of items on cultural beliefs, religious practices, gender norms, and sexual practices in the CHIS prompts the need for future studies to explore these factors among Asian American subgroups. Second, the cross-sectional nature of the CHIS data prevents a causal relationship. Data privacy protection and small sample sizes of various Asian subgroups may contribute to wide 95% confidence intervals, possibly introducing Type II errors. Combining certain subgroups, such as Japanese and Asian Indians, was necessary for statistical power in this study, limiting the generalizability of our findings to all Asian American subgroups in California or other states.

6. Conclusions

Significant heterogeneity in contraceptive use patterns was observed within Californian women and especially Asian American women. Given the positive outcomes for individuals’ health and socio-economic well-being associated with using contraception, it is important to facilitate access to the full range of contraceptive methods available for people of color, particularly in some Asian subgroups who reported a lower rate of birth control use in our study. To address the differences in the provision of sexual health services and promote sexual health equity for Asian women, person-centered, culturally competent, language-inclusive, and anti-oppressive practices and programs aimed at combating bias, stigma, and discrimination in the health care system are necessary.