Preventing unplanned pregnancies for women who are obese is especially important given the likelihood of co-morbidities that endanger both the woman and fetus. Given that the most effective contraception methods are available only by prescription, necessitating interaction with providers, this study addresses the following questions: Does obesity impact contraception use and women's choice in contraception type? If so, is there a possibility that health care provider bias toward obese individuals contributes to this impact?
This sequential mixed methods study leveraged quantitative analysis to inform qualitative interviews with family medicine physicians. Regression analysis was conducted using the National Survey of Family Growth (NSFG), Cycle 2006-2010. The analytic sample (n=5,600+) controlled for individual and socioeconomic factors including poverty, race, education and access to health care. Qualitative, structured interviews were conducted with family medicine residents employed by an accredited California family medicine residency program.
The findings demonstrate that sexually active women with a BMI over 35 (obese class II) are 49% less likely to use contraception than women with a BMI below 25 (p-value <.05.) Recent access to reproductive health care did not significantly improve rates of contraception. Women in obese class II who had a recent pelvic exam and/or family planning counseling remain 44% less likely to use contraception (p-value< .001). The findings also demonstrate that obesity is not a significant predictor of using a method prescribed or administered by a physician. Obese women are just as sexually active, as likely to access reproductive health care and - when prescribed - often use the most efficacious method of reversible contraception than other women.
These findings imply that continuing to focus intervention efforts primarily on access to
reproductive health care for this population may not deliver desired outcomes. The interviews explored the context in which obese patients receive care to highlight and examine important nuances specific to this population. Physicians cited patient concern about contraceptive side effects, provider bias and time and/or resources constraints as contributing to lower rates of use. When asked for suggestions, the majority of physicians recommended invoking a policy to ask all patients of reproductive age about family planning goals. Other common suggestions addressed time constraints, inadequate equipment and additional education for physicians regarding obesity specific reproductive health.
