Contraceptive Choices By Weight Status Among Women In The United States: An Analysis Of The 2015-2017 National Survey Of Family Growth.

Over 40% of adult women in the United States have obesity. Exploring the differences in contraceptive use among women with normal weight, overweight, and obesity will improve understanding of fertility and unintended pregnancies in reproductive-aged women. Our objective was to examine contraceptive choices by weight among women in the United States. This was a retrospective, cross-sectional study utilizing data from the 2015-2017 National Survey of Family Growth (NSFG). The 2015-2017 NSFG is a population-based survey conducted by the National Center for Health Statistics division of the Centers for Disease Control and Prevention that is nationally representative of the United States household population between ages 15-49 years. The NSFG includes information on participants' general and reproductive health, pregnancy, infertility, and use of contraception. Analyses of data were from 5,554 women, aged 15-49 years. Body mass index (BMI) was calculated based on self-reported height and weight and was divided into four categories. Those with a BMI <18.5 kg/m2, 18.5–24.9 kg/m2, 25.0–29.9 kg/m2, and ≥30.0 kg/m2 were classified as being underweight, normal, overweight and having obesity respectively. We excluded from analyses women < 20 years and those > 44 years old, those that were pregnant or recently delivered and those trying to get pregnant but included those with a history of previous tubal ligation. We used Chi-squared test to determine the relationship between the different contraceptive choices and weight variables. We performed multinomial logistic regression analysis to determine the relationship between each contraceptive choice and each weight category. Statistical analyses were performed using R version 3.6.1. Compared to women of normal weight, those that are overweight were more likely [1.56 (1.09-2.21), p=0.01] to use female sterilization and less likely [0.69 (0.49-0.98), p=0.04] to use oral contraceptive pills. Similarly, women with obesity were [2.09 (1.50-2.91), p <0.001] more likely to use female sterilization and were [1.9 (1.15-3.16), p=0.01] more likely to use Depo Provera than women of normal weight. In addition, women with obesity were less likely [0.68 (0.49-0.95), p=0.02] to use the pill and less likely [0.59 (0.36-0.94), p=0.03] to use male sterilization compared to women of normal weight. Female sterilization use was the method of choice for contraception in women who are overweight and women with obesity compared to their normal weight counterparts. Women with obesity are also less likely to use contraceptive pills and instead more likely to use Depo Provera for contraception.