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Black Women and Birth Control

Medically Reviewed by Traci C. Johnson, MD on June 03, 2022

Anyone can have an unplanned pregnancy. In fact, it happens to about 1 in every 2 women who get pregnant. But those rates are higher for Black women, and they’re less likely to use regular birth control than women in some other racial groups.

Why Do Black Women Have More Unintended Pregnancies?

There isn’t a clear driving force behind racial differences in pregnancy rates. But experts think contraception plays a role. Black women ages 15 to 49 are less likely than other racial groups to use birth control regularly. And those between 18 to 24 tend to prefer condoms, a less effective way to prevent pregnancy, when they use contraception.

Black women are less likely to use prescription contraception. That includes birth control pills and long-acting reversible contraceptives (LARCs). Besides not having sex (abstinence) and permanent sterilization (getting your tubes tied), LARCs are the most effective form of birth control.

Examples of LARCs include:

Why Are There Racial Differences in Birth Control Use?

Women of color face social and structural hurdles to health and reproductive care. This happens for several reasons. But experts largely blame centuries of inequality and racial discrimination.

Racial disparities can affect birth control access and use in the following ways:

High costs. Due to structural racism, people of color are less likely to have access to quality medical care and health insurance that they can afford. People without coverage are less likely to use -- or be able to pay for -- highly effective forms of birth control.

Medical mistrust. Some people in the Black community are less trusting of health professionals. There are well-documented reasons for this. Studies have found some doctors may urge Black (and Latina) women to have fewer kids or to start birth control early. Some urge sterilization.

This kind of pregnancy prevention pressure can backfire and result in less use of reliable contraception.

Desire to avoid hormones. Some contraceptives put chemicals in your bloodstream. And some Black women may not feel comfortable using these hormonal forms of birth control.

Pharmacy access. Studies have found Black women are less likely than white women to live near a pharmacy where it’s easy to buy or learn about birth control. Researchers call this a “contraception desert.” It refers to a setting where Black women have less access to:

  • Black or female pharmacists
  • Condoms on the shelf instead of behind a counter
  • Easy-to-understand brochures about birth control
  • Self-checkout for privacy
  • Pharmacies with longer hours

Fear about delaying motherhood. Black women are three to four times more likely to die from pregnancy-related reasons than white women. Those odds go up with age. Researchers think some Black women may want to have children at a younger age to boost their chances of a healthy pregnancy.

Dark History of Birth Control Among Black Women

Women of all races and ethnicities support equal access to birth control. But the United States has a long history of forcing or pressuring Black women to limit their fertility. This may play a part in why some Black women avoid prescription birth control, such as LARCs.

Some racial and reproductive wrongs include:

Eugenics. From the early 1900s to 1970s, many states supported the false idea that Black people are biologically less intelligent than white people. You may hear this called “scientific racism.”

There’s no evidence to support genetic differences based on race. Still, many Black women were sterilized without their permission.

Birth control and benefits. Throughout history, low-income Black women have been urged to use permanent birth control (sterilization) or have fewer children in order to get medical care or cash assistance from the government.

What’s the Best Birth Control for You?

There isn’t one kind of contraception that works for everyone. The “best” choice is the most effective birth control method that you feel comfortable with. It also needs to be something you’ll use every time you have sex.

Here are some things to consider when choosing your birth control:

  • Do you want kids? If so, how soon?
  • Do you smoke or have a history of blood clots?
  • Do you have other heart or blood vessel problems?
  • How often do you have sex?
  • Do you need to prevent HIV or sexually transmitted infections?

Here’s a breakdown of how well common methods of birth control can prevent pregnancy. These numbers refer to “typical” use. That leaves a little room for human error. Keep in mind some types of birth control are easier to use than others.

  • Progestin arm implant: Almost 100%
  • IUDs: Almost 100%
  • Birth control shot: 96%
  • Birth control pills, vaginal ring, or patch: 93%
  • Male condoms: 87%
  • Female condom: 79%

Hormonal contraceptives -- birth control pills, the vaginal ring, and the patch -- can be up to 99% effective. But you’d have to use them exactly as prescribed. And it’s easy to forget to take them at the same time each day, week, or month.

Emergency contraception, or the morning after pill, isn’t a regular form of birth control. But it can prevent pregnancy when another kind of birth control fails, like if a condom breaks during sex. You can take it up to 5 days after you have unprotected sex. But it’s best to take it sooner than that.

Talk to Your Doctor About Birth Control

Studies show people tend to choose more effective forms of birth control when given info on how well they work. To find out more, ask your doctor. They’ll help you decide what method fits best with your lifestyle.

If you’re under 18, it’s OK to talk to your doctor or nurse about birth control without your parents around. Everything about your visit is private. If you end up getting birth control, they can’t tell your parents about it. That’s due to something called doctor-patient confidentiality.

Most health insurance plans have to cover the full cost of prescription birth control. They also have to pay for any birth control counseling. Call your insurance provider to find out more.

If you don’t have health insurance, you may be able to get low-cost or free birth control from a family planning or reproductive health center in your area. You can also find services through Planned Parenthood locations.

Show Sources

SOURCES:

Contraception and Reproductive Medicine: “Are higher unintended pregnancy rates among minorities a result of disparate access to contraception?”

Contraception: “Racial and Ethnic Differences in Contraceptive Use Among Women Who Desire No Future Children, 2006-2010 National Survey of Family Growth.”

American Journal of Ethics: “Seeking Causes for Race-Related Disparities in Contraceptive Use.”

Obstetrics & Gynecology: “Racial and Ethnic Disparities in Reproductive Health Services and Outcomes, 2020.”

American Journal of Obstetrics & Gynecology: “Racial/ethnic disparities in contraceptive use: Variation by age and women’s reproductive experiences.”

The American College of Obstetricians and Gynecologists: “Long-Acting Reversible Contraception (LARC): Intrauterine Device and Implant.”

Journal of Racial and Ethnic Health Disparities: “Contraceptive Desert? Black-white differences in characteristics of nearby pharmacies.”

Health Equity: Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity.”

American Heart Association: “Why are Black women at such high risk of dying from pregnancy complications.”

Harvard Public Health: “America is Failing Its Black Mothers.”

Demography: “Black-White Differences in Pregnancy Desire During the Transition to Adulthood.”

National Human Genome Research Institute: “Eugenics and Scientific Racism.”

Evaluation Program Planning: “Message and price components of Family Caps: experimental evidence from New Jersey.”

Office of Disease Prevention and Health Promotion (MyHealthFinder): “Choose the Right Birth Control.”

Yale Medicine: “What Birth Control Is Best for Me?”

CDC: “Reproductive Health: Contraception.”

KidsHealth.org: “How Can I Get on the Pill Without Telling My Parents?”

Office on Women’s Health: “Birth control methods.”

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