Difficulty Walking and Contraceptive Use among Reproductive Aged Women: The 2019 CDC’s Behavioral Risk Factor Surveillance System (BRFSS)

A disproportionate number of physically disabled women face barriers to timely and appropriate reproductive healthcare. Yet, little is known about the relationships between functional limitations and contraceptive use. Further, racial minorities (e.g., Black and Hispanic disabled women) in the United States frequently experience racial inequality related compounding factors that exacerbate lack of access to quality healthcare, including contraceptive services. The objective of the current study was to investigate associations of difficulty walking with self-reported contraceptive use. In addition, we examined if the associations differed by racial/ethnic groups and correlates of contraceptive use among women with difficulty walking. Methods: This study was conducted using the CDC’s 2019 Behavioral Risk Factor Surveillance System (BRFSS). A total of 30,596 sexually active reproductive aged women (ages 15-44), not currently involved in a same-sex couple relationship, comprised the analytic population. Exposure was defined based on response (yes/no) to the question “Do you have serious difficulty walking or climbing stairs?”. The outcome was contraceptive use at last sexual intercourse (yes/no) with a man. Logistic regression models were used to calculate crude and adjusted (for age, marital status, education attainment, and employment status) odds ratios (aOR) and corresponding 95% Confidence Intervals (CIs). Stratified models and models with interaction terms were used to examine potential effect modification by race/ethnicity (non-Hispanic White, non-Hispanic Black and Hispanic). Results: In the 2019 BRFSS population, 7% (2,349) of sexually active reproductive-aged women reported difficulty walking. About 10.4% of women with difficulty walking reported using contraceptives. Participants with difficulty walking had 46% lower odds of contraceptive use than participants without difficulty walking (OR:0.54; 95%CI:0.49-0.58). This association was attenuated (37% lower odds) but remained significant after adjustment for other variables (aOR:0.63, 95%; 95%CI: 0.58-0.69). Among non-Hispanic White women, participants with difficulty walking had 40% lower odds of contraceptive use (aOR:0.57, 95%CI:0.51-0.63), compared with participants with no difficulty walking. A similar estimate among Hispanic women showed a lower, yet statistically significant effect size ((aOR:0.75, 95% CI: 0.60-0.94), while the same estimate among non-Hispanic Black women indicated a lower and non-statistically significant effect (aOR:0.85; 95%CI: 0.69-1.06) (p-value for interaction <0.001). Among factors evaluated, age, education, marital status, and employment were related to contraceptive use among reproductive age women with difficulty walking (all p-values <0.05). Conclusion: In this study, we found significant inverse associations between difficulty walking and contraceptive use. We also found evidence for an effect modifying the role of race in the relationship between difficulty walking and contraceptive use. The inverse association was present only among non-Hispanic White and Hispanic women, but not among non-Hispanic Black women. Our findings highlight individuals with difficulty walking, particularly subgroups (defined by race/ethnicity, education, income, etc.) with even higher risk who should be prioritized for reproductive health services (such as contraceptive services).