Multimorbidity and use of reversible contraception: Results from a Canadian cross-sectional survey

Abstract

Objective: Despite the importance of contraception for pregnancy planning in females with chronic conditions, little is known about contraception use in those with two or more chronic conditions-i.e., multimorbidity. We examined contraception use among females with multimorbidity, one chronic condition, and no identified chronic conditions.

Study design: We used data from the 2015 to 2016 Canadian Community Health Survey on 15 to 49-year-old females at risk of unintended pregnancy (n = 12,741), comparing females with ≥2 chronic conditions (21.3%) and one chronic condition (27.7%) to those with no identified chronic conditions (51.0%). We used modified Poisson regression to derive adjusted prevalence ratios (aPR) for any contraception vs no contraception, and multinomial logistic regression to derive adjusted odds ratios (aOR) for highly effective, moderately effective, and no contraception vs less effective contraception.

Results: Compared to females with no identified chronic conditions, those with multimorbidity were less likely to use any contraception (aPR 0.93, 95% CI 0.89 - 0.98). Females with multimorbidity were more likely than those with no identified chronic conditions to use no contraception (aOR 1.29, 95% CI 1.13 - 1.46), with little to no difference in the use of highly (aOR 1.08, 95% CI 0.91 - 1.29) or moderately effective contraception (aOR 0.98, 95% CI 0.86 - 1.13), vs less effective contraception. There were no differences between females with one chronic condition and no identified chronic conditions.

Conclusion: The lower overall rate of contraception use in females with multimorbidity reflects a need for more attention to family planning in this population, with prompt and convenient access to highly effective options.

Implications: Females with multimorbidity were less likely than those with no identified chronic conditions to use any contraception, and no more likely to use highly or moderately effective versus less effective contraception. Individuals with multimorbidity could benefit from attention to family planning, with prompt and convenient access to highly effective options.

Keywords: Chronic disease; Contraception; Multimorbidity; Reproductive health.