Intersection of Nativity and English Proficiency With Receipt of Person-Centered Contraceptive Counseling

Abstract

OBJECTIVE: To assess disparities in receipt of person-centered contraceptive counseling among a nationally representative sample of U.S.- and foreign-born individuals with differing English proficiency. METHODS: We conducted a secondary analysis of the 2017–2019 wave of the National Survey of Family Growth and included female respondents aged 15–49 years who received contraception services in the previous 12 months and provided responses to all four items of the Person-Centered Contraceptive Counseling measure. We categorized respondents into four groups: 1) U.S.-born individuals who speak English very well, 2) foreign-born individuals who speak English very well, 3) U.S.-born individuals who speak English less well, and 4) foreign-born individuals who speak English less well. We created an adjusted logistic regression model, with receipt of person-centered contraceptive counseling as the outcome and the four nativity–English proficiency groups as the primary independent variable, then calculated the predicted probability of receiving person-centered contraceptive counseling for each group, adjusted for age, income, urban or rural status, and parity as covariates. We also assessed the four Person-Centered Contraceptive Counseling items individually. RESULTS: Our final study sample included 2,221 respondents (weighted N=26,531,058). Respondents who spoke English very well had comparable adjusted predicted probabilities of reporting person-centered counseling regardless of nativity (52.2% [95% CI, 48.5–55.9%] for U.S.-born individuals and 50.6% [95% CI, 38.2–62.9%] for foreign-born individuals). Among respondents who spoke English less well, U.S.-born individuals had a lower adjusted probability of reporting person-centered counseling than foreign-born individuals (31.0% [95% CI, 13.5–48.5%] vs 40.6% [95% CI, 29.2–52.0%], respectively). The largest disparities were for the items related to letting the respondent say what mattered most to them about their birth control and taking their preferences about their birth control seriously. CONCLUSION: Person-centered contraceptive counseling was lower for respondents with limited English proficiency, particularly among U.S.-born individuals; English proficiency mitigated disparities by nativity. Clinicians should prioritize person-centered contraceptive care, especially for patients with limited English proficiency.