Household income and contraceptive methods among female youth: a cross-sectional study using the Canadian Community Health Survey (2009–2010 and 2013–2014)

Elizabeth Nethery; Laura Schummers; K. Suzanne Maginley; Sheila Dunn; Wendy V. Norman

doi:10.9778/cmajo.20190087

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Figure 1:
Flow diagram showing selection of sample for analysis. Note: CCHS = Canadian Community Health Survey. *Numbers total more than 420 because some records were missing more than 1 value.

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Table 1:

Contraceptive methods available in Canada, 2009–2014, by effectiveness

Effectiveness;^* method	Cost estimate^†
Tier 1: < 1 pregnancy per 100 per year	$$$
Intrauterine contraceptives (hormonal or nonhormonal), effective for up to 5 yr
Tier 2: 4–12 pregnancies per 100 per year	$$
Injectable contraceptives (depot medroxyprogesterone acetate), repeated every 3 mo
Oral contraceptives, vaginal ring or transdermal patch, repeated monthly	$$
Tier 3: ≥ 18 pregnancies per 100 per year
Male condom	$
Diaphragm + spermicide	$$
Female condom	$$
Fertility awareness methods/calendar	Free–$
Withdrawal	Free
No method	Free

↵* Range of effectiveness represents typical use. (3), (12)
↵† Cost varies because of differences in pharmacy/store discounts, pharmacists’ dispensing fees and supplemental insurance benefits. $ = least expensive, $$ = more expensive, $$$ = most expensive.

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Table 2:

Reported usual contraception method(s)

Method	Weighted population n = 826 711^*	Population-weighted prevalence estimate, %^† (95% CI)
Survey responses^‡
Oral contraceptives^§	489 256	59.2 (57.2–61.2)
Condoms	393 446	47.6 (45.6–49.6)
Other	63 765	7.7 (6.6–8.8)
Injectable contraceptives (DMPA)^¶	20 345	2.5 (1.9–3.0)
Diaphragm	8609	1.0 (0.7–1.4)
None	112 510	13.6 (12.3–15.0)
Derived results
Condoms and/or spermicide (no other methods indicated)^¶	139 044	16.8 (15.3–18.4)
≥ 2 contraceptive methods	260 803	36.5 (34.5–38.6)
Condoms plus oral contraceptives or DMPA^¶	240 022	29.0 (27.3–30.8)

Note: CI = confidence interval, DMPA = depot medroxyprogesterone acetate.
↵* Survey sample = 6025 respondents.
↵† Survey weighted.
↵‡ Respondents could indicate more than 1 method to the question “What is your usual method of birth control?” Results for spermicide only not shown owing to low numbers.
↵§ Primary outcome.
↵¶ Secondary outcomes: injectable contraceptives and condom/spermicide.

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Table 3:

Number of survey respondents, corresponding population estimates and weighted prevalence estimates for each contraceptive method, by sociodemographic characteristics

Covariate	Survey sample n = 6025	Weighted population, no. (%) n = 826 711	Contraceptive method; weighted prevalence estimate, % (95% CI)
Covariate	Survey sample n = 6025	Weighted population, no. (%) n = 826 711	Oral contraceptives	Injectable contraceptives	Condom only^*	None
Annual household income, $
< 80 000	3689	516 241 (62.4)	53.3 (50.7–55.9)	3.0 (2.2–3.8)	18.9 (16.9–21.0)	15.5 (13.7–17.3)
≥ 80 000	2336	310 470 (37.6)	69.0 (66.0–71.9)	1.5 (0.8–2.2)	13.3 (11.0–15.6)	10.5 (8.5–12.5)
Age, yr
15–17	1045	95 467 (11.5)	63.7 (59.7–67.8)	2.4 (1.3–3.6)	15.2 (12.2–18.3)	16.3 (13.3–19.4)
18–19	1325	157 515 (19.1)	59.2 (54.8–63.5)	2.6 (1.4–3.7)	17.8 (14.1–21.5)	14.9 (11.6–18.1)
20–24	3655	573 729 (69.4)	58.4 (55.9–60.9)	2.4 (1.7–3.1)	16.8 (14.9–18.7)	12.8 (11.2–14.5)
Race/ethnicity
White	4910	660 166 (79.9)	63.2 (61.0–65.3)	2.3 (1.7–2.9)	14.9 (13.2–16.6)	11.3 (10.0–12.7)
Visible minority	1115	166 545 (20.1)	43.3 (38.5–48.1)	3.2 (1.8–4.6)	24.3 (20.5–28.2)	22.6 (18.7–26.5)
Current student
No	2618	369 334 (44.7)	52.5 (49.4–55.7)	2.8 (1.9–3.7)	18.1 (15.5–20.6)	17.1 (14.8–19.5)
Yes	3407	457 377 (55.3)	64.5 (62.1–67.0)	2.2 (1.5–2.9)	15.8 (13.9–17.7)	10.8 (9.2–12.3)
Married/common-law
No	5063	676 199 (81.8)	59.9 (57.8–62.1)	2.4 (1.8–3.0)	17.7 (15.9–19.5)	13.2 (11.8–14.7)
Yes	962	150 513 (18.2)	55.9 (50.9–60.9)	2.8 (1.4–4.2)	13.0 (10.0–15.9)	15.3 (11.7–19.0)
Recent immigrant^†
No	5871	787 812 (95.3)	60.2 (58.2–62.2)	2.5 (1.9–3.0)	15.8 (14.3–17.4)	13.5 (12.1–14.9)
Yes	154	38 899 (4.7)	37.9 (27.3–48.5)	< 2.0	37.0 (27.4–46.7)	16.5 (10.1–22.9)
Highest household education
Less than high school	284	29 935 (3.6)	32.9 (23.8–42.1)	4.6 (1.8–7.5)	16.6 (4.8–28.4)	27.5 (19.4–35.7)
Completed high school	730	89 807 (10.9)	46.0 (40.1–51.9)	5.0 (2.6–7.4)	20.7 (15.7–25.7)	19.6 (15.4–23.8)
Some postsecondary	502	70 826 (8.6)	55.0 (47.7–62.3)	2.3 (0.3–4.3)	16.4 (11.5–21.3)	17.3 (11.9–22.6)
Completed postsecondary	4509	636 143 (76.9)	62.7 (60.5–65.0)	2.0 (1.4–2.6)	16.3 (14.6–18.1)	11.7 (10.2–13.2)
Living arrangement
Unattached alone/single/other	901	160 085 (21.3)	56.9 (51.8–62.0)	3.6 (2.0–5.1)	19.9 (15.8–24.0)	11.0 (8.3–13.8)
With partner or spouse	525	92 736 (12.3)	67.0 (61.1–72.9)	2.3 (0.4–4.2)	10.9 (7.3–14.5)	11.0 (6.8–15.1)
With partner and child	295	35 205 (4.7)	33.1 (23.8–42.4)	3.9 (1.0–6.8)	16.8 (10.1–23.4)	23.2 (15.4–31.1)
With own child/ren (no spouse)	219	20 809 (2.8)	33.7 (24.0–43.5)	4.1 (1.4–6.8)	12.6 (6.4–18.7)	28.2 (17.9–38.5)
Child living with parent(s) or siblings or both	3579	444 087 (59.0)	63.3 (60.8–65.8)	1.7 (1.1–2.3)	17.0 (14.9–19.1)	12.7 (11.0–14.4)
Consulted doctor or nurse in previous 12 mo
No	744	104 844 (12.7)	42.4 (36.3–48.5)	1.5 (0.4–2.6)	26.8 (21.9–31.8)	22.9 (17.9–27.8)
Yes	5278	721 490 (87.3)	61.6 (59.5–63.7)	2.6 (2.0–3.2)	15.4 (13.7–17.0)	12.3 (10.9–13.6)
Has family doctor
No	1132	168 906 (20.5)	48.1 (43.2–53.0)	2.0 (0.8–3.3)	21.0 (17.2–24.8)	18.2 (14.5–21.9)
Yes	4887	656 656 (79.5)	62.0 (59.9–64.2)	2.6 (2.0–3.2)	15.7 (14.0–17.4)	12.5 (11.0–13.9)
Northern resident^‡
No	5823	823 779 (99.6)	59.3 (57.3–61.3)	2.4 (1.9–3.0)	16.8 (15.2–18.4)	13.6 (12.2–14.9)
Yes	202	2933 (0.4)	33.9 (26.3–41.6)	9.6 (4.2–15.0)	22.5 (15.4–29.7)	19.4 (12.7–26.1)
Quebec resident^§
No	4747	619 576 (74.9)	57.9 (55.6–60.2)	2.6 (2.0–3.3)	17.2 (15.4–19.0)	15.1 (13.5–16.7)
Yes	1278	207 135 (25.1)	63.1 (59.1–67.1)	1.9 (0.9–2.9)	15.8 (12.8–18.7)	9.2 (6.8–11.6)

Note: CI = confidence interval.
↵* Includes those who used only spermicide and/or condoms.
↵† Immigrated to Canada within the previous 10 years.
↵‡ Resident of the Yukon Territory, Northwest Territories or Nunavut.
↵§ Quebec has a publicly funded prescription benefit program that includes contraceptive coverage for youth who are not already covered by a private drug plan.

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Table 4:

Association of lower versus higher annual household income on contraceptive methods

Primary outcome	Household income; weighted frequencies		Crude RR (95% CI) for lower-income group	Adjusted RR^* (95% CI) for lower-income group
Primary outcome	< $80 000 n = 516 241	≥ $80 000 n = 310 470	Crude RR (95% CI) for lower-income group	Adjusted RR^* (95% CI) for lower-income group
Oral contraceptives	275 176	214 080	0.77 (0.72–0.83)	0.85 (0.80–0.91)
Injectable contraceptives (DMPA)	15 573	4772	1.96 (1.16–3.32)	1.69 (0.98–2.92)
Condom only	97 682	41 363	1.42 (1.16–1.74)	1.36 (1.11–1.67)
Nonusers (no contraceptive method)	79 856	32 654	1.47 (1.17–1.84)	1.19 (0.94–1.50)
Multiple methods: condoms plus oral contraceptives or DMPA	126 256	113 766	0.67 (0.59–0.75)	0.81 (0.71–0.91)

Note: CI = confidence interval, DMPA = depot medroxyprogesterone acetate, RR = relative risk.
↵* Adjusted for household income, age, race/ethnicity, immigrant status, student status, marital status, household level of education and northern residence.