Multi-morbidity and Highly Effective Contraception in Reproductive-Age Women in the US Intermountain West: a Retrospective Cohort Study

  • Lori M. GawronEmail author
  • Jessica N. Sanders
  • Katherine Sward
  • Azadeh E. Poursaid
  • Rebecca Simmons
  • David K. Turok
Original Research



Women with chronic health conditions benefit from reproductive planning and access to highly effective contraception.


To determine the prevalence of and relationship between chronic health conditions and use of highly effective contraception among reproductive-age women.


Retrospective cohort study using electronic health records.


We identified all women 16–49 years who accessed care in the two largest health systems in the US Intermountain West between January 2010 and December 2014.

Main Measures

We employed administrative codes to identify highly effective contraception and flag chronic health conditions listed in the US Medical Eligibility Criteria for Contraceptive Use (US MEC) and known to increase risk of adverse pregnancy outcomes. We described use of highly effective contraception by demographics and chronic conditions. We used multinomial logistic regression to relate demographic and disease status to contraceptive use.

Key Results

Of 741,612 women assessed, 32.4% had at least one chronic health condition and 7.3% had two or more chronic conditions. Overall, 7.6% of women with a chronic health condition used highly effective contraception vs. 5.1% of women without a chronic condition. Women with chronic conditions were more likely to rely on public health insurance. The proportion of women using long-acting reversible contraception did not increase with chronic condition number (5.8% with 1 condition vs. 3.2% with 5 or more). In regression models adjusted for age, race, ethnicity, and payer, women with chronic conditions were more likely than those without chronic conditions to use highly effective contraception (aRR 1.4; 95% CI 1.4–1.5). Public insurance coverage was associated with both use of long-acting reversible contraception (aRR 2.2; 95% CI 2.1–2.3) and permanent contraception (aRR 2.9; 95% CI 2.7–3.1).


Nearly a third of reproductive-age women in a regional health system have one or more chronic health condition. Public insurance increases the likelihood that women with a chronic health condition use highly effective contraception.


contraception chronic disease LARC public insurance multi-morbidity 



Ware Branch, MD; Reed Barney, BA; Vickie Baer, Alison Frasier and Jeff Bennion

Funding information

This project is funded by the University of Utah Center for Clinical and Translational Science and the Program in Personalized Health Collaborative Pilot Project Grant. Team members receive support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Office of Research on Women’s Health of the National Institute of Health, LMG via K12HD085816, JNS via K12HD085852, and DKT via K24HD087436.

Compliance with Ethical Standards

The UUHC and IHC Institutional Review Boards approved this study.

Conflict of Interest

The authors declare that they do not have a conflict of interest. The University of Utah Department of Obstetrics and Gynecology receives industry funding from Sebela, Femasys, and Medicines360. No industry supported trial data or relationships influenced the collection or analysis of these data.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Lori M. Gawron
    • 1
    Email author
  • Jessica N. Sanders
    • 1
  • Katherine Sward
    • 2
    • 3
  • Azadeh E. Poursaid
    • 4
  • Rebecca Simmons
    • 1
  • David K. Turok
    • 1
  1. 1.Department of Obstetrics and Gynecology University of Utah School of MedicineSalt Lake CityUSA
  2. 2.College of NursingUniversity of UtahSalt Lake CityUSA
  3. 3.Department of Biomedical InformaticsUniversity of UtahSalt Lake CityUSA
  4. 4.School of MedicineUniversity of UtahSalt Lake CityUSA

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