Contraceptive practices in Québec in relation to immigration: A cross-sectional analysis of data from the Québec Population Health Survey

ObjectivesThis study aimed to examine the association between immigration status and women's contraceptive practices based on population data from government surveys.MethodsA secondary data analysis was conducted on the Quebec Population Health Survey (2014-2015), which aimed to represent 98.8% of the population of Quebec aged 15 years and older through stratified sampling and data weighting (response rate of 61%). Univariate and multivariable analyses were used to compare contraceptive practices between immigrant and Canadian-born women. Two dependent variables were considered: (1) women who used contraception vs. no contraceptive method of any kind, and (2) among women who used contraception, those who used methods that required them to access health care (birth control pill, IUD, or tubal ligation) vs. women who used other methods (condom, coitus interruptus, other).ResultsThe logistic regression results revealed a strong association between immigration status and contraceptive practices, at two levels: (1) immigrant women had lower odds to use contraception than Canadian-born women; and (2) of the women who use contraception, immigrants had lower odds than those born in Canada to use feminine medical contraception. These findings held true for immigrant women regardless of the number of years they have spent in Canada. Women who lived in low-income households or who had not had a medical consultation for more than one year also had lower odds to use feminine medical contraception.ConclusionBarriers in access to contraceptive care interfere with women's reproductive health and autonomy. The lower odds for immigrant women to use contraception, and particularly the most effective methods, suggest that their contraceptive care needs are at least partially unmet or inadequately addressed. This is concerning given that other studies show no differences in fertility intention between immigrant and Canadian-born women, and high rates of abortion for immigrant women. ObjectifsCette & eacute;tude examine l'association entre le statut d'immigration et les pratiques contraceptives des femmes, en prenant appui sur des donn & eacute;es d & eacute;mographiques provenant d'enqu & ecirc;tes gouvernementales.M & eacute;thodesL'& eacute;tude a r & eacute;alis & eacute; une analyse secondaire de donn & eacute;es de l'Enqu & ecirc;te qu & eacute;b & eacute;coise sur la sant & eacute; de la population (2014-2015), qui repr & eacute;sente 98,8% de la population qu & eacute;b & eacute;coise & acirc;g & eacute;e de 15 ans et plus, par le biais d'un & eacute;chantillonnage stratifi & eacute; et d'une pond & eacute;ration des donn & eacute;es (taux de r & eacute;ponse de 61%). Des analyses univari & eacute;es et multivari & eacute;es ont & eacute;t & eacute; utilis & eacute;es pour comparer les pratiques contraceptives des femmes immigrantes & agrave; celles des femmes n & eacute;es au Canada. Celles-ci ont repos & eacute; sur deux variables d & eacute;pendantes: 1) les femmes ayant utilis & eacute; un moyen de contraception vs. celles qui n'en ont utilis & eacute; aucun, et 2) parmi les femmes ayant utilis & eacute; une contraception, celles qui ont utilis & eacute; une m & eacute;thode n & eacute;cessitant l'acc & egrave;s & agrave; des soins de sant & eacute; (pilule contraceptive, st & eacute;rilet ou ligature des trompes) vs. celles qui ont utilis & eacute; d'autres m & eacute;thodes (pr & eacute;servatif, co & iuml;t interrompu, autre).R & eacute;sultatsLes r & eacute;sultats de la r & eacute;gression logistique ont montr & eacute; une forte association entre le statut d'immigrante et les pratiques contraceptives, & agrave; deux niveaux: 1) les femmes immigrantes avaient moins de chances d'utiliser la contraception que les femmes n & eacute;es au Canada; et 2) parmi les femmes qui utilisaient la contraception, les immigrantes avaient moins de chances que les femmes n & eacute;es au Canada d'utiliser la contraception m & eacute;dicale f & eacute;minine. Ces r & eacute;sultats restaient observables quel que soit le nombre d'ann & eacute;es pass & eacute;es au Canada par les femmes immigrantes. Les femmes qui vivaient dans des m & eacute;nages & agrave; faible revenu ou qui n'ont pas eu de consultation m & eacute;dicale depuis plus d'un an & eacute;taient & eacute;galement moins susceptibles d'utiliser une contraception m & eacute;dicale f & eacute;minine, quel que soit le statut d'immigration.ConclusionLes obstacles d'acc & egrave;s aux soins contraceptifs nuisent & agrave; la sant & eacute; reproductive et & agrave; l'autonomie procr & eacute;ative des femmes. Or, les plus faibles chances d'utiliser la contraception chez les femmes immigrantes, ainsi que leur moindre usage des m & eacute;thodes les plus efficaces, traduisent des besoins contraceptifs non combl & eacute;s ou mal combl & eacute;s. Cette constatation est pr & eacute;occupante & eacute;tant donn & eacute; que d'autres & eacute;tudes ne montrent aucune diff & eacute;rence dans les intentions de f & eacute;condit & eacute; entre les femmes immigrantes et les femmes n & eacute;es au Canada, et que les taux d'avortement sont & eacute;lev & eacute;s chez les femmes immigrantes.