Contraceptive use and condomless sex among sexually experienced disabled and non-disabled White, Black, and Hispanic female adolescents and young adults aged 18-25 in the United States.

Background Disabled and racial and ethnic minority women experience barriers to contraceptive access, autonomy, and method preference, yet little research examines these experiences at the intersection of marginalized identities. Our study objective was to examine associations between disability status, race, ethnicity, and contraceptive use among female adolescents and young adults. Methods We analyzed data from three consecutive waves of the National Survey of Family Growth (2011-2013, 2013-2015, 2015-2017) focusing on disabled and non-disabled White, Black, and Hispanic females aged 18-25 in the United States. We examined contraceptive use, condomless sex, and method type by disability status, race, and ethnicity, alone and in combination, using logistic regression with robust standard errors to calculate odds ratios with 95% confidence intervals (CI) for binary outcomes and multinomial logistic regression to estimate odds ratios (OR) for multi-category outcomes. Results Among females who ever had sex, (N = 3,410), at first sex, White non-disabled females were most likely to use short-acting hormonal/long-acting reversible contraceptives (LARC). Black disabled and Hispanic disabled females were significantly more likely to use no method compared to shorting-acting hormonal/LARC. Black and Hispanic non-disabled females had significantly higher rates of condomless sex compared to non-disabled White females. The pattern of racial and ethnic disparities persisted at last sex in the past 12 months and 3 months. Conclusions Disparities in contraceptive use were greatest among Black and Hispanic females, both with and without disabilities. The findings suggest the that the combined effects of racism and ableism create unique barriers to equitable sexual and reproductive health services. Healthcare systems, clinicians, and schools must provide disability-competent and culturally responsive interventions for people with disabilities, racial and ethnic minorities, and multiply marginalized individuals.