Contraceptive Use in France by Migration Background and the Role of Social Deprivation as a Mediator: A National Cross-Sectional Study.

BACKGROUND: Migrant women in high-income countries experience persistent disparities in sexual and reproductive health, including less contraceptive use. The mechanisms underlying these disparities remain insufficiently understood. This study examined the association between migration background and contraceptive use and effectiveness in France and assessed the extent to which social deprivation mediates this relationship. METHODS: We analysed data from the 2021 French National Perinatal Survey, a national cross-sectional study including 10,723 women who gave birth in metropolitan France. Contraceptive use before pregnancy planning was classified as effective versus less effective or none. Migration background was defined by geographic region of birth and duration of residence in France. Mediation analysis estimated the proportion of the association mediated by a social deprivation index. RESULTS: The odds of using less effective or no contraception was greater for migrant versus native women (adjusted OR = 2.67; 95%CI [2.41-2.95]). The association was strongest for migrant women residing in France for ≤ 1 year (adjusted OR = 9.28; 95%CI [6.13-14.06]) and decreased with duration of residence. Social deprivation mediated 9.3% (95%CI [6.3-12.3]) of the association between migration background and the use of less effective or no contraception, reaching 21.4% (95%CI[15.8-27.0]) among women born in sub-Saharan Africa. CONCLUSION: Large disparities in contraceptive use and effectiveness by migration background persist in France and are only partially explained by social deprivation. These findings highlight the influence of structural, cultural, and healthcare system factors beyond socioeconomic vulnerability and underscore the need for culturally responsive and equitable reproductive healthcare policies that address migrant-specific barriers. IMPLICATIONS: Improving contraceptive equity for migrant women requires interventions that extend beyond reducing socioeconomic disadvantage. Policies and healthcare services should strengthen culturally responsive contraceptive counselling, improve access to reproductive healthcare, and address migration-related barriers, particularly for recently arrived women.