Disparities in access to appointments for contraceptive services among Black, Hispanic, White, and recently incarcerated women in Alabama, Louisiana, and Mississippi

Abstract

ObjectiveTo measure differences in access to contraceptive services based on history of incarceration and its intersections with race/ethnicity and insurance status.Data Sources and Study SettingPrimary data were collected from telephone calls to physician offices in Alabama, Louisiana, and Mississippi in 2021.Study DesignWe deployed a field experiment. The outcome variables were appointment offers, wait days, and questions asked of the caller. The independent variables were callers' incarceration history, race/ethnicity, and insurance.Data Collection MethodsUsing standardized scripts, Black, Hispanic, and White female research assistants called actively licensed primary care physicians and Obstetrician/Gynecologists asking for the next available appointment for a contraception prescription. Physicians were randomly selected and randomly assigned to callers. In half of calls, callers mentioned recent incarceration. We also varied insurance status.Principal FindingsAppointment offer rates were five percentage points lower (95% CI: −0.10 to 0.01) for patients with a history of incarceration and 11 percentage points lower (95% CI: −0.15 to −0.06) for those with Medicaid. We did not find significant differences in appointment offer rates or wait days when incarceration status was interacted with race or insurance. Schedulers asked questions about insurance significantly more often to recently incarcerated Black patients and recently incarcerated patients who had Medicaid.ConclusionsWomen with a history of incarceration have less access to medical appointments; this access did not vary by race or insurance status among women with a history of incarceration.