Disparities in Contraceptive Access and Provision

Abstract

Even though contraceptive coverage expands under the Patient Protection and Affordable Care Act, reducing disparities in contraceptive access and provision requires that all providers assess their patient's reproductive life plans and that health systems work to minimize institutional and socioeconomic barriers. In this article, the challenges of providing equal access to contraceptive care, as well as recommendations for encouraging the use of effective contraception among all reproductive age women are reviewed.

LARC methods: entering a new age of contraception and reproductive health

“…The CHOICE study clearly demonstrated that unintended pregnancy rates can be dramatically reduced by eliminating financial barriers. When cost is not a factor this study found that 75 % of eligible women chose a LARC method [ 53 ]. Although multiple studies have shown that investment in contraception leads to significant cost-savings, access to LARC methods by poor women remains challenging.…”

Are higher unintended pregnancy rates among minorities a result of disparate access to contraception?

“…Historically, the United States has had a shameful history regarding forced sterilizations and reproductive injustices which may lead minority women to be distrustful of contraception [14,15]. There are also racial differences in contraceptive preferences.…”

“…African-American and Latina women suffer from misconceptions surrounding contraception, its use and efficacy [14]. The CHOICE project serves an example of using patient education to effectively overcome cultural beliefs that pose a barrier to the use of highly efficacious contraception.…”

“…Residency programs in obstetrics/gynecology, family practice and pediatrics along with nurse practitioners and physician assistants should ensure that providers are aware and well-educated about LARC methods and its contraindications. Appropriate counseling by providers "not only promotes effective methods but also directly translates to increased use" [14]. Use of published materials by organizations such as the American College of Obstetricians and Gynecologists (ACOG), Society of Family Planning (SFP), and the use of apps such as Medical Eligibility Criteria app produced by the CDC (https://www.cdc.gov/reproductivehealth/contraception/ usmec.htm) facilitate the appropriate selection of contraceptives for women with medical conditions such as hypertension.…”

“…Frequently, when African-American and Latina women choose contraception, they choose less effective contraception options (i.e. condoms) compared to white women [ 12 – 14 ]. Interestingly, data from the contraceptive CHOICE project revealed that prior to enrollment in the study, African-American women who have had a history of discrimination were more likely to choose less efficacious contraceptive measures (specifically barrier methods, natural family planning and withdrawal) but after enrollment, 67% of these women elected to use long-acting reversible contraception (LARC) [ 16 ].…”