Health insurance coverage and contraceptive use at the state level: findings from the 2017 Behavioral Risk Factor Surveillance System

Kavanaugh, Megan L.; Douglas-Hall, Ayana; Finn, Sean M.

doi:10.1016/j.conx.2019.100014

Cited by 23 publications

(23 citation statements)

References 19 publications

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“…Health insurance emerged as a key driver of lowered unfulfilled contraceptive preferences due to cost among both users and nonusers of contraception. National [16] and state-level [17] data indicate that individuals with health insurance have higher levels of contraceptive use than those with no coverage. Efforts aimed at reducing the cost burden on individuals for health care, especially via health insurance that covers a broad range of contraceptive methods such as that guaranteed under the ACA, contribute to individuals being able to realize reproductive autonomy with regards to choosing—and using—preferred methods of contraception.…”

Section: Discussionmentioning

confidence: 99%

Associations between unfulfilled contraceptive preferences due to cost and low-income patients’ access to and experiences of contraceptive care in the United States, 2015–2019

2022

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Section: Discussionmentioning

confidence: 99%

Associations between unfulfilled contraceptive preferences due to cost and low-income patients’ access to and experiences of contraceptive care in the United States, 2015–2019

2022

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“…And identifying differences in specific method use among population groups can help determine whether additional programmatic or policy attention needs to be directed toward ensuring access to the full range of methods available for everyone. Patterns of contraceptive use vary considerably at the state level, likely related to varying contexts across states with regards to population demographics and differential support for contraceptive access (3). Two examples of federal initiatives that have helped individuals to access contraceptive methods for free or low out-of-pocket costs include the Affordable Care Act (ACA) and the Title X family planning program, a federally funded initiative since 1970 that prioritizes providing free or low-cost family planning care to low-income and young individuals (4)(5)(6).…”

Section: Introduction Imentioning

confidence: 99%

Use of contraception among reproductive-aged women in the United States, 2014 and 2016

Kavanaugh

Pliskin

2020

F&S Reports

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To examine current levels, correlates of, and changes in contraceptive use among reproductive-age women in the United States between 2014 and 2016. Design: We conducted simple and multivariable logistic regression analyses to identify associations between user characteristics and contraceptive use, with specific attention to methods requiring a visit to a health care provider. Setting: Not applicable. Patient(s): All self-identified female respondents to the surveys. Secondary analysis of two rounds of the National Survey of Family Growth, an in-home, nationally representative survey of people ages 15-44 years (2013-2015) and 15-49 years (2015-2017). Intervention(s): None. Main Outcome Measure(s): Current use of a contraceptive method, including use of individual methods and grouped method use in 2016, and change in use from 2014. Result(s): Contraceptive use remained steady between 2014 and 2016 among sexually active females not seeking pregnancy (88%). Among users, use of long-acting reversible contraceptive (LARC) methods increased from 14% to 18%, as use of short-acting reversible contraceptive (SARC) methods fell from 32% to 28%. Implant use among 15-to 19-year-olds rose from 6% to 16% and represents one of the largest increases observed. Access to sexual and reproductive health care was strongly associated with use of all LARC and SARC methods except for the implant (adjusted odds ratios ranged from 3.21 to 13.53). Conclusion(s): Contraceptive users are shifting primarily among the most and moderately effective method groups, and not from contraceptive nonuse to use. Reductions in access to sexual and reproductive health care could have implications for individuals' ability to use their preferred contraceptive methods. (Fertil Steril Rep Ò 2020;1:83-93. Ó2020 by American Society for Reproductive Medicine.

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“…Our findings focused on Iowa SRH patients support the broader evidence base around cost being a key barrier to contraceptive access. Cross-sectional studies have highlighted the link between insurance coverage and most/moderately effective methods, most of which are provider-controlled (Culwell & Feinglass, 2007 ; Frost & Darroch, 2008 ; Kavanaugh & Pliskin, 2020 ; Kavanaugh et al, 2020 ). Several studies have described the impact of the ACA contraceptive coverage guarantee on both reduced out-of-pocket costs for contraception (Frederiksen et al, 2020 ; Sonfield et al, 2015 ) and increases in contraceptive use, especially in use of more expensive and effective methods like the IUD.…”

Section: Discussionmentioning

confidence: 99%

“…Nationally, those with any type of health insurance coverage have higher levels of overall contraceptive use, and those with access to contraceptive care facilitated by insurance coverage had higher odds of using certain provider-controlled methods like IUDs, pills, patches, shots, and rings (Kavanaugh & Pliskin, 2020 ). State-level evidence mirrors these insurance-driven contraceptive patterns (Kavanaugh et al, 2020 ). Several studies have demonstrated how the federal contraceptive coverage guarantee in the Affordable Care Act led to increases in both use of prescription contraceptive methods—especially IUDs and implants—as well as more consistent contraceptive use overall (Becker et al, 2021 ; Lee et al, 2020 ; Malcolm et al, 2021 ).…”

Section: Introductionmentioning

confidence: 87%

A Prospective Cohort Study of Changes in Access to Contraceptive Care and Use Two Years after Iowa Medicaid Coverage Restrictions at Abortion-Providing Facilities Went into Effect

Kavanaugh

Zolna

Pliskin

et al. 2022

Popul Res Policy Rev

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Inequities in access to contraception based on ability to pay can interfere with individuals’ reproductive autonomy. This study examines the impact of a 2017 state-level policy in Iowa restricting Medicaid coverage at abortion-providing health care centers on patients’ access to contraceptive care and subsequent contraceptive use. We draw on a unique panel dataset of individuals who originally sought care at a publicly supported family planning site in Iowa in 2018–2019 and then participated in subsequent follow-up surveys every 6 months for 2 years to examine an effect of access to care on contraceptive use. Among our final analytic sample of 368 individuals, our findings indicate that receipt of recent contraceptive care decreased over the study period; this coincided with patients shifting away from getting contraceptive care at sites potentially impacted by the 2017 Iowa Medicaid policy restriction while those getting this care at non-impacted sites remained relatively steady over the study period. At the same time, nonuse of contraception increased while use of a contraceptive method that carries cost, use of a provider-involved method, and satisfaction with one’s method decreased. We find that, after controlling for patient characteristics, those who shifted toward receiving contraceptive care experienced increases in these three contraceptive outcomes. We interpret this as preliminary descriptive evidence demonstrating an impact of disruptions in access to contraceptive care on contraceptive outcomes. Supportive payment and funding strategies for contraception, rather than policies that impede or restrict access, are needed to enable people to realize full reproductive autonomy.

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Health insurance coverage and contraceptive use at the state level: findings from the 2017 Behavioral Risk Factor Surveillance System

Cited by 23 publications

References 19 publications

Associations between unfulfilled contraceptive preferences due to cost and low-income patients’ access to and experiences of contraceptive care in the United States, 2015–2019

Associations between unfulfilled contraceptive preferences due to cost and low-income patients’ access to and experiences of contraceptive care in the United States, 2015–2019

Use of contraception among reproductive-aged women in the United States, 2014 and 2016

A Prospective Cohort Study of Changes in Access to Contraceptive Care and Use Two Years after Iowa Medicaid Coverage Restrictions at Abortion-Providing Facilities Went into Effect

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