Trends in Receipt of Contraceptive Services: Young Women in the U.S., 2002–2015

Abstract

Introduction: In order to understand adolescent girls’ and young women’s use of contraceptive services, this paper examines trends in receipt of contraceptive services, focusing on provider type and payment source. Methods: The analysis uses nationally representative data from females aged 15–25 years in the 2002, 2006–2010, and 2011–2015 National Surveys of Family Growth. In 2018, summary measures for receipt of any contraceptive service, the type of provider visited and payment used were created and compared across survey years and age groups (15–17 and 18–25 years). Results: From 2002 to 2011–2015, the proportion of adolescent girls aged 15–17 years relying on publicly funded clinics for contraceptive care fell from 47% to 24% (95% CI=38.4%, 55.0% and 95% CI=19.0%, 29.9%), whereas the proportion relying on private providers increased from 49% to 69% (95% CI=40.7%, 57.1% and 95% CI=61.6%, 76.2%). A significant, but smaller, shift away from clinics occurred among women aged 18–25 years. Over the same period, use of health insurance to pay for contraceptive services among all females aged 15–25 years increased from 68% to 81% (95% CI=64.7%, 71.3% and 95% CI=78.5%, 83.8%), whereas the proportion who had private insurance during the year, but did not use it to pay for contraceptive care, declined from 21% to 9% (95% CI=18.3%, 23.5% and 95% CI=6.8%, 10.7%). Conclusions: Private providers now provide the bulk of contraceptive services to adolescent girls and young women, with reduced reliance on publicly funded clinics. Supporting private practices in providing confidential and comprehensive family planning services must be a priority. Publicly funded clinics remain an important safety-net provider of contraceptive care for adolescent girls and young women.

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

“…Indeed, this exclusive focus on effectiveness prioritizes population-level reductions in pregnancies over individuals' own preferences regarding reproduction and contraception, despite many studies having documented that individuals prioritize many factors when selecting a contraceptive method, with effectiveness representing just one of these factors (18)(19)(20)(21)(22)(23). Notably, sexually active young adults ages 20-24 not seeking pregnancy were the only age group to experience decreases in overall contraceptive use but no significant change in specific methods or method groups between 2014 and 2016, which may be related to recent shifts in their source of, and increases in use of insurance coverage for, sexual and reproductive health care (24).…”

The Sexual and Reproductive Health of Adolescents and Young Adults During the COVID‐19 Pandemic

“…In the 2010-2015 period, more than one-fourth of AYA women who received contraceptive care went to a publicly funded clinic. 38 Service demand at these clinics may increase as young people's loss of private insurance makes care at private providers unaffordable.…”

Primary and reproductive healthcare access and use among reproductive aged women and female family planning patients in 3 states

“…Substantial research has documented associations between individuals’ demographic characteristics and both general healthcare and SRH service use and outcomes [ 11 , 12 ]. It is also well-documented that cost is one of the most persistent barriers to accessing healthcare in the United States [ 13 , 14 ].…”

“…Between 2018 and 2020, the number of female contraceptive patients served by sites receiving Title X funds dropped by 60% in Arizona, nearly 50% in Iowa, and 80% in Wisconsin, due to a combination of the Trump Administration's Final Rule and the COVID-19 pandemic [10]. Substantial research has documented associations between individuals' demographic characteristics and both general healthcare and SRH service use and outcomes [11,12]. It is also well-documented that cost is one of the most persistent barriers to accessing healthcare in the United States [13,14].…”