Use of Highly Effective Reversible Contraception in Title X Clinics: Variation by Selected State Characteristics

Hale, Nathan; Khoury, Amal; Smith, M.G.H.

doi:10.1016/j.whi.2018.03.003

Cited by 8 publications

(4 citation statements)

References 27 publications

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“…Research specifically investigating the role of optional Medicaid expansion (in effect beginning in 2014) under the ACA indicated that Medicaid expansion increased public insurance coverage (Boudreaux et al, 2019;Darney et al, 2020aDarney et al, , 2020bGibbs et al, 2020;Hale et al, 2018;Jones & Sonfield, 2016;Lanese & Oglesby, 2016), decreased uninsurance (Boudreaux et al, 2019;Darney et al, 2020aDarney et al, , 2020bDworsky et al, 2012;Early et al, 2018;Hale et al, 2018;Jones & Sonfield, 2016;Lanese & Oglesby, 2016), and increased Medicaid coverage of contraceptives (Veronica et al, 2017). Studies also indicated that Medicaid expansion decreased cost as a barrier to care (E. M. Johnston et al, 2018), increased self-reported contraceptive access (Moniz et al, 2018), increased contraceptive use (Boudreaux et al, 2019;Cher et al, 2019;Darney et al, 2020b;Hale et al, 2018), and decreased publicly funded unintended births (Veronica et al, 2017).…”

Section: Affordable Care Actmentioning

confidence: 99%

Policy impacts on contraceptive access in the United States: a scoping review

Swan

2023

J Pop Research

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Contraceptive access is influenced by policy decisions, which can expand and constrict the contraceptive options available. This study explored the impact of recent US federal policies on contraceptive access by identifying and reviewing empirical literature, which is then presented and discussed using Levesque et al.’s (2013) healthcare access framework. A scoping review was conducted to identify empirical studies (N = 96) examining the impact of recent federal policy (passed from 2009 to 2019) on contraceptive access. Most identified studies examined the role of the Affordable Care Act (n = 53) and Title X of the Public Health Service Act (n = 25), showing many benefits of both policies for contraceptive access, particularly through improved affordability, availability, and appropriateness of contraceptive care. Other identified studies examined the impact of policies funding abstinence-only sex education (n = 2) and the Teen Pregnancy Prevention Program (n = 3), military policies related to the availability of contraception (n = 1), guidelines for quality contraceptive care (n = 3), Title IX of the Education Amendments (n = 4), the Violence Against Women Act (n = 1), and the Veterans Access, Choice, and Accountability Act (n = 4). Through increased outreach efforts, normalising of care, availability of services, cost subsidies, and provider competencies, recent federal policy has, overall, enhanced contraceptive access across the dimensions of healthcare access. Numerous policy and practice gaps and needs are identified, and future directions for research, policy, and practice are suggested.

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Section: Affordable Care Actmentioning

confidence: 99%

Policy impacts on contraceptive access in the United States: a scoping review

Swan

2023

J Pop Research

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“…The South Carolina Choose Well contraceptive access initiative is the first and only initiative of its kind in the US Southeast. The need for a statewide contraceptive access initiative in South Carolina was informed by the high rate of unintended pregnancy in the state combined with lower rates of contraceptive use and large segments of the population facing barriers to care . The state’s Medicaid program was not expanded under the Patient Protection and Affordable Care Act, leaving many people with lower incomes without insurance coverage…”

Section: Introductionmentioning

confidence: 99%

“…The need for a statewide contraceptive access initiative in South Carolina was informed by the high rate of unintended pregnancy in the state 2 combined with lower rates of contraceptive use 3 and large segments of the population facing barriers to care. 4 The state's Medicaid program was not expanded under the Patient Protection and Affordable Care Act, leaving many people with lower incomes without insurance coverage. 5 The initiative launched in 2017 with a focus on promoting equitable access to contraception without coercion.…”

Section: Introductionmentioning

confidence: 99%

Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative

Hale,

Lee,

de Jong

et al. 2024

JAMA Netw Open

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ImportanceEvaluating the impact of statewide contraceptive access initiatives is necessary for informing health policy and practice.ObjectiveTo examine changes in contraceptive method use among a cohort of women of reproductive age in South Carolina during the Choose Well contraceptive access initiative.Design, Setting, and ParticipantsIn this cohort study, baseline data from the initial Statewide Survey of Women administered from October 1, 2017, to April 30, 2018, to a probability-based sample of women of reproductive age in South Carolina and a peer state (Alabama) were linked with 3 follow-up surveys given in 2019, 2020, and 2021. Responses about contraception use from the initial survey were compared with responses across follow-up surveys using the regression-based differences-in-differences method. Data analysis was performed from October 2023 to February 2024.ExposureThe South Carolina Choose Well contraceptive access initiative seeks to fill contraceptive access gaps and increase provision of a full range of contraceptive methods through engagement with a wide range of health care organizations across the state.Main Outcomes and MeasuresChanges in contraceptive method use, including long-acting reversible contraception (LARC), intrauterine devices (IUDs), implants, short-acting hormonal injection, and barrier or other methods between the baseline survey (2017-2018) and 3 subsequent surveys (2019-2021).ResultsA total of 1344 female participants (mean [SD] age, 34 [7] years) completed the first survey (667 in Alabama and 677 in South Carolina). Use of LARC significantly increased in South Carolina (119 [17.6%] to 138 [21.1%]) compared with Alabama (120 [18.0%] to 116 [18.1%]; P = .004). Use of IUDs increased in South Carolina (95 [14.0%] to 114 [17.4%]) compared with Alabama (92 [13.8%] to 102 [15.9%]; P = .003). These associations persisted in the adjusted analysis, with a significant increase in the odds of LARC (adjusted odds ratio, 1.24; 95% CI, 1.06-1.44) and IUD (adjusted odds ratio, 1.19; 95% CI, 1.06-1.32) use at follow-up in South Carolina compared with Alabama.Conclusions and RelevanceIn this cohort study of 1344 participants, increases in the use of IUDs in South Carolina were noted after the implementation of the South Carolina Choose Well initiative that were not observed in a peer state with no intervention. Our findings may provide support in favor of statewide contraceptive access initiatives and their role in promoting access to reproductive health services.

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“…Boudreaux et al, 2019 ; Gibbs et al, 2020 ), decreased uninsurance (e.g. Boudreaux et al, 2019 ; Hale et al, 2018 ), and decreased cost as a barrier to care (Johnston et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Pathways to reproductive autonomy: Using path analysis to predict family planning outcomes in the United States

Swan

McDonald

Price

2022

Health Social Care Comm

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In the United States, about half of pregnancies are unintended, and most women of reproductive age are at risk of unintended pregnancy. Research has explored predictors of contraceptive use and unintended pregnancy, but there is a lack of research regarding access to preferred contraceptive method(s) and the complex pathways from sociodemographic factors to these family planning outcomes. This study applied Levesque et al.'s (2013) healthcare access framework to investigate pathways from sociodemographic factors and indicators of access to family planning outcomes using secondary data. Data were collected at four time points via an online survey between November 2012 and June 2014. Participants were US women of reproductive age who were seeking to avoid pregnancy (N = 1036; Mage = 27.91, SD = 5.39; 6.9% Black, 13.6% Hispanic, 70.2% white, 9.4% other race/ethnicity). We conducted mediational path analysis, and results indicated that contraceptive knowledge (β = 0.116, p = 0.004), insurance coverage (β = 0.423, p < 0.001), and relational provider engagement (β = 0.265, p = 0.011) were significant predictors of access to preferred contraceptive method. Access to preferred contraceptive method directly predicted use of more effective contraception (β = 0.260, p < 0.001) and indirectly predicted decreased likelihood of experiencing unintended pregnancy via contraceptive method(s) effectiveness (β = −0.014, 95% confidence interval: −0.041, −0.005). This study identifies pathways to and through access to preferred contraceptive methods that may be important in determining family planning outcomes such as contraceptive use and unintended pregnancy. This information can be used to improve access to contraception, ultimately increasing reproductive autonomy by helping family planning outcomes align with patients' needs and priorities.

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Use of Highly Effective Reversible Contraception in Title X Clinics: Variation by Selected State Characteristics

Cited by 8 publications

References 27 publications

Policy impacts on contraceptive access in the United States: a scoping review

Policy impacts on contraceptive access in the United States: a scoping review

Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative

Pathways to reproductive autonomy: Using path analysis to predict family planning outcomes in the United States

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