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.
Contraception
Health care access
Iowa
Medicaid
Policy
Journal
Population research and policy review
ISSN: 0167-5923
Titre abrégé: Popul Res Policy Rev
Pays: Netherlands
ID NLM: 8309372
Informations de publication
Date de publication:
2022
2022
Historique:
received:
09
12
2021
accepted:
19
08
2022
pubmed:
13
9
2022
medline:
13
9
2022
entrez:
12
9
2022
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 36092460
doi: 10.1007/s11113-022-09740-4
pii: 9740
pmc: PMC9440451
doi:
Types de publication
Journal Article
Langues
eng
Pagination
2555-2583Informations de copyright
© The Author(s) 2022.
Déclaration de conflit d'intérêts
Conflict of interestThe authors have no competing interests to declare that are relevant to the content of this article.
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