Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA.
Reprod Health. 2021 Nov 22;18(1):235. doi: 10.1186/s12978-021-01289-3.
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 policy on contraceptive access.
Federal policy changes impacting contraceptive access over the past decade were identified in grey literature. These policy changes were organized into a timeline and analyzed according to Levesque et al.'s (2013) five dimensions of healthcare access (approachability, acceptability, availability/accommodation, affordability, and appropriateness), noting the most salient healthcare dimension impacted by the policy change and analyzing whether, according to this framework, the policy created a theoretical increase or decrease in contraceptive access.
Of those policy changes coded as increasing (n = 42) and decreasing (n = 28) contraceptive access, most were related to the affordability (increasing n = 13; decreasing n = 12), physical availability (increasing n = 10; decreasing n = 7), and appropriateness (increasing n = 12; decreasing n = 4) of contraceptive care. Policy changes largely followed partisan divides, with contraceptive access increasing in years with a Democratic president and decreasing when a Republican president was in office. Many policy changes were related to the Affordable Care Act (ACA) and Title X of the Public Health Services Act. The implementation of the ACA and subsequent updates to it have increased the affordability of contraception, whereas changes to Title X have decreased the availability and appropriateness of contraceptive care.
This study highlights recent policy changes impacting contraceptive access, organizing them according to the five dimensions of healthcare access. It outlines specific policy barriers to contraceptive access and provides suggestions for policy and practice action that will improve contraceptive access and reproductive autonomy. Opportunities to ensure contraceptive access for all Americans include promoting comprehensive sex education, extending the Community Health Center Fund, increasing contraceptive care options for people with employers who are exempted from the ACA contraceptive mandate, addressing discrimination and building trust in contraceptive care, and amplifying outreach efforts to combat misinformation and confusion created by continuous changes to key family planning policies. Continued research on the role of policy in determining reproductive autonomy is warranted, and practice and policy action is needed to improve contraceptive access.
避孕措施的可及性受到政策决策的影响，这些决策可以扩大或限制可获得的避孕选择。本研究探讨了美国最近的联邦政策对避孕措施可及性的影响。
在灰色文献中确定了过去十年中影响避孕措施可及性的联邦政策变化。根据 Levesque 等人（2013 年）提出的医疗保健可及性的五个维度（可接近性、可接受性、可获得性/适应性、可负担性和适宜性），将这些政策变化组织成一个时间表进行分析，注意到受政策变化影响的最突出的医疗保健维度，并根据该框架分析政策是否在理论上增加或减少了避孕措施的可及性。
在所编码的增加（n=42）和减少（n=28）避孕措施可及性的政策变化中，大多数与避孕护理的可负担性（增加 n=13；减少 n=12）、实际可获得性（增加 n=10；减少 n=7）和适宜性（增加 n=12；减少 n=4）有关。政策变化在很大程度上遵循党派分歧，在民主党总统执政的年份，避孕措施可及性增加，而在共和党总统执政时则减少。许多政策变化与《平价医疗法案》（ACA）和《公共卫生服务法案》第十编有关。ACA 的实施及其随后的更新增加了避孕的可负担性，而对第十编的修改则降低了避孕护理的可获得性和适宜性。
本研究强调了最近影响避孕措施可及性的政策变化，根据医疗保健可及性的五个维度对其进行了组织。它概述了避孕措施可及性的具体政策障碍，并为改善避孕措施可及性和生殖自主权提供了政策和实践行动建议。确保所有美国人都能获得避孕措施的机会包括促进全面性教育、扩大社区卫生中心基金、为不受 ACA 避孕授权豁免的雇主的人增加避孕护理选择、解决歧视问题并建立对避孕护理的信任，以及扩大外联工作，以应对关键计划生育政策不断变化带来的误解和困惑。需要继续研究政策在确定生殖自主权方面的作用，并且需要采取实践和政策行动来改善避孕措施的可及性。
