Health care access and contraceptive use among adult women in the United States in 2017.

OBJECTIVE

To examine the relationship between insurance status and contraceptive use, with health care access as a mediating variable.

STUDY DESIGN

This study uses data from the 2017 Behavioral Risk Factor Surveillance Survey to determine whether having a personal healthcare provider and experiencing cost as a barrier to care mediate the relationship between health insurance status and contraceptive use among women at risk of unintended pregnancy. Contraceptive use is measured 3 ways: as a binary variable (use vs non-use), by prescription status, and by tiered effectiveness.

RESULTS

Having insurance increases the odds of using all categories of contraception. Having a personal health care provider mediates this relationship, with having a personal health care provider increasing the odds of using any contraceptive, using a prescription method, and using a tier I or tier II method. Experiencing cost as a barrier to care is not associated with contraceptive use in weighted multivariable models but does mediate the relationship between having insurance and using tier-II methods.

CONCLUSIONS

These findings suggest that having health insurance and an ongoing relationship with a health care provider are key to ensuring consistent access to the full range of contraceptive options. This is particularly relevant in light of the ongoing policy debates regarding laws intended to increase health insurance access and decrease barriers to contraceptive use.

IMPLICATIONS

This paper updates and extends previous findings to show that the relationship between healthcare access and contraceptive use persists after the implementation of the Affordable Care Act and that having a personal provider partially explains this relationship.