Rice Whitney S, Redd Sara K, Luke Alina A, Komro Kelli, Jacob Arriola Kimberly, Hall Kelli Stidham
Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Prev Med Rep. 2022 May 13;27:101827. doi: 10.1016/j.pmedr.2022.101827. eCollection 2022 Jun.
Person-centered contraceptive access benefits reproductive autonomy, sexual wellbeing, menstrual regulation, and other preventive health. However, contraceptive access varies by social and geographic position, with policies either perpetuating or alleviating health inequities. We describe geographic and time-trend variation in an index from fewer (less expansive) to greater (more expansive) aggregation of U.S. state-level contraceptive access policies across 50 states and Washington, D.C. (collectively, states) from 2006 to 2021. We collected data from primary and secondary sources on 23 policies regulating contraceptive education, insurance coverage, minor's rights, provider authority, and more. As of 2021, the most enacted policies expanded contraceptive access through: 1) prescribing authority for nurse practitioners, certified nurse-midwives (n = 50, 98 % of states), and clinical nurse specialists (n = 38, 75 %); 2) Medicaid expansion (n = 38, 75 %); 3) prescription method insurance coverage (n = 30, 59 %); and 4) dispensing authority for nurse practitioners and certified nurse-midwives (n = 29, 57 %). The average overall U.S. policy index value increased in expansiveness from 6.9 in 2006 to 8.6 in 2021. States in the West and Northeast regions had the most expansive contraceptive access landscapes (average index values of 9.0 and 8.2, respectively) and grew more expansive over time (increased by 4-5 policies). The Midwest and South had least expansive landscapes (average index values of 5.0 and 6.1, respectively). Regions with more expansive sexual and reproductive health policy environments further expanded access, whereas least expansive environments were maintained. More nuanced understanding of how contraceptive policy diffusion affects health outcomes and equity is needed to inform public health advocacy and law making.
以个人为中心的避孕服务可促进生殖自主权、性健康、月经调节及其他预防性健康。然而，避孕服务的可及性因社会和地理位置而异，相关政策可能会加剧或缓解健康不平等。我们描述了2006年至2021年期间美国50个州和华盛顿特区（统称“各州”）州级避孕服务政策从较少（较不宽泛）到较多（较宽泛）汇总的指数的地理和时间趋势变化。我们从主要和次要来源收集了关于23项规范避孕教育、保险覆盖、未成年人权利、提供者权限等政策的数据。截至2021年，实施最多的政策通过以下方式扩大了避孕服务的可及性：1）执业护士、认证助产士（n = 50，占各州的98%）和临床护理专家（n = 38，占75%）的处方权；2）医疗补助扩大（n = 38，占75%）；3）处方方式保险覆盖（n = 30，占59%）；4）执业护士和认证助产士的配药权（n = 29，占57%）。美国政策指数的总体平均值从2006年的6.9上升到2021年的8.6，在宽泛程度上有所增加。西部和东北部地区的州拥有最宽泛的避孕服务环境（平均指数值分别为9.0和8.2），且随着时间的推移变得更加宽泛（增加了4 - 5项政策）。中西部和南部地区的环境最不宽泛（平均指数值分别为5.0和6.1）。性与生殖健康政策环境较宽泛的地区进一步扩大了服务可及性，而最不宽泛的环境则保持不变。需要更细致地了解避孕政策传播如何影响健康结果和公平性，以为公共卫生宣传和立法提供信息。
