Kavanaugh Megan L, Pliskin Emma, Hussain Rubina
Guttmacher Institute, New York, NY, United States.
Contracept X. 2022 May 6;4:100076. doi: 10.1016/j.conx.2022.100076. eCollection 2022.
To identify prevalence of unfulfilled contraceptive preferences due to cost among low-income United States female contraceptive method users and nonusers, and associations between access to, and experience with, contraceptive care and this outcome.
We drew on data from the 2015-2019 National Surveys of Family Growth to conduct simple and multivariable logistic regression analyses on unfulfilled contraceptive preferences due to cost among nationally representative samples of low-income women ages 15 to 49 who were current contraceptive users ( = 3178) and nonusers ( = 1073).
Overall, 23% of female contraceptive users reported they would use a different method, and 39% of nonusers reported they would start using a method, if cost were not an issue. Controlling for user characteristics, low-income contraceptive users who received recent publicly supported contraceptive care reported significantly higher levels of unfulfilled contraceptive preferences due to cost than those without any access to SRH care (aOR = 1.6, CI 1.0-2.5), while having private (aOR = 0.6, CI 0.4-0.9) or public (aOR = 0.7, CI 0.5-1.0) health insurance was associated with significantly lower levels of this outcome. Nonusers of contraception who had recently received publicly supported contraceptive care also reported marginally higher levels of this outcome (aOR = 2.2, CI 1.0-5.1). Contraceptive users who received recent person-centered contraceptive counseling had marginally lower odds of unfulfilled contraceptive preferences due to cost (aOR = 0.6, CI 0.4-1.0).
Cost is a barrier to using preferred contraception for both contraceptive users and nonusers; health insurance coverage and person-centered contraceptive counseling may help contraceptive users to overcome cost barriers and realize their contraceptive preferences.
Factors related to contraceptive access at the systems level-specifically the subsidization and experience of contraceptive care-impact whether cost serves as a barrier to individuals' contraceptive preferences. Delivery of patient-centered care and shoring up health insurance coverage for all can help to mitigate cost barriers and enable individuals to realize their contraceptive preferences.
确定美国低收入女性避孕药具使用者和非使用者中因费用导致的未满足避孕偏好的患病率，以及获得避孕护理的机会、避孕护理体验与这一结果之间的关联。
我们利用2015 - 2019年全国家庭成长调查的数据，对年龄在15至49岁的低收入女性全国代表性样本中因费用导致的未满足避孕偏好进行单变量和多变量逻辑回归分析，这些样本包括当前的避孕药具使用者（n = 3178）和非使用者（n = 1073）。
总体而言，23%的女性避孕药具使用者表示，如果费用不是问题，她们会使用不同的方法；39%的非使用者表示，如果费用不是问题，她们会开始使用某种方法。在控制使用者特征后，近期接受过公共支持的避孕护理的低收入避孕药具使用者因费用导致的未满足避孕偏好水平显著高于那些没有任何生殖健康护理机会的使用者（调整后的比值比[aOR]=1.6，置信区间[CI]为1.0 - 2.5），而拥有私人（aOR = 0.6，CI 0.4 - 0.9）或公共（aOR = 0.7，CI 0.5 - 1.0）医疗保险与该结果水平显著降低相关。近期接受过公共支持的避孕护理的非避孕使用者也报告该结果水平略高（aOR = 2.2，CI 1.0 - 5.1）。近期接受过以人为主的避孕咨询的避孕药具使用者因费用导致的未满足避孕偏好的几率略低（aOR = 0.6，CI 0.4 - 1.0）。
费用是避孕药具使用者和非使用者使用首选避孕方法的障碍；医疗保险覆盖范围和以人为主的避孕咨询可能有助于避孕药具使用者克服费用障碍并实现其避孕偏好。
系统层面与避孕获取相关的因素，特别是避孕护理的补贴和体验，会影响费用是否成为个人避孕偏好的障碍。提供以患者为中心的护理并加强全民医疗保险覆盖范围有助于减轻费用障碍，使个人能够实现其避孕偏好。
