Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Keywords: Contraceptive care; Family planning; Grey literature; Healthcare access; Reproductive health.
Legislation influences if, when, and how people access contraception. Healthcare access can be conceptualized across five dimensions: approachability, acceptability, availability/accommodation, affordability, and appropriateness. Applying this healthcare access framework can help understand barriers to and facilitators of contraceptive access. In this study, I conducted a systematic Google search to identify recent federal policy changes related to contraceptive access. I organized these policy changes into a timeline and analyzed them according to the healthcare access framework mentioned above. Through this analysis, I have highlighted specific policy barriers to contraceptive access and provided suggestions for policy and practice action that can improve contraceptive access and reproductive autonomy.Findings indicated that Levesque et al.'s (2013) dimensions of healthcare access are relevant to contraceptive care. Many recent US policy changes related to contraceptive access are described in this study, and the analysis showed that these policy changes have fluctuated with election cycles and according to partisan divides. Two key US policies related to contraceptive access, the Affordable Care Act and Title X of the Public Health Services Act, have sustained many changes across the past decade. These policies have increased contraceptive access in the United States by dedicating funding to family planning availability and affordability and increasing insurance coverage for contraceptive care. However, recent changes to these policies threaten contraceptive access and reproductive autonomy. There is a need for continued research regarding the ways that policy influences reproductive autonomy and a need for practice and policy action to improve contraceptive access.
© 2021. The Author(s).