Seven in 10 U.S. women of reproductive age—44 million women—make at least one medical visit to obtain sexual and reproductive health (SRH) services each year, and approximately 25 million make a visit for contraceptive services, according to "U.S. Women's Use of Sexual and Reproductive Health Services: Trends, Sources of Care and Factors Associated with Use, 1995–2010," by Jennifer Frost. Over the last decade, publicly supported safety net clinics have become increasingly important in giving young and low-income women access to care; the proportion of women receiving SRH services at this type of clinic rose from 17% of those receiving care in 1995 to 23% each year between 2006 and 2010.
An analysis of data from the National Survey of Family Growth showed that clinics that receive funding through the Title X national family planning program are critical in providing access to care, serving 14% of women who received contraceptive services in 2006–2010. This includes 25% of poor women and 36% of uninsured women. Nearly one in five women (18%) who obtained testing or treatment for STIs did so at a clinic that receives Title X funds, as did 14% of women who received an HIV test. Moreover, women who visited Title X-funded clinics for their annual gynecologic exams were nearly twice as likely to have a conversation about birth control with their clinician as women going to private doctors.
"Publicly supported clinics that provide family planning services, and in particular those funded by Title X, play a vital role in providing a full range of sexual and reproductive health services to the growing number of low-income women who need affordable care," says study author Jennifer Frost. "For many women, these clinics are their main, or even their only, source of health care over the course of the year."
Frost found that more than six in 10 women who obtained care at a Title X-funded clinic in 2006–2010 reported that the clinic was their usual source for medical care. Similarly, a survey of women attending clinics that specialized in contraceptive care found that 41% reported that the clinic was their only source of care in the past year.
The study also showed that, between 1995 and 2006–2010, the percentage of women who used private insurance to pay for contraceptive visits increased substantially—from 48% to 63%—while the percentage of women reporting they had paid the full cost of their care, without insurance or subsidies, dropped from 27% to 9%. These trends in women's payment patterns and service use reflect earlier reports showing substantial increases in private insurance coverage of contraception since the mid-1990s, when changes in state and federal laws and regulations began to require coverage of contraceptive services and supplies in many private insurance plans.
"Health insurance coverage, whether private or public, reduces the financial obstacles that prevent women from accessing critical services, and increases the likelihood that they will receive care," says Adam Sonfield, Guttmacher Institute senior public policy associate. "As more women gain insurance coverage as the Affordable Care Act is implemented, safety net clinics, such as those funded through Title X, will be critical to ensuring that they are able to access the care they need."