The majority (71%) of women aged 15–44 who sought contraceptive services at Title X–funded health centers in 2016 had public or private health insurance coverage, according to a new analysis by Guttmacher researchers Megan Kavanaugh, Mia Zolna and Kristen Burke. Of those who had insurance, 83% planned to use their coverage to pay for the contraceptive services they received. The authors surveyed a nationally representative sample of 2,911 women aged 15–44 who sought contraceptive care at 43 Title X–funded health centers between March and October 2016.

"It is encouraging that most women had health insurance coverage and planned to use it to obtain contraceptive services at the time of this survey," says Kavanaugh, lead author of the analysis. "However, we found that coverage gaps still existed among contraceptive patients at Title X–funded health centers, and ongoing attempts to undermine the accessibility of health insurance may cause those gaps to widen."

Notably, six in 10 Title X patients reported that this facility provided their only source of broader health care over the past year, illuminating the important role that Title X–funded health centers play as an entry point into the health care system. Patients’ reported reasons for choosing a particular health center most commonly included familiarity with the site (70%) and the quality and convenience of the care offered (59%). Those obtaining care at clinics specializing in reproductive health, including Planned Parenthood sites, were most likely to have chosen their health center because of the availability of free or low-cost services and the confidentiality of care.

Although the majority of patients had health insurance coverage, disparities in coverage between U.S.-born and immigrant Title X patients mirrored differences between these groups documented in the broader population. Among U.S.-born patients, 75% had some type of public or private coverage, and 85% of those planned to use their coverage to pay for services. However, foreign-born patients were far less likely than their U.S.-born counterparts either to have coverage (46%) or to use it (78%).

"Under the Affordable Care Act [ACA], we have taken important steps toward closing health insurance coverage gaps," says Kinsey Hasstedt, Guttmacher policy expert. "Efforts to undermine the ACA’s contraceptive coverage guarantee and Medicaid jeopardize those gains."

More than one-quarter of patients who had health insurance but did not use it to pay for services cited concerns that someone might find out about their seeking family planning care. Such concerns were more common among younger women: 53% of those younger than 20 expressed these concerns, compared with 20% of those aged 20–29. According to a recent analysis, confidentiality concerns may lead some young people to forgo seeking sexual and reproductive health care services; Title X−funded clinics are a critical resource for young people who might otherwise not have a discreet source of care.

"The Title X program has long helped marginalized individuals to obtain high-quality, confidential, comprehensive contraceptive care," says Hasstedt. "Clearly, the health care providers Title X supports remain trusted sources of care valued by the communities they serve." 

"Use of Health Insurance Among Clients Seeking Contraceptive Services at Title X–Funded Facilities in 2016," by Megan Kavanaugh, Mia Zolna and Kristen Burke, is currently available online in Perspectives on Sexual and Reproductive Health.