Cost-Related Barriers Prevent Low-Income Women in the United States from Using Their Preferred Contraceptive Method, New Study Finds

Health insurance coverage and person-centered care can support reproductive autonomy

Up to 40% of women with low incomes in the United States would use a different contraceptive method—or would start using a method—if cost were not a factor, according to a new Guttmacher Institute study published today.

National data from 2015–2019 suggest that 23% of low-income female contraceptive users* would prefer to use a different method if cost were not an issue. Among women with low incomes not using contraceptives, 39% would prefer to use a method if not for cost-related barriers.

"All people, regardless of income, should be able to choose and use the contraceptive method that works for them, free from cost-related barriers," says Megan Kavanaugh, principal research scientist at the Guttmacher Institute. "A person’s ability to access their preferred contraception is an essential component of reproductive choice and decision making."

The study findings indicate that health insurance coverage and quality of care are key factors that affect low-income individuals’ ability to use their preferred contraceptive method in the context of cost barriers. Among women using contraceptives, those who had no health insurance more commonly reported that they would use a different method if cost were not an issue than those with private or public insurance.

In addition, compared with those who did not access sexual and reproductive care, low-income individuals who received publicly supported contraceptive care reported more frequently that they wanted to use a different method, underscoring that this type of publicly supported care is necessary but not sufficient to fully overcome cost barriers to using preferred contraceptives.

Contraceptive counseling that focuses on the person’s needs and preferences is another factor that may contribute to the ability to choose and use one’s preferred contraceptive method. Contraceptive users with low incomes who had received person-centered contraceptive counseling were slightly less likely to have their preferences in contraception unmet due to cost than those who had not received person-centered counseling.

"Cost is a significant barrier to preferred contraception for individuals with limited resources, even in health care settings that are specifically designed to minimize those barriers," says Dr. Kavanaugh. "Expanding health insurance coverage and ensuring access to patient-centered counseling can help support reproductive choice and decision making, especially for the individuals who are most impacted by cost-related barriers to care."

*We use "female" and "women" to reflect the terminology used in the National Survey of Family Growth, from which we draw our data. We recognize that gender identities are diverse and not everyone who uses contraceptives may identify as a woman.