Cost Continues to Pose Significant Barriers to Contraceptive Access

New Study in Three US States Provides Baseline Data to Monitor the Impact of Policy Shifts on Access to Reproductive Health Care

A new Guttmacher study examining the sociodemographic and health care–seeking profiles of individuals in Arizona, Iowa and Wisconsin found that nearly 20% of respondents reported that they had trouble or experienced delays in obtaining their preferred method of birth control in the past year, primarily as a result of cost and insurance-related barriers. 

“Primary and reproductive healthcare access and use among reproductive aged women and female family planning patients in three states,” by Liza Fuentes, Ayana Douglas-Hall, Christina E. Geddes and Megan L. Kavanaugh, was published recently in PLOS ONE, a prominent peer-reviewed, open access scientific journal. This analysis is part of the Institute’s larger Reproductive Health Impact Study, a research initiative that analyzes the effects of federal and state policy changes on publicly funded family planning care in Arizona, Iowa, New Jersey and Wisconsin. 

According to the study findings, cost is a primary barrier to accessing health care services in general, including preferred contraceptive methods. Survey respondents reported that they struggled to access services because of a lack of health insurance coverage, cost and logistic issues (such as child care or arranging travel to a health care facility). Not having health insurance was strongly associated with having delays or trouble in obtaining one’s desired contraceptive method. 

“These findings provide a baseline for us to monitor changes in access to and use of reproductive health services following drastic family planning funding shifts,” says Liza Fuentes, former senior research scientist at the Guttmacher Institute. “As sexual and reproductive health policies continue to shift at the state and national levels, it is important to track how these policy changes—whether they improve access or hinder it—impact people’s ability to get the health care services they want and need.”  

In each of the three study states, the researchers conducted a state-representative survey of women aged 18–44 and a survey of female family planning patients at publicly funded health care sites. The Iowa surveys were conducted between September 2018 and June 2019, and the Arizona and Wisconsin surveys between November 2019 and August 2020. The three states were selected because each had significant shifts in public funding for family planning and other reproductive health services in the last few years, which enabled the researchers to integrate the impact that policy changes had on access to sexual and reproductive health care. 

“The bottom line is that a person’s income should not determine whether they have access to quality sexual and reproductive health care, but as our work and decades of research before it demonstrates, cost barriers continue to loom large for far too many people,” says Fuentes. “This situation has been made worse by attacks on affordable contraceptive services in many states and at the federal level, for instance through Medicaid restrictions or the now-reversed Title X gag rule put in place by the Trump administration.”  

About the Reproductive Health Impact Study

The Reproductive Health Impact Study analyzes the effects of federal and state policy changes on publicly funded family planning care in the United States. The study focuses on Arizona, Iowa, New Jersey and Wisconsin, and the Guttmacher Institute works with research, policy, grantee and provider partners in each state to document the impact of policies implemented from 2017 to 2022 on family planning service delivery and the patients who rely on this care.  

Emerging findings from this study are building a robust evidence base that demonstrates the disruptions to care stemming from ideologically motivated policy attacks on reproductive health services and the detrimental impacts of these attacks on patients and providers. The study findings also significantly enhance the body of evidence regarding the impacts of the COVID-19 pandemic on sexual and reproductive health service provision.