Guttmacher’s latest US-focused research explores pressing topics across the sexual and reproductive health and rights (SRHR) landscape, including where and how people obtain contraceptive services, access to gender-affirming care (GAC) at publicly supported clinics and medication abortion-related bleeding.
Where Do US Women Obtain Birth Control and How Do They Pay for It?
Published in Women’s Health Issues, this study analyzes the 2022-2023 National Survey of Family Growth (NSFG) data to better understand where US women of reproductive age obtain contraception and related SRH care and how they pay for it.
Key findings:
- In 2022, 64% of US women aged 15-49 received at least one SRH service and more than one-third received contraceptive care.
- Private insurance was the most common way individuals paid for contraceptive services (65%), but this varied by income, insurance coverage and source of care.
- Publicly supported clinics served a notable share of adolescent, low-income, publicly insured and uninsured women (30-36%).
- More than 40% of women who received contraceptive services at publicly supported clinics paid with Medicaid, compared to 18% at private providers.
- Out-of-pocket payments were most common among uninsured women (60%) and least common among those with Medicaid (13%).
“These findings underscore the important role that publicly supported clinics play in the US reproductive health care system, providing a critical safety net for young people, people with low incomes and those without insurance,” says Dr. Hannah Olson, lead author and Guttmacher senior research scientist. “Ongoing policy efforts that undermine these clinics and the funding that sustains them threaten to further destabilize the nation’s reproductive health care infrastructure and restrict access to contraceptive services and related care.”
How Do Publicly Supported Clinics Offer Gender-Affirming Care for Youth?
Originally published in Women’s Health Issues, a new Guttmacher study sought to understand the extent to which publicly supported clinics follow protocols supportive of transgender people. The researchers further analyzed the findings by clinic type and state policy regarding gender affirming care (GAC) for youth.
Key findings:
- Of the 446 clinics surveyed, only 25% reported offering gender-affirming hormone therapy.
- A high proportion of Planned Parenthood clinics reported adhering to transgender-inclusive protocols compared with other clinic types.
- More clinics in states where GAC for youth is permitted said they follow supportive protocols, compared with clinics in states where that care is banned.
“As transgender communities continue to face hostile attacks from many directions, publicly supported clinics are increasingly essential in providing accessible and affordable gender-affirming care,” says Guttmacher principal research scientist and lead author, Dr. Alicia VandeVusse. “Further investment and research are crucial in making publicly supported clinics an access point for trans patients seeking critical reproductive health care services, including gender-affirming care.”
How Do We Measure Medication Abortion-Related Bleeding?
Bleeding is a normal and expected result of a medication abortion, but people's expectations and experiences vary. Published in Contraception, Guttmacher researchers conducted a systematic scoping review of 111 studies to evaluate how medication abortion-related bleeding is measured and reported.
Key findings:
- Most studies measured bleeding duration (89) and volume (65), while fewer measured time to onset (35), expectations (32) and acceptability (22) of bleeding.
- Studies used various data collection approaches, including patient diaries and symptom logs, questionnaires and in-depth interviews.
- No included studies used measures that had been developed through a participatory process involving patients.
“This study aims to help clinicians, researchers and advocates better comprehend the scope of existing approaches for measuring and understanding medication abortion-related bleeding,” says Dr. Alice F. Cartwright, lead author and Guttmacher senior research scientist. “These findings show us that there are gaps in understanding people’s experiences with medication abortion-related bleeding. Developing patient-informed measures will facilitate the supply of comprehensive, clear and accurate information and support to people having abortions.”