New Study Reveals Lasting Impact of Financial Barriers on Arizonans' Access to Sexual and Reproductive Health Care

Burdensome, unexpected costs resulting from changes in family planning policies influenced whether, when and where Arizona residents sought care

Read the full study here. 

Financial barriers forced many study participants of reproductive age in Arizona to delay or forgo reproductive health care, according to a new study from the Guttmacher Institute. “Cost-related barriers to sexual and reproductive health care: results from a longitudinal qualitative study in Arizona,” part of Guttmacher’s larger Reproductive Health Impact Study, analyzed respondents’ strategies to mitigate cost barriers from mid-2019 through late 2021, a period marked by significant changes in the family planning policy landscape. 

“For an individual to exercise their full reproductive autonomy, they must have access to comprehensive sexual and reproductive health care services,” says Alicia VandeVusse, senior research scientist at the Guttmacher Institute. “However, cost often poses a challenging—if not insurmountable—barrier to accessing care. This study adds to a growing body of research that demonstrates how people in the US are often forced to prioritize affordability over health, cost avoidance over prevention and insurance acceptance over quality.” 

The study, which was published in SSM-Qualitative Research in Health, recruited people assigned female at birth aged 15 and older who accessed sexual and reproductive health care in Arizona in 2019. Respondents participated in three interviews at six- to nine-month intervals beginning in the summer of 2020. Researchers conducted longitudinal interviews with 32 participants during a period of shifting state and federal policies, including restrictions imposed by the Trump administration on the Title X national family planning program. Often referred to as the “domestic gag rule,” this mandate prevented facilities that relied on Title X funding from offering patients abortion care or information.    

Notably, the study found that more than half of respondents postponed seeking sexual and reproductive health care because of a lack of insurance or previous experience with burdensome or unexpected costs. In some cases, this exacerbated an existing condition or worsened the respondent’s health in other ways. As one respondent said: 

“One month ago, I went to the hospital because [my fibroids] hurt, and besides, my menstruation was heavier than usual. So, since I could no longer bear the pain, I went to Mexico to the hospital because I did not have health insurance.…I would like to have health insurance here. I would like to have an operation here because I would be less afraid.” 

In addition, cost barriers often led to respondents changing where they received care. This often resulted in disruptions to care, experiences of lower-quality care and the inability to receive care from a preferred provider. Both insured and uninsured respondents reported care-switching behavior as a result of financial concerns.  

One respondent described being turned away at her regular care site because there wasn’t a doctor that day who was certified to accept her Arizona Medicaid insurance. As a result, she had to go to an urgent care site:

“I'm glad that I was able to have that taken care of, but it was frustrating when you go to a [care site] and they say, ‘Sorry, but we don’t have a doctor that can take your insurance.’” 

“What this study shows, and what we are committed to, is the critical importance of ensuring that services and resources are available to youth, the underinsured and uninsured, low-wage earners and other medically underrepresented groups who have been systematically excluded from receiving care,” said Bré Thomas, CEO of Affirm, Arizona’s Title X agency. “It’s critical that state policymakers prioritize making high-quality sexual and reproductive health care accessible to all Arizonans.” 

Read the full study here. 

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. 

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