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. 2022 May 13:27:101827.
doi: 10.1016/j.pmedr.2022.101827. eCollection 2022 Jun.

Dispersion of contraceptive access policies across the United States from 2006 to 2021

Whitney S Rice  1 , Sara K Redd  2 , Alina A Luke  1 , Kelli Komro  1 , Kimberly Jacob Arriola  1 , Kelli Stidham Hall  3
Affiliations

Dispersion of contraceptive access policies across the United States from 2006 to 2021

Whitney S Rice et al. Prev Med Rep. .

Abstract

Person-centered contraceptive access benefits reproductive autonomy, sexual wellbeing, menstrual regulation, and other preventive health. However, contraceptive access varies by social and geographic position, with policies either perpetuating or alleviating health inequities. We describe geographic and time-trend variation in an index from fewer (less expansive) to greater (more expansive) aggregation of U.S. state-level contraceptive access policies across 50 states and Washington, D.C. (collectively, states) from 2006 to 2021. We collected data from primary and secondary sources on 23 policies regulating contraceptive education, insurance coverage, minor's rights, provider authority, and more. As of 2021, the most enacted policies expanded contraceptive access through: 1) prescribing authority for nurse practitioners, certified nurse-midwives (n = 50, 98 % of states), and clinical nurse specialists (n = 38, 75 %); 2) Medicaid expansion (n = 38, 75 %); 3) prescription method insurance coverage (n = 30, 59 %); and 4) dispensing authority for nurse practitioners and certified nurse-midwives (n = 29, 57 %). The average overall U.S. policy index value increased in expansiveness from 6.9 in 2006 to 8.6 in 2021. States in the West and Northeast regions had the most expansive contraceptive access landscapes (average index values of 9.0 and 8.2, respectively) and grew more expansive over time (increased by 4-5 policies). The Midwest and South had least expansive landscapes (average index values of 5.0 and 6.1, respectively). Regions with more expansive sexual and reproductive health policy environments further expanded access, whereas least expansive environments were maintained. More nuanced understanding of how contraceptive policy diffusion affects health outcomes and equity is needed to inform public health advocacy and law making.

Keywords: Family planning services; Health policy; Public health; Reproductive healthcare; State policy.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Contraceptive Access Policy Index Values: 2006, 2014, and 2021.
Fig. 2
Fig. 2
Contraceptive Access Policy Index Quartiles: 2006, 2014, and 2021.
See this image and copyright information in PMC

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