Changes in contraceptive method use, access, and experiences of care during a statewide contraceptive initiative

Abstract

Objective: To examine changes in contraceptive use, access, and care experiences during a statewide contraceptive access initiative, Delaware Contraceptive Access Now.

Study design: We used responses from the Delaware/Maryland Survey of Women at the early wave (November, 2016-March, 2017) and late wave (February, 2021-October, 2021). Our cross-sectional sample included 6467 respondents at risk of unintended pregnancy. We used logistic regression to examine changes in contraceptive outcomes, controlling for age, race/ethnicity, income, education, marital status, and employment. Using interaction terms between state and survey wave, we compared population-level changes in outcomes in Delaware to changes in Maryland, which did not implement a similar contraceptive initiative.

Results: The change in long-acting reversible contraceptive (LARC) use in Delaware compared to Maryland was estimated as a 2.8% point increase, but was not statistically significant (95% CI: -2.8, 8.3). Knowing where to get free LARC increased by 6.2% points (95% CI: 0.4, 12.1; p < 0.05) in Delaware compared to Maryland. Both Delaware and Maryland indicated substantial within-state decreases in reporting their doctor asked about plans for pregnancy (Delaware: -8.9% points; Maryland: -15.1% points), but the decrease in Delaware was significantly smaller: 5.6% points (95% CI: -0.9, 12.1; p < 0.1). Delaware also had a net decrease of 4.7% points (95% CI: -9.9, 0.5; p < 0.1), compared to Maryland, among those very or somewhat satisfied with their current method.

Conclusions: We observed a mixed picture of changes in contraceptive use, access, and care experiences during the program. Our findings will be useful to Delaware program administrators and others, including the federal government, as they adopt similar reforms.

Implications: We found that the Delaware contraceptive access initiative substantially increased knowledge of free LARC access and led to a relative increase in respondents reporting they had been asked about their pregnancy plans, compared to Maryland, but was not associated with other outcomes.

Keywords: Access to contraception; Long-acting reversible contraception; Statewide contraceptive initiative; Survey of women.