Medtech
State Opportunities to Improve Contraceptive Care and Access
Nearly half of all pregnancies in the United States are unintended. Preventing unintended pregnancies is…
The post <strong>State Opportunities…
Nearly half of all pregnancies in the United States are unintended. Preventing unintended pregnancies is a shared public health goal as unintended pregnancies are significantly associated with adverse maternal and infant health outcomes, including postpartum depression, interpersonal violence, preterm birth, and low birth weight.
The Healthy People 2030 family planning objectives include improving pregnancy planning and preventing unintended pregnancy. Increasing access to a range of birth control options is an evidence-based intervention to decrease unintended pregnancy. However, In the United States, 19 million women of reproductive age in need of publicly funded contraception live in contraceptive deserts, defined as areas with less than one health center for every 1,000 women in need of publicly funded contraception.
Although there has been recent focus on reproductive health care policy, barriers to contraceptive access persist. In a recent poll by the Kaiser Family Foundation, 20 percent of uninsured females of reproductive age cited cost as a barrier for continuing use of a contraceptive method, and 4 in 10 females of reproductive age do not know most insurance plans are required to pay the full cost of birth control.
State Strategies to Improve Access to Contraceptive Care
The federal government oversees many aspects of contraceptive care and access, notably the approval of contraceptives through the Food and Drug Administration, the Title X Family Planning Program, and the Affordable Care Act’s requirement to cover preventive services for women. Together with these federal program investments and policies, states have also improved access to contraceptives through coverage, payment, and quality policies.
To learn more about state Medicaid strategies to provide access to contraceptive care, check out our explainer.
An analysis of contraceptive access policies from 2006 to 2021 found the most enacted policies to increase access include prescribing authority for nurse practitioners, certified nurse-midwives, and clinical nurse specialists; Medicaid expansion; and dispensing authority by nurses.
States are also focused on offering an extended supply of contraception, pharmacist prescribing, and telehealth. Despite these advances, barriers to policy implementation remain, including development of regulations, provider knowledge of policies, and workforce shortages. Unequal uptake of state policies, coupled with implementation barriers, ultimately leads to limitations in access for contraceptive users across states.
One strategy to reduce unintended pregnancy is through long-acting reversible contraception (LARC). Historically, there have been barriers for LARC use due to the cost of the device and low reimbursement rates. To address these barriers, state Medicaid agencies can provide incentives and unbundle immediate postpartum LARC insertion from the global maternity fee.
To learn more, visit the NASHP and National Institute for Children’s Health Quality brief, “Strategies to Increase Access to Long-Acting Reversible Contraception (LARC) in Medicaid.”
States have additional innovation opportunities for contraceptive care and access. To date, 28 states and Washington, DC, have extended postpartum Medicaid coverage to 12 months. The 2023 Consolidated Appropriations Act made this a permanent eligibility change for states that extended coverage under the American Rescue Plan. For those states providing this coverage, there is an opportunity to improve contraception access and delivery. Extended postpartum coverage is already shown to increase use of contraceptive services. Additionally, increased flexibilities during the public health emergency, such as telehealth policies, can be considered for permanent use.
NASHP is embarking on a project to identify and share emerging state policies to increase access to contraceptive care. This work is guided by an advisory group of state officials from state Medicaid, public health, and state-based exchanges. NASHP will support state officials and release case studies on contraceptive access over the next year.
This work is made possible through generous support from Arnold Ventures.
The post <strong>State Opportunities to Improve Contraceptive Care and Access</strong> appeared first on NASHP.
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