Dispersion of Contraceptive Access Policies Across the United States from 2006 to 2021
Table of Contents
Table of Contents
Report Publish Date: June 2022
This journal article describes a study of state contraceptive policies and how they changed over time from 2006 to 2021.
Primary Takeaways
The most commonly enacted policies during the period studied expanded access by giving prescribing or dispensing authority to nurse practitioners, certified nurse-midwives, and clinical nurse specialists; by expanding Medicaid; and by requiring insurers that cover prescription drugs to cover FDA-approved contraceptives.
States in the West and Northeast had the most contraceptive access and expanded it considerably over time. States in the Midwest and South had fewer policies promoting access and access stayed about the same over time.
Overview and Objectives
Access to contraceptives is important for sexual health, reproductive autonomy, menstrual health, and child and maternal health. Across the U.S., people have different access to contraceptives depending on where they live. The authors wanted to know how state policies that promote or deny contraceptive access had changed over a 15-year period.
Hypothesis or Approach
The authors collected information on whether states had any of the 23 policies that restrict or expand access to contraceptives in any of the 15 years studied. The researchers then created an index to determine how expansive or restrictive each state’s policies were overall. They created three maps that show states’ index values in 2006, 2017, and 2021.
How This Influences Change
The authors say their policy mapping approach can be used to help understand the relationship between how easily accessible contraceptives are in a state and the state’s health outcomes and equity.
Research: Go Deeper
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.
Preventive Medicine Reports, June 2022, https://doi.org/10.1016/j.pmedr.2022.101827
Fig. 1. Contraceptive Access Policy Index Values: 2006, 2014, and 2021. Page 7
Research Team
This study and report was conducted and created by the following people.
- Rice WS
- Redd SK
- Luke AA
- Komro K
- Jacob Arriola K
- Stidham Hall K
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