There are approximately 61 million women of reproductive age (15-44 years) in the United States, and at any given time, 70% of them are at risk of unintended pregnancy—that is, they are sexually active but do not want to become pregnant. About 72% of women who currently use contraception use non-permanent methods, such as the pill, patch, implant, injectable, vaginal ring, IUDs, and condoms. A recent article published in Medical Care by Marshall, Schmittdiel, Chandra, Calhoun, and Raine-Bennett addresses the relationship between prescription copayments and contraceptive adherence in a cohort of women ages 19-29 with a new prescription for the contraceptive pill, patch, or ring at Kaiser Permanente Northern California during 2011-2014.
Approximately 45% of all pregnancies in the United States are unintended, with these rates highest among low-income women, women ages 18-24, and minority women. Rates of unintended pregnancy are lowest among higher-income women, white women, college graduates, and married women. More than 40% of unintended pregnancies occur while a person is inconsistently using contraception.
Many factors are associated with contraceptive nonadherence, including individual-level behavior, relationship, and sociodemographic factors, as well as characteristics of the various forms of contraception. Marshall and colleagues explore cost-sharing as an additional factor. Cost-sharing is the financial payment that patients make when using healthcare services, which includes deductibles, coinsurance, and copayments. Many studies have examined adherence to chronic disease medications (such as statin therapy for cardiac disease prevention, hypertensive agents, and insulin for diabetes management), and, like Marshall and colleagues, most have found that more cost-sharing is associated with less medication adherence.
Marshall and colleagues found that prescription copayments may serve as a barrier to adherence for pharmacy-dispensed contraception. Fortunately, the Affordable Care Act (ACA) now mandates that health insurance plans provide full financial coverage for all Food and Drug Administration (FDA) approved contraceptive options, without cost-sharing. Marshall and colleagues provide good evidence that this policy will likely increase adherence.
Access to reproductive healthcare is key to the social and economic empowerment of women in society.
- Women are empowered in society through education. Access to contraception plays a significant role in this empowerment, as it increases the odds that women will graduate from high school, college, and professional programs.
- The Guttmacher Institute reports that access to contraception has resulted in more women pursuing and graduating from college, which results in increased earning power and decreased gender pay gap.
- Access to contraception has also been found to be a catalyst for women pursuing careers in dentistry, medicine, and law.
- Financial and geographic access to contraception is widely accepted as the primary mechanism for reduction and prevention of adolescent pregnancy.
- The Centers for Disease Control and Prevention (CDC) states that adolescent pregnancy is a significant contributor to high school dropout rates for young women.
- CDC states that approximately 50% of adolescent mothers achieve a high school diploma by the age of 22 years old, whereas 90% of female students who are not adolescent mothers graduate from high school.
Additionally, in 2014, the abortion rate in the United States reached an all-time low. A recent policy analysis in the Guttmacher Policy Review argues that improved access to contraception was the primary contributor—increased access to contraception results in fewer unintended pregnancies and thus, fewer elective abortions. While some policymakers try to decrease abortion rates by enacting burdensome requirements on healthcare providers and patients, my hope is that the current administration recognizes the role of contraceptive access in the abortion rate decline. As noted by Deschner and Cohen,
“Extensive evidence demonstrates […] that when modern contraceptives are made available to women, their increased use over time replaces previous reliance on abortion and becomes the major factor associated with reduced abortion rates. Policymakers seeking to reduce the incidence of abortion would do well to address its root cause—unintended pregnancy—by facilitating widespread access to modern contraceptives and by promoting their effective use.”
The American Public Health Association supports “protection and fulfillment of universal rights to safe, voluntary, confidential access to the full range of contraceptive methods” and “urges governments and international organizations to respect, protect, and fulfill sexual and reproductive health and rights.” Affordable access to contraception is key to the social and economic empowerment of women in society.
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