Dispersion of Contraceptive Access Policies across the United States from 2006 to 2021

Principal Investigator
Rollins School of Public Health, Emory University

Overview

Person-centered contraceptive access promotes reproductive autonomy, sexual wellbeing, menstrual regulation, and other preventive health measures. However, contraceptive access varies by social and geographic position, reflecting patterns in the US contraceptive access policy climate. State-level contraceptive access policies can enable access to family planning care, particularly for systemically marginalized and less socioeconomically advantaged groups, or conversely, may disproportionately disadvantage such communities. The US has experienced an increase in state-level family planning legislation affecting (and restricting) access over the last 10 years; however, few studies have examined changes in the US contraceptive access policy landscape over time. In a study recently published in Preventive Medicine Reports, Rice et al. examine patterns in the number of and changes in a spectrum of US state-level policies regulating access to contraceptive services over a 16-year period.

Findings

Drawing on policy data from multiple sources, the authors collected data on 23 US state-level policies expanding or restricting access to contraceptive care in all 50 states and Washington, DC from 2006 to 2021. Using this data, the authors created a contraceptive access policy index, which demonstrates the expansiveness of a state’s contraceptive access landscape, with the lowest values representing the least expansive landscapes and the highest values representing the most expansive landscapes. The research team then assessed variations in individual policies and the contraceptive access policy index over the study period and found:

  • As of 2021:
    • The most common contraceptive access policies included prescriptive authority laws for nurse practitioners (NP), certified nurse-midwives (CNM), and clinical nurse specialists (CNS), Medicaid expansion, prescription method insurance coverage, and dispensing authority laws for NPs and CNMs.
    • The least common policies included bans on state family planning funds being used for abortion counseling or referral, policies permitting pharmacists to dispense emergency or other contraception without prescriptions, and prohibition of coverage restrictions or delays.
  • Over the study period, the average state contraceptive access landscape grew marginally more expansive.
  • In 2006, the Midwest and South had the least expansive contraceptive access landscapes while the Northeast and West had the most expansive landscapes, and by 2021, states in the Midwest and South had contraceptive access landscapes that were markedly less expansive than states in the Northeast and West.

Implications for Policy and Practice

Overall, this analysis of state-level contraceptive access policy diffusion across states largely reflected growth in the expansiveness of state contraceptive access landscapes – namely via policies granting prescribing and dispensing authority to APRNs and Medicaid expansion. Additionally, findings indicate that US regions with the most expansive sexual and reproductive health policy environments further expanded access, whereas the least expansive environments were maintained. The present analysis adds an important but understudied focus on contraception laws to other recent legal mapping research characterizing state-level trends in the diffusion of sexual and reproductive health (namely abortion and HIV prevention) policies. Characterization of policy diffusion patterns and evaluation of their health and social effects are needed to inform public health advocacy and lawmaking.

Published
in
Preventive Medicine Reports