The “3” Series – Forging the Future of Health Care
3 Facts About Contraceptive Care:
The Good, The Bad, and the Ugly
Dartmouth Institute Assistant Professor Rachel Thompson heads the Institute’s Right For Me research study, which aims to improve conversations about birth control and support people to make decisions that are right for them.
The Good: Contraceptive access is better than ever.
The contraceptive coverage mandate in the Patient Protection and Affordable Care Act (ACA) has transformed contraceptive access. The ACA requires insurance plans to cover at least one contraceptive method from each of the 18 categories of FDA-approved methods without cost-sharing. Recent research shows that patients’ out-of-pocket expenditure on contraceptives has fallen significantly since its introduction1. Evidence on downstream impacts, including contraceptive utilization and avoidance of unintended pregnancy, is expected to further underscore the importance of a continued commitment to this policy.
The Bad: Some patients still receive biased contraceptive counseling.
Biased contraceptive counseling can take many forms: advocating only certain contraceptive methods, systematically discussing some methods before others, or providing false, unbalanced, or incomplete information about contraceptive options. Patients notice and dislike biased contraceptive counseling and have highlighted its harmful effects on their trust, health service utilization, and contraceptive behaviors2. Research examining the impact of different counseling approaches in a variety of outcome domains is a key priority.
The Ugly: Disparities in contraceptive care delivery and outcomes persist.
Disparities based on race and ethnicity, income, age, gender identity, and other factors continue to be observed in aspects of contraceptive care delivery and outcomes including contraceptive recommendations3, contraceptive utilization4, and rates of unintended pregnancy5. Research examining the factors perpetuating these disparities and innovate approaches to reducing them is critical and urgent.
1 Law A, Wen L, Lin J, Tangirala M, Schwartz JS, Zampaglione E. Are women benefiting from the Affordable Care Act? A real-world evaluation of the impact of the Affordable Care Act on out-of-pocket costs for contraceptives. Contraception. 2016;93(5):392-397.
2 Higgins JA, Kramer RD, Ryder KM. Provider bias in long-acting reversible contraception (LARC) promotion and removal: Perceptions of young adult women. Am J Public Health. 2016;106(11):1932-1937.
3 Dehlendorf C, Ruskin R, Grumbach K, et al. Recommendations for intrauterine contraception: a randomized trial of the effects of patients’ race/ethnicity and socioeconomic status. Am J Obstet Gynecol. 2010;203(4):319.e1-8.
4 Dehlendorf C, Park SY, Emeremni CA, Comer D, Vincett K, Borrero S. Racial/ethnic disparities in contraceptive use: Variation by age and women’s reproductive experiences. Am J Obstet Gynecol. 2014;210(6):526.e1-526.e9.