Evaluating Policies to Improve Access to Contraception in the US

Session Submission Type: Panel

Abstract

Access to the full range of contraceptive methods is necessary to ensure reproductive health and autonomy by providing all people methods to determine whether, when, and under what circumstances to become pregnant. Better access to contraception is associated with reduced risk of unwanted pregnancy and pregnancy-related morbidity and mortality, and is cost-saving for healthcare payers. More than a decade after the Affordable Care Act (ACA) required insurance coverage of nearly all contraceptive methods without cost-sharing, there are still significant barriers to access. For example, in a 2024 survey of US females of reproductive age, nearly one-quarter reported that they were not using their preferred contraceptive method. This panel will feature four research studies that shed light on how state-level policies, and implementation of such policies, may improve access to contraception. The first study curates a state-quarter level Medicaid dataset and applies a Callaway-Sant'Anna difference-in-differences estimator to evaluate state-level policies requiring Medicaid to cover extended supply of contraception (i.e., 12 months of contraceptive pills at a single prescription fill). The second study applies a quasi-experimental difference-in-differences analysis to estimate the effects of a Massachusetts statewide standing order allowing pharmacies to dispense emergency contraception including Ella and Plan B. The third study develops methods to quantify the contraceptive workforce in Medicaid administrative data, identifying the specialties of clinicians who prescribe contraception and identifying geographic variation in access to prescribers and the full range of contraceptive methods. The fourth study uses staggered difference-in-differences methods to estimate the impact of state laws that permit nurse practitioners and midwives full practice authority to prescribe medications, including contraception, on fertility. Taken together, findings from this work will offer participants a multi-faceted discussion about different state policy strategies to enhance access to contraception, as well as exploring how state-level, provider-level, and patient-level data can best be used to provide a comprehensive evaluation of these policies. The ultimate goal of the panel is to provide actionable evidence about how state policies can improve reproductive health.

Policy Area

• Health Policy

Chair

• Marian Jarlenski, University of Pittsburgh

Discussants

• Pricila H Mullachery, Temple University

• Miranda Elyse Yaver, University of Pittsburgh

Organizer

• Marian Jarlenski, University of Pittsburgh

Individual Presentations

• Impact of Medicaid Extended Contraceptive Supply Policies on States’ Oral Contraceptive Prescription Duration - Presenting Author: Emma Mairson, Johns Hopkins University

• Changes in Emergency Contraceptive Fills After Massachusetts’ Statewide Standing Order - Presenting Author: Rebecca Myerson, Emory University

• Quantifying the Contraception Workforce and Access Landscape in National Medicaid Data - Presenting Author: Julia Strasser, George Washington University

• From Scope to Births: APRN Full Practice Authority and Fertility - Presenting Author: Moiz Bhai, University of Arkansas