Impact of contraceptive coverage policies

Summer Sherburne Hawkins, PhD

Contraceptive insurance mandates and pharmacy access to emergency contraception do not translate to changes in contraceptive use or unprotected sexual intercourse among adolescent girls in the United States, according to a youth survey in the Journal of Public Health.¹

“The state policy landscape has increased access to sexual and reproductive health services over the past 2 decades,” said principal investigator Summer Sherburne Hawkins, PhD, associate professor of social work at Boston College in Chestnut Hill, Massachusetts. “Therefore, we wanted to examine the effects of these policy changes on adolescent girls' contraceptive use and unprotected sexual intercourse.”

The study authors assessed Youth Risk Behavior Survey data from 2003 to 2017 on 116,180 adolescent female students in grades 9 to 12 from 34 states.

For the final year of the survey, 15.75% of all adolescents who reported being sexually active did not use any contraceptive method at last sexual intercourse, with a higher prevalence of non-use among Black and Hispanic girls.

On the other hand, use of longer-acting methods increased from 4.84% in 2003 to 10.98% in 2017, and use of birth control pills from 19.09% to 22.44%, while reported use of condoms decreased from 50.70% to 39.22% over the 15-year study period.

The survey also revealed significant differences in contraceptive use, based on adolescents’ reported race/ethnicity and age. 

For instance, Black and Hispanic adolescent girls were 68% and 64%, respectively, less likely to report use of birth control pills than their White counterparts.

Conversely, reported condom use among Black and Hispanic adolescent girls were 1.26 and 1.17 times higher, respectively, compared to White adolescent girls.

Black adolescent girls were also significantly more likely to use longer-acting methods than White adolescent girls.

Furthermore, compared to White adolescent girls, adolescent girls of all other races were significantly more likely to report having unprotected sexual intercourse.

Results showed that older adolescent girls were significantly more likely to report use of birth control pills and longer-acting methods, but significantly less likely to report condom use at their last sexual intercourse. 

For example, compared to girls aged 14, girls aged 18 were 3.56 times more likely to report use of birth control pills and roughly 50% less likely to report condom use.

The survey also revealed that pharmacy access to emergency contraception significantly increased condom use in girls aged 16 and 18.

“While we hypothesized that contraceptive insurance mandates could increase prescription contraceptive use among adolescents who may have been accessing contraceptive services through their parent/guardian’s private insurance, we found no evidence of these effects,” Hawkins told Contemporary OB/GYN®. “Our results suggest there may be non-cost-related barriers to adolescents’ contraceptive access, such as confidentiality and geographic accessibility, that are impacting use.”

The findings support previous research demonstrating that increased access to emergency contraception does not compromise use of other more effective methods or lead to an increase in reported levels of unprotected sexual intercourse, according to Hawkins.

“Emergency contraception still remains difficult to access for many young adolescents, due to state-level restrictions,” she said. “Focusing on affordability and increased accessibility to emergency contraception can be critical to providing adolescent girls with access to a comprehensive range of contraceptive methods, including safer and more effective longer-acting methods.”

Reference

1. Paul PL, Pace LE, Hawkins SS. Impact of contraceptive coverage policies on contraceptive use and risky sexual behavior among adolescent girls in the USA. J Public Health. Published online November 26, 2021. doi:org/10.1093/pubmed/fdab387