Advertisement

Perceived and Insurance-Related Barriers to the Provision of Contraceptive Services in U.S. Abortion Care Settings

      Abstract

      Background

      Abortion facilities represent a potentially convenient setting for providing contraception to women experiencing unintended pregnancies. This analysis examines a range of factors that may act as barriers to integrating contraceptive and abortion services and documents abortion providers’ perspectives on their role in their patients’ contraceptive care.

      Methods

      Administrators from 173 large, nonhospital facilities that provide abortions in the United States responded to a structured survey between May and September 2009. We used chi-square tests to assess differences in categorical outcomes.

      Results

      Although the majority of U.S. abortion facilities offer a range of contraceptive methods on site, facility staff identified multiple barriers to full integration of the two services, in particular, insurance, patient, and cost barriers. Few of these perceived barriers, however, were associated with differences in the actual provision of most contraceptive methods. Specialized abortion clinics that do not accept health insurance were less likely to have highly effective methods, such as intrauterine devices and implants, on site. Facilities located in Medicaid states were more likely to accept both public and private health insurance for contraceptive services.

      Conclusion

      Increased access to contraceptive services during abortion care is one strategy for reducing repeat unintended pregnancy, and stakeholders at all levels—including abortion providers, insurance companies, and policy makers—have a role to play in achieving this goal.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cohen S.A.
        Repeat abortion, repeat unintended pregnancy, repeat and misguided government policies.
        Guttmacher Policy Review. 2007; 10: 8-12
        • Fox M.C.
        • Oat-Judge J.
        • Severson K.
        • Jamshidia R.M.
        • Singh R.H.
        • et al.
        Immediate placement of intrauterine devices after first and second trimester pregnancy termination.
        Contraception. 2011; 83: 34-40
        • Goodman S.
        • Hendlish S.K.
        • Reeves M.F.
        • Foster-Rosales A.
        Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion.
        Contraception. 2008; 78: 143-148
        • Jones R.K.
        • Finer L.B.
        • Singh S.
        Abortion in the United States: Incidence and access to services, 2005.
        Perspectives on Sexual and Reproductive Health. 2008; 40: 6-16
        • Jones R.K.
        • Finer L.B.
        • Singh S.
        Characteristics of U.S. abortion patients, 2008.
        The Guttmacher Institute, New York2010
        • Jones R.K.
        • Kooistra K.
        abortion incidence and access to abortion services in the United States, 2008.
        Perspectives on Sexual and Reproductive Health. 2011; 43: 41-50
        • Kacanek D.
        • Dennis A.
        • Miller K.
        • Blanchard K.
        Medicaid funding for abortion: Providers’ experiences with cases involving rape, incest and life endangerment.
        Perspectives on Sexual and Reproductive Health. 2010; 42: 79-86
        • Kavanaugh M.L.
        • Jones R.K.
        • Finer L.B.
        How commonly do U.S. abortion clinics offer contraception?.
        Contraception. 2010; 82: 331-336
        • Landry D.J.
        • Wei J.
        • Frost J.J.
        Public and private providers’ involvement in improving their patients’ contraceptive use.
        Contraception. 2008; 78: 42-51
        • Mavranezouli I.
        The cost-effectiveness of long-acting reversible contraceptive methods in the UK: Analysis based on a decision analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline.
        Human Reproduction. 2008; 23: 1338-1345
      1. National Abortion Federation. (2010). 2010 clinical policy guidelines. Available: http://www.prochoice.org.

        • Pazol K.
        • Gamble S.B.
        • Parker W.Y.
        • Cook D.A.
        • Zane S.B.
        • Hamden S.
        Abortion surveillance, United States—2006.
        Morbidity and Mortality Weekly Report. 2009; 58 (No. SS-8)
        • Planned Parenthood Federation of America, Inc
        Manual of medical standards and guidelines.
        Author, New York2003
        • World Health Organization (WHO), Division of Family and Reproductive Health
        Post-abortion family planning: A practical guide for programme managers.
        Author, Geneva1997

      Biography

      Megan Kavanaugh, DrPH, was an Ellertson Fellow from 2008–2010 and is now Senior Research Associate at the Guttmacher Institute, New York, NY. Her research portfolio has focused on unintended pregnancy, contraceptive use, post-abortion contraception and attitudes about abortion.

      Biography

      Rachel Jones, PhD, is also a Senior Research Associate at the Guttmacher Institute. Her work has focused on adolescent sexual health, abortion, and male sexual and reproductive health.

      Biography

      Lawrence Finer, PhD, is Director of Domestic Research at the Guttmacher Institute. He is responsible for supervising Guttmacher's research portfolio of U.S.-focused projects on family planning services, contraceptive services, contraceptive use patterns, pregnancy and abortion, and adolescent reproductive health.