Invited paper| Volume 21, ISSUE 3, SUPPLEMENT , S26-S31, May 2011

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



      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.


      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.


      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.


      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.
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      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.


      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.


      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.