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Contraceptive Method Uptake at Title X Health Centers in Utah

Published:March 06, 2021DOI:https://doi.org/10.1016/j.whi.2021.01.003

      Abstract

      Background

      The Title X family planning program previously supported contraception for Utah clients with low incomes, yet its contributions may not have been sufficient to allow clients to select their preferred methods, including long-acting reversible contraceptives (LARCs). In this study, we compare the contraceptive method choices of self-paying clients with low incomes at three participating Title X health centers in Salt Lake County, Utah, before and after the removal of additional cost barriers.

      Methods

      We used retrospective medical record review to assess clients’ contraceptive choices during two 6-month periods: a control period with Title X-assisted sliding scale payment schedules (n = 2,776) and an intervention period offering no-cost contraceptive care (n = 2,065). We used logistic regression to identify the likelihood of selecting a LARC during the intervention period and multinomial regression to identify the selection probability of different types of available LARCs.

      Results

      During the control period, 16% of participants chose a LARC compared with 26% in the intervention period (p ≤ .001). During the intervention period, participants were 1.8 times more likely to select LARCs (95% confidence interval, 1.65–2.13) compared with non-LARC methods, holding covariates constant. In the multinomial regression, participants were three times more likely during the intervention period to select an implant than a pill, patch, or ring, holding all other covariates constant (odds ratio, 3.08; 95% confidence interval, 2.47–3.83).

      Conclusions

      Title X clients offered contraceptive methods without cost more frequently selected a LARC method. Title X funding reductions may impede individuals’ access to their contraceptive methods of choice.
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      Biography

      Corinne Sexsmith, MS, is a Clinical Research Coordinator, University of Utah, with a background in the nonprofit sector. Corinne received her Master's in Human Development and Social Policy and is passionate about implementation research and promoting women's health in the community.

      Biography

      Jessica Sanders, PhD, MSPH, is an Assistant Professor in Obstetrics and Gynecology, University of Utah. Using a public health lens, Dr. Sanders conducts and advocates for the use of interdisciplinary academic and clinical research to inform evidence-based policy in Utah and beyond.

      Biography

      Rebecca G. Simmons, PhD, MPH, is a public health scientist with expertise in evaluating implementation interventions around sexual/reproductive health in domestic and global settings. She conducts research assessing how contraceptive use and needs change over the life course and fertility-awareness based methods.

      Biography

      Cristen Dalessandro, PhD, is a sociologist and postdoctoral fellow in Family Planning at the University of Utah. Her previous publications and research have focused on the sexual health and intimate relationship lives of young adults.

      Biography

      David Turok, MD, MPH, is an Associate Professor who directs the Division of Family Planning, University of Utah. He is the principal investigator of several NIH, industry, and foundation grants focusing on overcoming barriers to contraception and developing new contraceptive methods.