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.
Article info
Publication history
Published online: March 06, 2021
Accepted:
January 22,
2021
Received in revised form:
January 12,
2021
Received:
March 11,
2020
Footnotes
ClinicalTrials.gov Identifier: NCT02734199
Declaration of Interest: D.K.T. serves as a consultant for Sebela Pharmaceuticals. The other authors report no conflicts of interest.
Identification
Copyright
© 2021 Jacobs Institute of Women's Health. Published by Elsevier Inc.
