Cost and Other Economic Factors Affect People’s Access to Contraceptives
November 1, 2025 8 minutes read
By Melinda Young
New research examines how contraception costs can affect young people’s decision-making about whether to use contraception. A separate study looks at how researchers need access to more data about contraception cost barriers and other obstacles to optimal sexual and reproductive health.1,2 “This is an increasingly important issue that cost remains that key barrier to ensuring equal access to sexual and reproductive healthcare,” says Hannah Olson, PhD, MSPH, a senior research scientist with the Guttmacher Institute in New York, NY.
“It’s important to have really good data sources that can help us understand how people are paying for care and [handling] other barriers they experience in trying to access care,” Olson adds. Olson’s research looked at 29 relevant data sources to see what the availability is of ongoing high-quality data on key sexual and reproductive health metrics, including cost of contraception.2
A new behavioral economic assessment study asked college students at a large Southern university how likely they would be to use condoms and/or emergency contraception based on various factors, including cost, the time it would take to obtain them, and whether they lived in a state that banned abortion.1 The study found that as the cost of contraceptives increases, students are less likely to use them and more likely to either abstain from sexual activity or have sex without contraception. Also, if students live in a state where abortion is banned, they are less likely to have sex without affordable and immediate access to condoms and/or emergency contraception.1
“Delay discounting is how things farther away in time lose subjective value. A common example is asking someone if they would rather have $500 now or $1,000 in a year from now,” says Jin H. Yoon, PhD, an associate professor, department of psychiatry and behavioral sciences, at the University of Texas Health Science Center, the John P. and Kathrine G. McGovern Medical School, and the Center for Neurobehavioral Research on Addictions in Houston, TX.
In Yoon’s previous research, he found that people who are willing to settle for less money now in exchange for the immediate reward of the money are people who are more likely to use drugs instead of making other decisions that would result in better health and economic rewards. “We all can make impulsive decisions and focus on the immediate gains,” he explains. “But in terms of drug use and risky sex, sometimes the immediate benefits will overshadow long-term gains, which are far away.” The study found that people who reported having higher-risk sexual experiences also were less likely to want to use a condom when having sexual intercourse.1
Participants completed a 23-item Sexual Risk Survey questionnaire that assessed the frequency of risky sexual behavior in the past six months. Risky behavior included sexual risk-taking with uncommitted partners, risky sex acts — meaning sex without a condom, impulsive sexual behaviors, such as unplanned sexual encounter with someone they just met, and intent to engage in risky sexual behaviors and risky anal sex.1 Researchers also assessed participants’ knowledge and attitudes about reproduction and condoms, and whether they had confidence in their knowledge of when it was safe to have sex. They also assessed their attitudes about contraceptives. Those with higher scores had greater knowledge, confidence, and more positive attitudes about contraceptives. Participants’ attitudes and knowledge about emergency contraception also were assessed.1
Investigators asked participants to “Imagine that you are in a social situation such as a party or bar, and you meet an attractive person with whom you immediately hit it off and share a connection. At the end of the night, you end up together, and it is clear you are both interested in having sex.”1 Then, participants were told to assume they were not in a committed relationship, they had their current financial picture, there was no other source of condoms, and they were not on other forms of birth control. Plus, the person they found attractive would be leaving town the next day.1
Given that scenario, they were asked to consider their willingness to purchase a three-pack of condoms at various prices and by various time delays to getting the condoms. The time delays ranged up to two hours, and the prices ranged from 10 cents to $500. For each time delay they could say whether they would “definitely [have] sex now without a condom” or “definitely wait for a condom.”1
In the scenario involving emergency contraception, referred to as the morning after pill, participants were told they had unprotected sex the night before and the sexual encounter occurred near ovulation. They had only one source available to purchase the morning after pill, and insurance would not cover the cost. They were asked if they would purchase the pill at various prices, ranging from zero to $10,000, and then answer either “definitely not purchase” or “definitely would purchase.”1
Participants’ responses to the scenario of a closed economy where they met someone at a party or bar and had one shot at having sex with this attractive person were that as the price of condoms went up, they were less likely to buy a condom, Yoon says. When they were asked for the maximum price they would pay for a condom if they lived in a state with an abortion ban, the price they would accept was similar to what they would pay if they lived in a state without an abortion ban. But their behavior regarding waiting to have sex changed depending on the circumstance. If they lived in a state with an abortion ban, they were more likely to abstain from sex, he explains.
“The follow-up decision to not have sex was higher [when there was an abortion ban] if they found condoms to be too expensive,” Yoon says. It was more likely they would delay having sex until they could get a condom when abortion was illegal. But as a group, they were more likely to have sex without a condom as the delay got bigger, especially if they lived in a place where abortion was legal, he adds.
For studies about contraception access, reproductive health and pregnancy outcomes, and the impact of costs, researchers need accurate, comprehensive data from both state-level and federal sources. “Without good data sources on payment methods and payment barriers, we can’t get a clear picture of contraceptive access and which barriers exist to contraceptive access that we need to work on alleviating,” Olson explains. “Cost has always been and remains an increasingly important barrier to ensure equal access — especially with recent legislation that will remove millions of people from Medicaid over the next 10 years.” The Joint Economic Committee Minority reported in May 2025 that 13.7 million people would lose health insurance from Medicaid and Affordable Care Act (ACA) through 2034.3
Olson’s paper about government and other data sources was motivated by a need identified by scholars to get shared understanding of information that is already collected, as well as gaps that still remain, she says. For instance, sexual and reproductive healthcare researchers want to know the answers to these questions:
- What are all the sources of data about where people obtain contraceptives?
- What barriers are they experiencing?
- How are those services being provided?
- What are the quality-of-care measures around service provision?
- How can we understand patient experiences?
“Our hope is this landscape can be a good starting point for researchers and those of us charged with holding them accountable in meeting beneficiaries and their patients,” Olson says. “This includes those that are the most marginalized and experiencing the most barriers.”
The paper highlights opportunities to improve future data collection efforts by filling in some of the gaps researchers identified, she adds.2 “One gap is the degree to which cost and other barriers are disrupting access to care on individual and systems levels,” Olson adds.
“A core motivation for this and why it would matter to clinicians, program planners, and policy makers, is that without good sources of data, we don’t understand what we know and don’t know,” she explains. “We can’t get a clear picture of what contraceptive access looks like and what are the barriers patients are experiencing in getting care.”
A notable example of how lack of data can have a negative effect on clinical data is national data collection about maternal and infant morbidity and mortality. The Pregnancy Risk Assessment Monitoring System (PRAMS) has an uncertain future, and it is variable at state level, she notes. “PRAMS is one data set that has experienced a lot of tumultuous time in recent months,” Olson adds. “PRAMS is a data set that is a surveillance system and is developed to reduce morbidity and mortality and track health and outcomes during pregnancy.” PRAMS’ information on postpartum family planning and contraceptive service provision is important to informing clinical practice, she adds.
In recent months, PRAMS data are not uniformly available to clinicians, national boards that make clinical recommendations, and policy makers. The federal government dismantled PRAMS data in the spring of 2025, and it is unclear when or if data collection will return. The Centers for Disease Control and Prevention’s webpage for PRAMS has not been updated in 2025 other than a statement that says PRAMS Automated Research File (ARF) data requests are not being processed, currently, and researchers need to contact each site/state separately.4-6
“Monitoring systems are a core public health surveillance system that a lot of clinicians and public health practitioners rely on to keep fingers on the pulse of maternal newborn health,” Olson says. Large datasets for other sexual and reproductive healthcare issues also may become more difficult to access in coming months and years, but there are no good answers about how barriers to data may affect clinical practice, she notes.
“It will vary based on the data source, based on the unit of analysis, and based on specific data being collected,” Olson explains. “I don’t know what the time lag will be and when and if a critical data source is no longer available.”
Information that clinicians need to understand patients’ health and reproductive health outcomes might affect clinicians fairly quickly. With the PRAMS example, data from PRAMS is what informed West Virginia public health officials about a growing trend of pregnant women smoking and jeopardizing their newborns’ health. Learning of the problem through PRAMS led to the state developing targeted interventions, including a smoking cessation curriculum that clinicians could promote at each prenatal visit.4
National data collection involving contraceptive access also can help inform clinical care of minority groups, such as LGBTQ and gender-diverse patients, immigrants, and racially minoritized patients who have unique health needs and experience additional health challenges, Olson says. “It’s hard to collect data on unique subpopulations to get sufficient sample sizes and ensure data collection tools are tailored appropriately and are ethical and meet privacy standards to protect respondents,” she says.
“But it’s really important that we are able to have a better understanding of the needs and services provided to these populations that are uniquely marginalized,” Olson adds. “Data allows us to understand and fill in gaps so that we can improve our monitoring and clinical care to the degree to which we are able to understand and alleviate barriers to contraceptive access,” Olson says.
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Yoon JH, Pericot-Valverde I, de Dios C, et al. Behavioral economic assessment of contraceptive use and abortion access among college cis women in the US. Arch Sex Behav. 2025;54:2539-2552.
2. Olson H, Kavanaugh ML, Fowler C, et al. A landscape of available data on contraceptive care in the United States. Contraception. 2025; Sep 8:111204. [Online ahead of print].
3. Joint Economic Committee Minority Report. State-by-state data — 13.7 million people would lose health insurance from Medicaid, ACA cuts. U.S. Congress Joint Economic Committee — Minority. May 2025. https://www.jec.senate.gov/public/_cache/files/d5fb1359-92a6-47ac-8fae-aeffb1de2f6e/jec-fact-sheet-on-state-by-state-impacts-of-health-care-cuts.pdf
4. Carroll AE. When public data disappear: What we lose and why it matters. HealthAffairs. July 7, 2025. https://www.healthaffairs.org/content/forefront/public-data-disappear-we-lose-and-why-matters
5. National Association of Certified Professional Midwives, American College of Nurse-Midwives, Association of Women’s Health, Obstetric and Neonatal Nurses. Joint Statement from NACPM, ACNM on the Closing of the CDC’s PRAMS Program. ACNM, NACPM, AWHONN. April 9, 2025. https://midwife.org/wp-content/uploads/2025/04/Joint-Statement-from-NACPM-ACNM-and-AWHONN.pdf
6. Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS Data. Centers for Disease Control and Prevention. Aug. 22, 2024. https://www.cdc.gov/prams/php/data-research/index.html
New research examines how contraception costs can affect young people’s decision-making about whether to use contraception.
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