A study of more than 250,000 primary care physicians revealed that fewer than half prescribed hormonal birth control methods and only 10% provided intrauterine devices (IUDs) or implants to patients with Medicaid coverage.1
All patients need the full range of contraceptive methods, regardless of their insurance status. This includes long-acting reversible contraceptives (LARC), says Julia Strasser, DrPH, MPH, study co-author, an assistant research professor in health policy and management, and the director of the Jacobs Institute of Women’s Health at George Washington University.
“The goal is for physicians to be able to provide the full range of methods to their patients without having to refer them to another provider,” Strasser says.
This is not suggesting that physicians incentivize patients to use one method over another. “We know there’s a history of coercion, especially among low-income people,” Strasser says.
People with Medicaid insurance already face barriers to healthcare because some provides are less likely to accept patients with Medicaid instead of private insurance or Medicare. “We also know patients covered under Medicaid might have longer wait times to get an appointment,” Strasser says. “There are barriers to getting in the door in the first place, and a huge difference in the proportion providing prescription methods of [birth control] rather than long-acting methods.”
It was not the goal to blame physicians for not providing comprehensive contraception services, Strasser emphasizes. “It’s more along the lines of they need support to offer this care,” she adds. “For primary care providers in particular, there isn’t the medical education during both residency and continuing medical education that requires them to have a component about long-acting methods.”
Better medical education would help increase clinicians’ knowledge of LARC. “For physicians who are having residency training where it’s not fully integrated into their training, having that additional support would help providers match patient needs,” Strasser says.
Strasser and colleagues encountered a surprising finding regarding whether providers practiced in a state with Medicaid expansion. “What was surprising is that pediatrics and internal medicine physicians in states that had expanded Medicaid were less likely to provide IUDs and implants,” Strasser says. “That’s not what you would expect.”
It is possible this is because expansion states have a larger pool of physicians and specialists who see Medicaid patients, so primary care doctors can refer patients to physicians who can provide them with LARC. “But that’s a hypothesis,” Strasser notes. “We didn’t look into why.”
Strasser and colleagues noted that comprehensive contraceptive care is a critical component of healthcare for patients, no matter what insurance they use.
Since Title X programs have been underfunded and were decimated during the Trump years because of the abortion gag rule, people with Medicaid or those who are uninsured have fewer places to go to receive contraception care. They need access to family physicians and OB/GYNs to obtain their contraception of choice, Strasser explains.
Also, the same people who promoted the abortion bans that cover the Southern United States and others are suggesting that some forms of contraception also should be restricted or banned, including IUDs and emergency contraception. “These claims that IUDs or emergency contraception cause abortion are wrong,” Strasser says. “There’s a danger of [lawmakers] enacting policies that are based off of falsehoods.”
All patients need access to both contraception and abortion care. “We absolutely need access to contraception, regardless of what happens to abortion,” Strasser adds.
REFERENCE
- Bodas M, Strasser J, Luo Q, et al. Association of primary care physicians’ individual- and community-level characteristics with contraceptive service provision to Medicaid beneficiaries. JAMA Health Forum 2023;4:e230106.
A study of more than 250,000 primary care physicians revealed that fewer than half prescribed hormonal birth control methods and only 10% provided intrauterine devices or implants to patients with Medicaid coverage.
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