By Melinda Young
Even before the U.S. Supreme Court overturned Roe v. Wade, many pregnancy-capable people in the United States were unable to get the contraceptive method they desired. New research shows how barriers affected women in Mississippi, where nearly two in five could not use their desired contraception.1
Investigators recruited Mississippi residents capable of pregnancy — ages 18 to 45 years — between September 2020 and February 2021 to complete an online survey. They asked them if they wanted to use a different contraceptive method or start using one and which method they preferred. They found that 37% of respondents had unmet contraceptive preferences, and 83% of respondents reported one or more barriers to accessing reproductive healthcare in an office setting.1
“We had done several studies in Mississippi prior to this and knew people were reporting barriers to getting contraception,” says Kari White, PhD, MPH, executive and scientific director at Resound Research for Reproductive Health, Tides Center, an independent nonprofit in Austin, TX.
“We had stories of long wait times to get appointments to health department clinics, and people were not necessarily using the method of contraception they wanted,” she says. “The percentage of people who were reporting not using their preferred method or having a barrier to healthcare was surprisingly high.”
Similar research in other states, like Ohio, Texas, and Wisconsin, also has shown many barriers to contraceptive access and people not using their preferred method of contraception. But the findings in Mississippi were more dramatic, White says.
“In this study, we saw that the percentage of Mississippi residents who were not using their preferred method was two times more than what we saw at the national level and higher than what we see in other studies from Ohio and Wisconsin,” she adds.
Cost was a chief barrier. Many respondents said they would use a different contraceptive method if it did not cost them anything. Long waiting times were another common barrier. And people also reported their provider would not accept their insurance or had inconvenient office or clinic hours.1
“What we heard through other research is that, given the ways in which healthcare staffing is done, a limited number of sites offered IUDs [intrauterine devices] or implants,” White explains. “So, if someone was interested in those methods, a health department in their county may not have them.”
Their options were limited, such as traveling to another county or waiting for a monthly visit to their county by a nurse practitioner, who could provide that method, she adds. “We found that 30% of the people who were not using their preferred method wanted a short-acting hormonal contraceptive, 28% wanted an IUD or implant, and 26% wanted a permanent method,” White says.
Those who could not afford contraception, even birth control pills, may have been among the Americans who fell through the cracks of the Affordable Care Act’s contraceptive mandate. Either they were uninsured, or they had private insurance that was exempt from the policy that required a co-pay for their contraceptive method of choice, she explains.
“It’s a combination of those factors,” White says. “We are going to be doing more research in coming months to dig in a little bit more about barriers to specific methods and ways to address those.” Some respondents said their insurance would not cover a specific method, such as the implant.
“Shortly after we did this study, there was an abortion ban in Mississippi, and people were facing incredibly long travel if they were considering an abortion in a facility,” White notes. “That’s not the only reason to support people getting reproductive access, but it certainly does make the context in which people are thinking about contraception even more salient.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
Reference
- Nagle A, Lerma K, Sierra G, White K. Barriers to preferred contraception use in Mississippi. J Women’s Health (Larchmt). 2024;Sep 4. doi:10.1089/jwh.2024.0127. [Online ahead of print].
