Association of State Funding for Comprehensive Reproductive Health Care With Use of Contraception Among Latina Patients and Non-Latina Patients in Oregon

• Type of Material: Article
• Authors: Megan A Cohen, Emory University; Emily R Boniface, Oregon Health & Science University; Megan Skye, Oregon Health & Science University; Rachel Linz, Oregon Health Authority; Nisreen Pedhiwala, Oregon Health Authority; Maria I Rodriguez, Oregon Health & Science University
• Language: English
• Date: 2023-07-28
• Publisher: JAMA Health Forum
• Publication Version: Final Published Version
• Copyright Statement: 2023 Cohen MA et al. JAMA Health Forum.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamahealthforum.2023.2144
• Title of Journal or Parent Work: JAMA Health Forum
• Volume: 4
• Issue: 7
• Start Page: E232144
• End Page: E232144
• Grant/Funding Information: This work was conducted with the support of Early Clinical Investigator grant 1019092 from the Medical Research Foundation of Oregon.
• Keywords: Cohort Studies; Reproductive Health; Contraceptive Agents; Contraception; Female; Humans; Family Planning Services
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Public Health

Abstract

Importance: There are well-documented racial and ethnic disparities in effective contraceptive use due to multiple factors. A key contributor may be differential insurance coverage and patient costs. The Oregon Reproductive Health Equity Act (RHEA), enacted in 2017, ensures full coverage of reproductive health care without cost sharing for all Oregonians with low income. Objective: To assess whether removing financial barriers to accessing contraceptive care is associated with an improvement in use of moderately and highly effective contraceptive methods among Latina women compared with non-Latina women. Design, Setting, and Participants: This cohort study included women aged 12 to 51 years who sought contraceptive care in the Oregon Health Authority Reproductive Health Program from April 2016 to March 2020. Patients using permanent contraception, those missing data on ethnicity, and non-Oregon residents were excluded. Data analysis was performed in January 2021. Exposures: Contraceptive care in the Reproductive Health Program after RHEA implementation. Main Outcomes and Measures: The main outcome was prevalence of use of moderately effective methods (contraceptive pills, patch, ring, or injection) or highly effective methods (long-acting reversible contraceptives) at the time of the contraceptive visit. Difference-in-differences analysis was used to compare moderately and highly effective contraception use between Latina and non-Latina patients. Secondary outcomes were proportions of adoption or continuation of moderately and highly effective methods, prevalence of highly effective methods, and adoption or continuation of highly effective methods. The unit of analysis was at the clinic visit level. Results: The study sample consisted of 295604 evaluable clinic visits, in which 28.4% of individuals identified as Latina and 71.6% of individuals identified as non-Latina. The mean (SD) age was 25.5 (8.1) years. With difference-in-differences analysis, there was a significant adjusted 1.9 percentage point (95% CI, 0.2-3.6 percentage points) increase in prevalence of moderately or highly effective contraceptive methods for Latina patients compared with non-Latina patients. There were no significant differences for other outcomes of interest. Conclusions: This cohort study found that in Oregon, legislation removing financial barriers to accessing contraceptive care was associated with significant mitigation in disparate moderately and highly effective contraceptive method prevalence for Latina patients compared with non-Latina patients. The findings suggest that state funds successfully supplanted federal funds to enable continued robust comprehensive family planning services after withdrawal from Title X..