They'll use it if it's free: Contraceptive choices among uninsured low-income women

Publicly funded family planning programs increase access to contraceptive services for low-income women, but it is unclear whether women would be motivated to maintain the same contraceptive protection if public funding became unavailable. California's Family PACT Program provides free family planning services to nearly 1.5 million uninsured low-income women annually. We conducted clinic exit interviews with 1,262 female clients who were neither pregnant nor seeking pregnancy, of whom 14% were new and 86% were established clients. Both new and established clients improved the efficacy of contraceptive methods they used as a result of the clinic visit. Among new clients, the proportion not using contraception decreased from 18% to 2% after the visit and the proportion using highly effective contraception increased from 28% to 42%. Among established clients, the proportion using highly effective contraception increased from 62% to 75%. However, when women were asked what method they would use if they had to pay for it, 39% reported that they would switch to a less effective, but cheaper, method than the one they adopted in Family PACT. Non-white women, and those who said that they would have sex even if they did not have birth control, were significantly more likely to report that they would adopt a less effective method if they had to pay for it (AOR 1.4 (p=0.0348) and 2.0 (p<0.0001), respectively). Conclusion: Publicly funded family planning services are essential. Many uninsured low-income women would increase their risk of unintended pregnancy if access to services was restricted.