Access to contraception in the wake of Massachusetts health care reform: Research and recommendations

Background: In 2006, Massachusetts passed legislation mandating all residents have health insurance by July 2007.

Purpose: We undertook two studies to explore the impact of Massachusetts health care reform on contraceptive access among low-income women and young adults, and collaborated with statewide agencies to develop recommendations based on the results.

Methods: Both studies included English- and Spanish-language focus group discussions with low-income and young women and reviews of the insurance plans available to them. One study also included self-administered surveys of family planning agencies and in-depth interviews with family planning clinic staff.

Results: Low-income women and young adults benefited from and have high opinions of health care reform; however, new obstacles to accessing contraception emerged under reform for both groups, including information barriers and difficulties enrolling in and maintaining eligibility for insurance plans. Young women reported high co-pays, a lack of prescription drug coverage, religious restrictions on plans, and privacy concerns when insured under a parent's plan. Health care access for those whose first language was not English and those living outside of urban areas has not improved or has gotten worse.

Conclusion: Our recommendations for improving access to contraception in the wake of Massachusetts reform include: creating user-friendly information resources, ensuring prescription drug coverage in young adult plans, developing mechanisms to provide contraceptive services to the underinsured and those in between insurance plans, and addressing privacy concerns of dependents insured under parental plans. As national reform is implemented, proactive measures are needed to facilitate access to contraception.