Abstract
The impact of state policy environment on contraceptive access: A comparison of community college students in California and Texas
APHA 2022 Annual Meeting and Expo
Background: As many states pass restrictive reproductive health policies, it is increasingly important to understand state differences in access to contraceptive care.
Objective: This study examined differences in contraceptive access among community college students in California and Texas, states with similar populations in need of family planning services yet contrasting health policies.
Methods: We used baseline data from an ongoing cluster randomized controlled trial at 27 community colleges in California and Texas. Participants were 1,830 women aged 18-25, first-year community college students, sexually active with a male partner, and not seeking pregnancy. We used multivariate logistic regression analyses for clustered data to compare contraceptive access by state.
Results: Students in California were significantly more likely to have visited a healthcare provider for contraception in the past year than those in Texas, independent of insurance coverage and sociodemographic characteristics (49% vs. 39%, p < .05; aOR: 1.42 [95% CI: 1.03–1.95]). Although awareness of their state family planning program was low in both California (13%) and Texas (14%), students in California had far greater knowledge about where to get free or low-cost contraception (63% vs. 34%, p < .001; aOR, 3.04 [95% CI, 2.30–4.02]). California students were less likely than Texas students to worry about the cost of contraception (50% vs. 66%, p < .001; aOR 0.56, [95% CI, 0.46–0.68]).
Conclusion: The state policy environment, including public funding for family planning services, has important consequences for students’ access to affordable contraceptive services during their pursuit of higher education.