Where U.S. Women Obtained Contraceptive and Related Care and How They Paid for It in 2022-2023: An Analysis of the National Survey of Family Growth.

Objective: We aimed to examine receipt of contraceptive and other sexual and reproductive health (SRH) services among U.S. women of reproductive age in 2022-2023, sources of care, and payment methods, with attention to implications for the SRH safety net.

Materials and methods: Using female respondent data from the 2022-2023 National Survey of Family Growth, we examined receipt of and source of care for 14 SRH services, including contraceptive, preventive gynecologic, sexually transmitted infection testing, and pregnancy-related services. We examined payment methods for contraceptive services by source of care, classified by provider type and funding status, and demographic characteristics.

Results: In the prior year, most U.S. women aged 15-49 (64%) received at least one SRH service and more than one-third received contraceptive services. While most obtained SRH care from private providers, publicly supported clinics served a notable share of adolescent, low-income, publicly insured, and uninsured women (30-36%). Overall, private insurance was the most common way individuals paid for contraceptive services (65%), but this varied by income, type of insurance coverage, and source of care. More than 40% of women who received contraceptive services at publicly supported clinics reported paying with Medicaid, compared with 18% at private providers. Out-of-pocket payments were most common among uninsured women (60%) and least common among those with Medicaid (13%). Uninsured women reported receiving no-cost services more often than those with insurance.

Implications for policy and practice: Publicly supported clinics are essential sources of SRH care, particularly for under-resourced populations. Recent policy changes threaten this safety net. Protecting publicly funded SRH services and maintaining robust provider networks is critical to ensuring equitable access to essential care.