{"title":"2015-2019年美国低收入患者避孕护理可及性和经历与成本导致的未实现避孕偏好之间的关系","authors":"Megan L. Kavanaugh, Emma Pliskin, Rubina Hussain","doi":"10.1016/j.conx.2022.100076","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To identify prevalence of unfulfilled contraceptive preferences due to cost among low-income United States female contraceptive method users and nonusers, and associations between access to, and experience with, contraceptive care and this outcome.</p></div><div><h3>Methods</h3><p>We drew on data from the 2015–2019 National Surveys of Family Growth to conduct simple and multivariable logistic regression analyses on unfulfilled contraceptive preferences due to cost among nationally representative samples of low-income women ages 15 to 49 who were current contraceptive users (<em>N</em> = 3178) and nonusers (<em>N</em> = 1073).</p></div><div><h3>Results</h3><p>Overall, 23% of female contraceptive users reported they would use a different method, and 39% of nonusers reported they would start using a method, if cost were not an issue. Controlling for user characteristics, low-income contraceptive users who received recent publicly supported contraceptive care reported significantly higher levels of unfulfilled contraceptive preferences due to cost than those without any access to SRH care (aOR = 1.6, CI 1.0–2.5), while having private (aOR = 0.6, CI 0.4–0.9) or public (aOR = 0.7, CI 0.5–1.0) health insurance was associated with significantly lower levels of this outcome. Nonusers of contraception who had recently received publicly supported contraceptive care also reported marginally higher levels of this outcome (aOR = 2.2, CI 1.0–5.1). Contraceptive users who received recent person-centered contraceptive counseling had marginally lower odds of unfulfilled contraceptive preferences due to cost (aOR = 0.6, CI 0.4–1.0).</p></div><div><h3>Conclusions</h3><p>Cost is a barrier to using preferred contraception for both contraceptive users and nonusers; health insurance coverage and person-centered contraceptive counseling may help contraceptive users to overcome cost barriers and realize their contraceptive preferences.</p></div><div><h3>Implications</h3><p>Factors related to contraceptive access at the systems level—specifically the subsidization and experience of contraceptive care—impact whether cost serves as a barrier to individuals’ contraceptive preferences. Delivery of patient-centered care and shoring up health insurance coverage for all can help to mitigate cost barriers and enable individuals to realize their contraceptive preferences.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100076"},"PeriodicalIF":0.0000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590151622000053/pdfft?md5=e0f143f55359f22eff42e1e77d5056ca&pid=1-s2.0-S2590151622000053-main.pdf","citationCount":"7","resultStr":"{\"title\":\"Associations between unfulfilled contraceptive preferences due to cost and low-income patients’ access to and experiences of contraceptive care in the United States, 2015–2019\",\"authors\":\"Megan L. 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Controlling for user characteristics, low-income contraceptive users who received recent publicly supported contraceptive care reported significantly higher levels of unfulfilled contraceptive preferences due to cost than those without any access to SRH care (aOR = 1.6, CI 1.0–2.5), while having private (aOR = 0.6, CI 0.4–0.9) or public (aOR = 0.7, CI 0.5–1.0) health insurance was associated with significantly lower levels of this outcome. Nonusers of contraception who had recently received publicly supported contraceptive care also reported marginally higher levels of this outcome (aOR = 2.2, CI 1.0–5.1). Contraceptive users who received recent person-centered contraceptive counseling had marginally lower odds of unfulfilled contraceptive preferences due to cost (aOR = 0.6, CI 0.4–1.0).</p></div><div><h3>Conclusions</h3><p>Cost is a barrier to using preferred contraception for both contraceptive users and nonusers; health insurance coverage and person-centered contraceptive counseling may help contraceptive users to overcome cost barriers and realize their contraceptive preferences.</p></div><div><h3>Implications</h3><p>Factors related to contraceptive access at the systems level—specifically the subsidization and experience of contraceptive care—impact whether cost serves as a barrier to individuals’ contraceptive preferences. 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引用次数: 7
摘要
目的确定美国低收入女性避孕方法使用者和非使用者中由于成本原因而未实现避孕偏好的流行程度，以及避孕护理的可及性和经历与这一结果之间的关系。方法利用2015-2019年全国家庭增长调查的数据，对全国代表性样本中15至49岁的低收入妇女(N = 3178)和非避孕药使用者(N = 1073)的未实现避孕偏好进行简单和多变量logistic回归分析。结果总体而言，23%的女性避孕药使用者报告说她们会使用不同的方法，39%的非使用者报告说如果费用不是问题，她们会开始使用一种方法。在控制了用户特征后，近期接受公共支持的避孕服务的低收入避孕使用者报告的由于成本原因导致的未实现避孕偏好水平明显高于没有获得任何性健康生殖健康服务的低收入避孕使用者(aOR = 1.6, CI 1.0-2.5)，而拥有私人(aOR = 0.6, CI 0.4-0.9)或公共(aOR = 0.7, CI 0.5-1.0)健康保险的低收入避孕使用者报告的未实现避孕偏好水平显著低于没有获得任何性健康生殖健康服务的低收入避孕使用者。最近接受公共支持的避孕护理的非避孕者也报告了略高的结果水平(aOR = 2.2, CI 1.0-5.1)。最近接受以人为中心的避孕咨询的避孕药具使用者由于成本原因，未实现避孕偏好的几率略低(aOR = 0.6, CI 0.4-1.0)。结论费用是避孕药具使用者和非避孕药具使用者使用首选避孕药具的障碍;健康保险覆盖范围和以人为本的避孕咨询可以帮助避孕使用者克服成本障碍，实现他们的避孕偏好。与系统层面的避孕获取相关的因素——特别是避孕护理的补贴和经验——影响成本是否成为个人避孕偏好的障碍。提供以病人为中心的护理和扩大医疗保险覆盖范围，有助于减轻成本障碍，使个人能够实现自己的避孕偏好。
Associations between unfulfilled contraceptive preferences due to cost and low-income patients’ access to and experiences of contraceptive care in the United States, 2015–2019
Objective
To identify prevalence of unfulfilled contraceptive preferences due to cost among low-income United States female contraceptive method users and nonusers, and associations between access to, and experience with, contraceptive care and this outcome.
Methods
We drew on data from the 2015–2019 National Surveys of Family Growth to conduct simple and multivariable logistic regression analyses on unfulfilled contraceptive preferences due to cost among nationally representative samples of low-income women ages 15 to 49 who were current contraceptive users (N = 3178) and nonusers (N = 1073).
Results
Overall, 23% of female contraceptive users reported they would use a different method, and 39% of nonusers reported they would start using a method, if cost were not an issue. Controlling for user characteristics, low-income contraceptive users who received recent publicly supported contraceptive care reported significantly higher levels of unfulfilled contraceptive preferences due to cost than those without any access to SRH care (aOR = 1.6, CI 1.0–2.5), while having private (aOR = 0.6, CI 0.4–0.9) or public (aOR = 0.7, CI 0.5–1.0) health insurance was associated with significantly lower levels of this outcome. Nonusers of contraception who had recently received publicly supported contraceptive care also reported marginally higher levels of this outcome (aOR = 2.2, CI 1.0–5.1). Contraceptive users who received recent person-centered contraceptive counseling had marginally lower odds of unfulfilled contraceptive preferences due to cost (aOR = 0.6, CI 0.4–1.0).
Conclusions
Cost is a barrier to using preferred contraception for both contraceptive users and nonusers; health insurance coverage and person-centered contraceptive counseling may help contraceptive users to overcome cost barriers and realize their contraceptive preferences.
Implications
Factors related to contraceptive access at the systems level—specifically the subsidization and experience of contraceptive care—impact whether cost serves as a barrier to individuals’ contraceptive preferences. Delivery of patient-centered care and shoring up health insurance coverage for all can help to mitigate cost barriers and enable individuals to realize their contraceptive preferences.
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