Low-income women's access to contraception after Massachusetts health care reform

In 2006, Massachusetts passed legislation aimed at improving access to health care by mandating all residents have health insurance by July 2007. Massachusetts’ groundbreaking effort to achieve universal health care for its residents offered a unique opportunity to examine how health care reform policies affect low-income women and family planning providers.

With support from the National Institute for Reproductive Health and the Title X Regional Office for New England, Ibis and the Massachusetts Department of Public Health Family Planning Program collaborated on a project to explore how Massachusetts health care reform impacted low-income women's access to contraception as well as how the landmark legislation impacted delivery of contraception for family planning providers that provide reproductive health services on a sliding scale fee through freestanding family planning clinics and community health centers.

From August 2008 through March 2009, we undertook a four-part mixed-methods study.  We conducted: 1) Nine focus group discussions with a total of 52 low-income English- and Spanish-speaking women, 2) 16 in-depth interviews with family planning providers, 3) Ten self-administered surveys of family planning administrators, and 4) A systematic review of websites for government-subsidized insurance plans specifically focusing on contraceptive coverage.

We found that though health care reform legislation has benefited many women, barriers remain to ensuring consistent access to contraception for low-income women. Though women continue to be able to readily obtain contraceptives, challenges such as maintaining insurance coverage, understanding benefits, securing an appointment with a provider, and obtaining prescriptions present barriers to contraceptive access. In addition, our research found that health care reform has left out some populations of women. For immigrants, young women, those with unstable employment or income, and those experiencing common life changes such as moving or pregnancy, access to health care has not improved or has gotten worse since health care reform. Finally, we found that family planning providers help mitigate some of the challenges with implementing health care reform as they have provided specific outreach to and services for hard-to-reach and underserved populations and have also helped women navigate and enroll in the new insurance plans. These findings have a number of implications for national health care reform.