July 25, 2013 — Summary of "U.S. Women's Use of Sexual and Reproductive Health Services: Trends, Sources of Care and Factors Associated With Use, 19952010," Frost, Guttmacher Institute, May 2013.
Approximately 44 million -- or seven out of 10 -- U.S. women of reproductive age make at least one medical visit to obtain sexual and reproductive health services annually, and about 25 million make a visit for contraceptive services, according to an analysis by the Guttmacher Institute's Jennifer Frost.
The analysis aimed to provide a comprehensive look at trends related to the types of SRH services received from various providers in the hopes of informing the work of lawmakers and program planners when developing recommendations to improve the delivery and financing of SRH services.
For the analysis, Frost used data from the 1995, 2002 and 2006-2010 National Survey of Family Growth, which included thousands of U.S. women ages 15 through 44. Respondents were asked whether they received one or more of 15 SRH services -- including contraception, pelvic exams, testing or treatment for HIV or other sexually transmitted infections, and pregnancy testing -- from a doctor or other medical provider within the past year.
The analysis focused on several key measures related to SRH services: receipt of services, mix of services, source of SRH care, usual source of medical care and women's characteristics.
The analysis revealed that the number of women receiving annual STI testing, treatment or counseling more than doubled between 1995 and 2006-2010, from 4.6 million to 9.8 million. Specifically, the proportion of sexually active women ages 15 through 25 who were screened for chlamydia rose from 25% in 2000 to 48% in 2010. Meanwhile, the reported chlamydia rate among women grew from 369 cases per 100,000 women in 1996 to 716 per 100,000 in 2009. Frost noted that the trend of increased STI testing and diagnoses likely are tied to changes in clinical guidelines regarding screening.
The analysis also found that the percentage of women of reproductive age receiving annual contraceptive services increased from 36% in 1995 to 40% in 2006-2010, with a noted increase among older women. Frost suggested that the increase among older women are related to changes in the types of contraceptive methods available and used, especially for older women, who in the past relied mostly on condoms and sterilization. Just 14% of contraceptive-using women ages 35 to 39 and 8% of those ages 40 to 44 used hormonal contraceptives or intrauterine devices in 1995, compared with 26% of women ages 35 to 39 and 15% of those ages 40 to 44 who used those methods in 2006-2010.
The analysis revealed disparities in the receipt of SRH services among certain groups of women. For example, uninsured women were less likely than those with private coverage or Medicaid to have received any type of SRH service in the past 12 months. Uninsured women also were less likely to discuss birth control with their doctors during annual gynecological visits.
Frost wrote, "Publicly funded family planning clinics ... play a critical role in providing SRH services to the increasing numbers of poor and low-income women who need affordable care," noting that 28% of all women receiving any type of contraceptive services obtained them at such clinics. Further, 35% of women obtaining STI testing, treatment or counseling and more than 50% of women seeking emergency contraception care did so at publicly funded clinics.
The analysis showed that from 1995 to 2006-2010, the number of women who went to a publicly funded clinic for any SRH service rose from 7.3 million to 10.2 million. According to the analysis, the increase reflects a recent rise in the number of women with incomes below the poverty level and a greater need for publicly funded contraceptive services in general.
Compared with women who visited private facilities, women who visited a publicly funded clinic received a wider range of SRH services and were more likely to discuss methods of contraception during an annual gynecological visit.
Frost noted that clinics funded through the federal Title X family planning program play a particularly important role. Fourteen percent of women who received contraceptive services; 18% who obtained STI testing, treatment or counseling; and more than one-third who sought EC did so at Title X funded clinics. Additionally, 63% of women who received SRH care at a Title X funded clinic said the clinic was their primary source for medical care.
The analysis also showed that between 1995 and 2006-2010, the percentage of women who used private insurance to pay for contraceptive services rose significantly, from 48% in 1995 to 63% in 2006-2010. Meanwhile, the percentage of women who reported paying the full cost of their care fell from 27% to 9%. According to Frost, these changes represent an increase in the number of privately insured U.S. residents that began in the mid-1990s, when state and federal governments began changing laws and regulations requiring insurers to cover the costs of contraceptive services. The Affordable Care Act (PL 111-148) likely will accelerate the trend of private insurance paying for a greater proportion of contraceptive visits, Frost noted.
Frost wrote, "Moving forward, our findings clearly show that health insurance coverage -- either private or public -- reduces financial obstacles to receipt of critical SRH services and increases the likelihood that women will receive care." Frost noted, "Under the ACA, the financial barriers faced by women who currently lack coverage will be greatly reduced," which could result in "lower morbidity and mortality from reproductive cancers, fewer complications from ST[I]s and reduced rates of unintended pregnancy."
However, those benefits will not be realized unless "there are providers available and willing to serve those women who are newly insured." Further, program planners and policymakers involved with implementing the ACA must ensure that "women continue to have access to a wide range of SRH care provider sources, as our analysis makes clear that one size or provider type does not fit all women's needs."
Frost proposed a model that would "encourage the formation of linkages between primary care providers and reproductive health-focused clinics," in which women would have the option of receiving SRH care from a specialized provider while maintaining a "primary care relationship with a family doctor or primary care clinic."