source Several studies indicate that costs play a key role in the contraceptive behavior of substantial numbers of U.S. women. A national survey from 2004 of women 18–44 who were using reversible contraception found that one-third of them would switch methods if they did not have to worry about cost; only four in 10 of those women were using a hormonal method or an IUD, and nearly half were relying on condoms. In fact, women citing cost concerns were twice as likely as other women to rely on condoms or less effective methods like withdrawal or periodic abstinence.47
Similarly, in a nationally representative survey from 2005 of private family practice physicians and obstetrician-gynecologists, two-thirds of the providers believed that at least 10% of their clients experienced difficulty paying for visits or services, including 7% of providers who believed this was the case for at least half their clients. Six in 10 of the family practice physicians and seven in 10 of the obstetrician-gynecologists believed that reducing costs for insured patients by improving coverage of contraceptive care would be very important for improving their patients’ contraceptive method use. A parallel survey of providers at publicly supported clinics found similar results, although more of them (22%) reported having at least 50% of their clients experiencing cost barriers.48
The current recession, more severe in depth and length than any in this country in decades, has provided further evidence. A 2009 study of low- and middle-income sexually active women found that 52% of them were worse off financially than the year before. Of those who were worse off, three-quarters said that they could not afford to have a baby right then. And while nearly four in 10 of those worse off reported being more careful in their contraceptive use in the current economic climate, many of the financially challenged women reported barriers to contraceptive use: 34% said they had a harder time paying for birth control, 30% had put off a gynecology or birth control visit to save money, 25% of pill users saved money through inconsistent use and 56% of those with jobs worried about having to take time off from work to visit a doctor or clinic.49
A recent study of 10,000 women in the St. Louis area provides clear evidence of the impact that removing financial barriers can have on contraceptive use. When study participants were offered the choice of any contraceptive method, including long-acting reversible methods of contraception such as the IUD and implant, at no cost, two-thirds chose long-acting methods, a level far higher than in the general population.
All of this helps explain why, according to the most recent data, rates of unintended pregnancies are far higher among poor women (112 per 1,000 women under 100% poverty in 2001) and low-income women (81 per 1,000 women at 100–199% poverty) than among higher-income women (29 per 1,000 women at or above 200% poverty).51
Indeed, that disparity increased substantially between 1994 and 2001, as the unintended pregnancy rate declined among higher-income women but grew among poor and lower-income women.
