Development and validation of the Access to Contraceptive Care and Early Abortion Support Services (ACCESS) measure

Barriers to contraceptive access in the United States have intensified following the 2022 Dobbs decision, disproportionately affecting marginalized populations. This study aimed to develop and validate the Access to Contraceptive Care and Early Abortion Support Services (ACCESS) measure to assess key dimensions of contraceptive access.

We followed a sequential approach to measure development, including: (1) defining constructs and generating items based on existing access frameworks; (2) expert review (n = 30); (3) cognitive interviews with patients (n = 14); (4) survey administration as part of a randomized trial of individuals considering tubal sterilization (N = 440); and (5) psychometric analyses, including exploratory factor analysis and reliability testing.

Factor analysis revealed a two-factor structure: (1) Availability & Awareness (seven items) and (2) Affordability (two items), explaining 51-59% of variance across six contraceptive methods. Internal consistency of the measure was acceptable for four of the six family planning methods assessed. Factor loadings were consistent across methods, and all items demonstrated acceptable content validity.

The ACCESS measure is a valid and reliable tool for assessing contraceptive access in the US. It captures important dimensions of access and can be used to monitor disparities and inform policies aimed at improving reproductive healthcare access.

Clinicians and policymakers can use this measure to identify barriers, monitor disparities, and direct interventions aimed at improving equitable access to family planning services, particularly in the wake of policy changes that disproportionately impact marginalized populations.