State-level contraceptive access policies and preventive sexual and reproductive health service use outcomes

Contraceptive access provides opportunity for related preventive health care. Thus, we explore whether changes in state contraceptive access policies relate to preventive health service use inequities.

We examined associations between a 2006-2017 state contraceptive access policy index and probabilities of individual-level receipt of pelvic exam, Pap test, and sexually transmitted infection (STI) services during the last year, as reported during time-corresponding cycles of the National Survey of Family Growth (NSFG). We used multivariate logistic regression and linear probability models, that accounted for survey weights and adjusted for individual- and state-level characteristics and state and year fixed effects. We further tested interaction effects by race/ethnicity, socioeconomic status, education, and sexual orientation.

Among 21,537 NSFG respondents (mean age 29 years) from 2006 to 2017, 52% reported receiving a Pap test, 50% reported receiving a pelvic exam, and 20% reported receiving STI services. Main effects models testing the relationship between the contraceptive access policy index and the three outcomes among the entire population produced null findings. However, models testing interaction effects by social group found significant interactions between state contraceptive policy environments and individual-level race/ethnicity, education, income level, sexual orientation for receipt of Pap tests, pelvic exams, and STI services, revealing increased preventive services for certain social groups defined by lower education and income.

Individual preventive health service use associated with state contraceptive access environments varied by sociodemographic factors, highlighting the potential for state policy to act as a lever to alleviate inequities in access to care.

Overarchingly, more expansive contraceptive access is associated with increased preventive sexual and reproductive health care use for certain social groups. Thus, state policies expanding contraceptive access may mitigate broader inequities in access to care by facilitating opportunities for receipt of other preventive services, particularly Pap tests and pelvic exams.