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What is contraceptive access? A comprehensive, multi-level framework to inform research, policy, and practice
Riley J Steiner1, Sarah M Axelson1, Claudia Nuñez-Eddy1
1Power to Decide, Washington, DC, USA.
Objectives:
Despite the importance of access to contraception for sexual and reproductive well-being, there is a lack of consensus about what "contraceptive access" entails. We present a multi-level and multi-dimensional framework for conceptualizing contraceptive access and discuss how it can be used to inform research, policy, and practice.
Study Design:
As the foundation for the contraceptive access framework, we used the social-ecological model and two frameworks for health care access, along with findings from an environmental scan of literature relevant to contraceptive access. To develop an initial version, we aligned contraceptive access concepts with the broader conceptual frameworks. We refined our framework based on input from an expert workgroup.
Results:
The conceptual framework includes multi-level modifiable factors (i.e., underlying factors that create the conditions of contraceptive access) and modification strategies (i.e., actionable interventions or approaches that can be used to change the modifiable determinants) aligned with six dimensions of access: awareness, availability, accessibility, accommodation, acceptability, and affordability. The modification strategies influence modifiable determinants, which create the access conditions for individual-level pathways to seeking and obtaining one's preferred contraceptive method or long-acting reversible contraception removal services.
Conclusions:
We call on the sexual and reproductive health community to apply the framework to inform research, policy, and clinical and public health practice. Specific applications include measure development, surveillance, policy advocacy, clinic-based quality improvement, and state-level contraceptive access initiatives. The opportunities and challenges of using the framework in these ways can inform how it evolves to best reflect contraceptive access.
Implications:
The conceptual framework can provide a shared understanding of how contraceptive access can be restricted or expanded. The framework can be used to strengthen efforts to assess and improve contraceptive access so that it is just, person-centered, and attainable for all.
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