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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.
Contraception
|November 18, 2025
Summary
A new framework defines contraceptive access across multiple levels and dimensions. This multi-level, multi-dimensional model aims to improve research, policy, and practice for equitable sexual and reproductive health services.
Area of Science:
- Sexual and Reproductive Health
- Health Services Research
- Health Policy
Background:
- Access to contraception is crucial for sexual and reproductive well-being.
- Existing definitions of contraceptive access lack consensus.
- A clear framework is needed to guide research, policy, and practice.
Purpose of the Study:
- To present a multi-level and multi-dimensional framework for conceptualizing contraceptive access.
- To provide a shared understanding of factors influencing contraceptive access.
- To inform research, policy, and practice for improving contraceptive access.
Main Methods:
- Utilized the social-ecological model and health care access frameworks.
- Conducted an environmental scan of relevant literature.
- Developed and refined the framework with an expert workgroup.
Main Results:
- The framework includes multi-level modifiable factors and modification strategies.
- Six dimensions of access are identified: awareness, availability, accessibility, accommodation, acceptability, and affordability.
- Modification strategies impact determinants, influencing pathways to obtaining contraception.
Conclusions:
- The framework offers a shared understanding to assess and improve contraceptive access.
- It can guide measure development, surveillance, policy advocacy, and quality improvement initiatives.
- Application of the framework can promote just, person-centered, and attainable contraceptive access for all.
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