Disparities in reproductive health care linger

Women who are younger, economically disadvantaged or undereducated used fewer reproductive health services in recent years, highlighting disparities that persist despite decades of progress expanding access to such care.

The gaps in utilization can contribute to teenage pregnancies and more sexually transmitted diseases, says a study published online Dec. 15, 2011, in the American Journal of Public Health. They are consequences nurse practitioner and lead study author Kelli Stidham Hall sees in the community adolescent health clinic where she practices in Princeton, N.J.

"I am seeing these trends play out in my clinical practice," said Hall, a postdoctoral research associate with the Office of Population Research at Princeton University. "It is devastating to see the drop in service use and see the women come in with an unintended pregnancy. You can really see the need."

Researchers examined 2002-08 data on 4,421 women 15 to 24 years old, with an average age of 19. More than half of the women (52%) were below 200% of the poverty level, and 25% had been uninsured during the previous year. About two-thirds of the women had sexual intercourse, said the study (link).

Nearly 60% of the women used reproductive health services within the past year, and 48% used contraceptive services. Researchers did not consider use of obstetrical services.

Among sexually experienced women, use of reproductive health services was lowest among adolescents between 15 and 17, at 68%, compared with 82% for those 20 to 24. Fifty-six percent of women living at less than 200% of the federal poverty level used reproductive health services, compared with 62% of women in households with an annual income of $50,000 or more. Use of reproductive health care also was lower among women with the lowest education levels, the study said.

The findings follow a study in the September 2011 issue of Human Reproduction that showed an overall 15% drop in use of family planning services and an 8% drop in use of reproductive health services between 2002 and 2008 (link).

A temporary decline?

Factors contributing to disparities in care may include lack of insurance, reductions in funding for some women's health services and the recession, which hit in the final years of the study, Hall said.

Overall, Medicaid funding for such services has increased since the 1990s, said Adam Sonfield, senior public policy associate with the Guttmacher Institute, which promotes reproductive health. Many states have received Medicaid expansions that allow them to enroll women specifically for reproductive health services.

But much of those Medicaid expansions are to compensate for a loss of private money, with more people losing private insurance coverage. "There are more women who are uninsured and more women who qualify for Medicaid," Sonfield said.

The studies likely show a temporary drop in use of reproductive health services, he said. Ongoing research at the Guttmacher Institute suggests that use of such services is once again on an upward trend, as they have been since the 1990s, Sonfield said.

Hall said she and her colleagues are analyzing more current data. Some research has shown declines in teen pregnancy rates and increased contraceptive use. Such findings are consistent with what often happens during difficult economic times as women take added precautions to prevent pregnancy, she said.

"We have multiple forces at play," Hall said. "It will be interesting to see what the data show."