Investing in Reproductive Health: Contraceptive Use and Preference Fulfillment Among Low-Income Individuals Across State Policy Contexts

Abstract While most people with the capacity for pregnancy in the United States use some form of contraception, accessing high-quality provider-based contraceptive care can be difficult for people with limited resources. Since the early 1970s, Medicaid and Title X have provided individual and systems-level funding for contraceptive care and other vital sexual and reproductive health services to those with financial need, but such investments vary by state. Using data from 5208 individuals with a likely need for public support for family planning from 26 states that fielded the Behavioral Risk Factor Surveillance System’s family planning module in 2022, this study investigates the relationship between public policies and funding streams in support of sexual and reproductive health services at the state-level with individual contraceptive use and preferences. Using bivariate and multivariable logistic regression, we find that, among people with a likely need for public support for family planning, those living in states with more expansive Medicaid eligibility policies and more funding for Title X service grants and Title V maternal child health block grants were more likely to use contraception and have their contraceptive preferences fulfilled than individuals in states with higher Medicaid eligibility thresholds or less funding for the provision of these services. These findings highlight the importance of continued investment in family planning and related services to meet the contraceptive needs and preferences of people at risk of pregnancy in the United States and ensure greater equity across our society in people’s ability to exercise their reproductive autonomy.