Preferred contraceptive method in Texas vs. California

State Policies Impact Young People’s Use of Their Preferred Contraceptive Method

Kristine Hopkins, Jennifer Yarger, Irene Rossetto, Audrey Sanchez, Elisa Brown, Sarah Elmes, Thaddeus Mantaro, Kari White, and Cynthia C. Harper

When young people can use the contraceptive method of their choice, they are able to exercise reproductive autonomy. For those who want to use a method that requires a prescription or visit to a doctor’s office or clinic, using a method of one’s choice also demonstrates access to health care. However, many young people are not able to use their preferred contraceptive method, with cost being a primary barrier.

State policies can make it easier for young people to access the contraception of their choice by increasing insurance coverage and reducing costs barriers.

California is one of 38 states to expand full-benefit Medicaid coverage. California’s program covers all U.S. citizens, permanent residents, and legal residents who live in households with incomes up to 138% of the federal poverty level. It also covers young adults under age 26, regardless of immigration status. In contrast, Texas is one of 12 states that have not expanded full Medicaid. Texas extends full Medicaid coverage only to U.S. citizens and legal immigrants who are parents or guardians of dependent children and have incomes up to 16% of the federal poverty level.

California and Texas have implemented policies to provide contraception to the uninsured. California’s family planning program provides comprehensive services at no cost to all low-income, uninsured California residents of childbearing age. Texas’s program, on the other hand, only covers low-income, uninsured U.S. citizens and qualified legal immigrants who can get pregnant.

Using data from a recent study [1] of community college students in California and Texas, the authors explored the impact of insurance coverage on the use of preferred contraceptive method. Young people attending community college are an important population to study because more students from lower-income families attend two-year institutions than attend four-year institutions. This overwhelming difference contributes to structural inequities that limit access to health insurance and, as a consequence, young people’s use of their preferred contraceptive method.

Key Findings

• Students in Texas were less likely to use their preferred contraceptive method than students in California.
  • Overall, 38% of Texas students vs. 51% of California students were using their preferred method.
  • Among uninsured Texas students, only 27% were using their preferred method, see figure.
  • Even among insured students in Texas, only 40% were using their preferred method.
  • In California, there were no significant differences between the uninsured (54%) and insured (52%) in use of a preferred method.
• The main reasons why students were not using their preferred contraceptive method included financial barriers, information or availability barriers, and parent or partner barriers.
  • Financial barriers were cited by more Texas students than California students (37% vs. 19%) and by more uninsured than insured (51% vs. 19%).
  • Half of students in both states and half of the uninsured cited information/availability barriers, which included “I don’t know where to get it” and “It’s too much hassle to get it."
  • Over one-third of students both states and over one-third of the uninsured cited parent/partner barriers, which included “My parents don’t know that I’m sexually active” and “My partner doesn’t want me to use it.”

Policy Implications

These findings present new evidence that where young people live plays an important role in their ability to use the contraceptive method of their choice. The policies and programs that help or hinder access to health services, particularly for the uninsured, clearly make a difference. Researchers did not find a difference between the uninsured and insured in California in use of preferred method. This suggests that California’s strong family planning safety net is helping to provide coverage to many uninsured residents. Texas’s more restrictive health care policy environment, including much more limited access to Medicaid and other programs for low-income and uninsured residents, all likely play a role in Texas students’ limited use of their preferred method.

It is critical to expand access to preferred contraceptive methods in all states. In states with abortion bans, it is especially urgent to improve young people’s access to the contraception they want to use.

Reference

Hopkins, K., Yarger, J., Rossetto, I., Sanchez, A., Brown, E., Elmes, S., Mantaro, T., White, K., & Harper, C.C. (2023). Use of preferred contraceptive method among young adults in Texas and California: A comparison by state and insurance coverage. PLOS ONE. https://doi.org/10.1371/journal.pone.0290726

Suggested Citation

Hopkins, K., Yarger, J., Rossetto, I., Sanchez, A., Brown, E., Elmes, S., Mantaro, T., White, K., & Harper, C.C. (2023). State policies impact young people’s use of their preferred contraceptive method. PRC Research Brief 8(5). http://dx.doi.org/10.26153/tsw/48669.

About the Authors

Kristine Hopkins (khopkins@prc.utexas.edu), Irene Rossetto, and Audrey Sanchez are researchers with the Population Research Center, The University of Texas at Austin; Jennifer Yarger is an assistant professor in the Philip R. Lee Institute for Health Policy Studies and the Department of Epidemiology and Biostatistics and is affiliated with the Bixby Center for Global Reproductive Health, University of California, San Francisco (UCSF); Elisa Brown is an associate professor in the Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center; at the time of this study, Sarah Elmes was a research data analyst with Beyond the Pill at the Bixby Center for Global Reproductive Health, UCSF; Thaddeus Mantaro is the dean of Student Health and Wellness at Dallas College; Kari White is a PRC faculty scholar and associate professor of social work at UT Austin. Cynthia C. Harper is a professor in the department of Obstetrics, Gynecology & Reproductive Sciences; interim vice-chair for research; director of UCSF-Kaiser Permanente Building Interdisciplinary Research Careers in Women’s Health (BIRCWH); and director of Beyond the Pill Program, UCSF.

Acknowledgements

This work was supported by the William and Flora Hewlett Foundation, The JPB Foundation, the National Institute of Diabetes, Digestive, and Kidney Disorders (K12DK111028), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2C HD042849), awarded to the Population Research Center at The University of Texas at Austin. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.