Trends and Differentials in Receipt of Sexual and Reproductive Health Services in the United States: 2006–2019
Seven in 10 U.S. women of reproductive age, some 44 million women, make at least one medical visit to obtain sexual and reproductive health (SRH) services each year. While the overall number of women receiving any SRH service remained relatively stable between 2006–2010 and 2015–2019, the number of women receiving preventive gynecologic care fell and the number receiving STI testing doubled. Understanding trends and patterns around women’s use of SRH services—including what services they receive, where they go for care, and how they pay for care—is critical for program planners and policymakers who aim to improve both access to care and the health of women and families.
Shifts in Sources of Care and the Impact of the ACA
Implementation of the Affordable Care Act has likely contributed to some of the changes observed in where women receive contraceptive and other SRH services and how they pay for that care. The share of women receiving contraceptive services who go to private providers rose as more women gained private or public health insurance coverage. Conversely, there was a complementary drop in the share of women receiving contraceptive services who went to a publicly funded clinic.
The following table illustrates the shift in contraceptive service sources between the two periods:
| Source of Contraceptive Services | 2006–2010 Share | 2015–2019 Share |
|---|---|---|
| Private Providers | 69% | 77% |
| Publicly Funded Clinics | 27% | 18% |
Among women served at publicly funded clinics between 2006–2010 and 2015–2019, there were significant increases in the use of both public and private insurance to pay for their care. However, for non-Hispanic Black women, immigrant women and uninsured women, there was no increase in the use of private providers for contraceptive care during this timeframe.
Disparities in Access and Service Use
Disparities in use of SRH services persist, as Hispanic women are significantly less likely than non-Hispanic White women to receive SRH services, and uninsured women are significantly less likely to receive services than privately insured women. Publicly funded clinics remain critical sources of SRH care for many women, with younger women, lower income women, women of color, foreign-born women, women with Medicaid coverage and women who are uninsured especially likely to rely on them. Among women who go to clinics for SRH care, two-thirds report that the clinic is their usual source for medical care.
The Evolution of Preventive Care and Contraceptive Options
Many critical preventive care services are provided within the context of these SRH visits. The Centers for Disease Control and Prevention (CDC) recommends a core set of preventive services that providers should offer to help patients avoid negative health outcomes. Regarding new options, it might seem obvious that the development of sexual and reproductive health options, including self-injectable contraceptives, should be centered around women’s needs and wants.
Currently, the journey for specific services like contraceptive self-injection is riddled by challenges:
- Many women aren’t even made aware that contraception is relevant and valuable for their lives.
- Seeking information about sexual and reproductive health services remains clouded in stigma and fear.
- Women often face unfounded fears about side effects, inconsistent pricing, and poor quality of available products.
- Barriers remain even when women feel comfortable demanding what sexual and reproductive health services and products they want and need.
Identifying gaps in the services provided or in the care received by subgroups of the population are important steps necessary for designing programs and service delivery options that will best meet the SRH care needs of women. Efforts to increase health insurance coverage do not automatically translate into high uptake or increased utilization of services, as several barriers may still prevent individuals from enrolling or from utilizing the available services.