Low-Income Women's Access to Contraception After Massachusetts Health Care Reform

Publication Date: September 2009

Publisher: MDPH Family Planning Program; Ibis Reproductive Health

Author(s): Lenore Tsikitas; Karen Edlund; Jennifer McIntosh; Jill Clark; Britt Wahlin; Kelly Blanchard; Denisse Cordova; Amanda Dennis

Research Area: Health

Keywords: contraception; Massachusetts; healthcare reform; low-income

Type: Report

Coverage: Massachusetts


In 2006, Massachusetts passed legislation aimed at improving access to health care by mandating all residents have health insurance by July 2007. Government-subsidized plans called Commonwealth Care, administered by the Commonwealth Connector, include family planning as a covered benefit. Women formerly served at clinics supported by the Massachusetts Department of Public Health (MDPH) and Federal Title X funding who have acquired health insurance in compliance with the individual insurance mandates of health care reform may face increased co-pays for services, in addition to the new burden of insurance premiums. However, health care reform may also help to increase women’s access to services.

Investigators collected data from family planning providers and clients using 16 qualitative in-depth interviews (clinic staff), ten self-administered surveys (agency staff), and nine focus group discussions (clients) of which four were in English and four were in Spanish. Qualitative data was supplemented by a desk-review of the new insurance plans, specifically focusing on contraceptive coverage.

There were several key findings. First, most women who participated in the study reported that they continue to have relatively easy access to contraceptive services, but it appears that some new barriers to accessing contraception have arisen from reform. Limits to the amount of contraception dispensed at once, high co-pays, inconvenient pharmacy locations, pharmacists’ lack of knowledge about what prescriptions are covered by the new subsidized plans, and even women’s unfamiliarity with how to use prescriptions were named as new challenges to contraceptive access for previously uninsured women accustomed to obtaining care from clinics and community health centers. In addition, our research found that health care reform has left out some populations of women. For immigrants, young women, those with unstable employment or income, and those experiencing common life changes such as moving or pregnancy, access to health care has not improved or has gotten worse since health care reform was enacted. Finally, a key finding was that family planning providers are helping to mitigate some of the challenges with implementing health care reform. They have provided specific outreach to and services for hard-to-reach and underserved populations and have also helped women navigate and enroll in the new insurance plans.