Reproductive health care barriers range from access to interpersonal challenges

Key takeaways :

• Compared with 16.1% in 2017, 18.6% of women in 2021 experienced three or more barriers to reproductive health services.
• The most experienced barrier was finding health services where one felt comfortable.

From 2017 to 2021, barriers to reproductive health care increased, with the largest increases among women from historically disadvantaged populations, according to study data published in JAMA Network Open.

“The objective of our study was to describe changes in barriers and access to a broad spectrum of reproductive health services from individuals’ perspectives using serial, nationally representative, cross-sectional surveys fielded in August 2017 and December 2021,” Aliza Adler, an MPH candidate in the division of maternal, adolescent and child health at the School of Public Health at the University of California, Berkeley, and colleagues wrote. “We hypothesized that due to factors such as COVID-19 and increasing federal restrictions on reproduction health services, barriers to reproductive health services would increase over this period, with historically marginalized groups, including minoritized racial and ethnic groups and individuals with lower incomes, experiencing the greatest impact.”

In this cross-sectional study, researchers analyzed serial survey data collected in August 2017 and December 2021 from 29,496 adult members of KnowledgePanel (Ipsos) who were assigned female at birth. The surveys asked participants to respond to questions regarding reproductive health care experiences and opinions.

The primary outcome was the number and type of barriers to reproductive health care services experienced in the past 3 years.

Overall, 7,022 (mean age, 33.9 years) participants completed the survey in 2017 and 6,841 (mean age, 34.2 years) participants completed the survey in 2021. Of the 89% of respondents who reported trying to access reproductive health services, 5.5% were Asian or Pacific Islander, 13.7% were Black, 19.1% were Hispanic, 58.2% were white and 3.5% were multiracial or of another race or ethnicity. Researchers did not have data on sexual orientation for 2017, but for 2021, 5,219 participants were heterosexual, 95 were gay or lesbian, 441 were bisexual, 84 were queer, 103 were of other sexual orientation and 79 participants had missing data.

Participants were more likely to report experiencing a barrier to reproductive health care in the past 3 years in 2021 compared with in 2017 for all but two barriers: difficulty paying for reproductive health services, which decreased significantly (–1.9%; P = .046), and finding a physician or clinic that accepts one’s insurance, which was unchanged (0.9%; P = .33). More participants reported three or more barriers in 2021 compared with 2017 (18.6% vs. 16.1%; P = .008). The mean number of barriers increased from 1.09 in 2017 to 1.29 in 2021 in multivariable analyses (P < .001).

The most commonly reported barrier to reproductive health care in both 2017 and 2021 was finding a physician or clinic where the participant felt comfortable (19.9% and 24.8%, respectively). Other barriers included getting time off work or school to attend a physician visit (19.1% and 24.2%, respectively), payment (19.2% and 17.3%, respectively), finding someone who takes the participant’s insurance (15.4% and 16.3%, respectively), finding childcare (10.8% and 13.2%, respectively), finding transportation (7.9% and 10.5%, respectively), finding physicians or clinics offering reproductive health (8.7% and 10.5%, respectively), and close relationships and family not wanting the participant to go to a physician or clinic (3% and 4.5%, respectively).

Participants who were aged 25 to 29 years (n = 960), identified as Hispanic (n = 1,199), had no high school diploma (n = 238), lived below 100% of the federal poverty level (n = 1,045) or took the survey in Spanish (n = 520) experienced the greatest increases in the mean number of barriers faced between 2017 and 2021, according to the researchers.

“We found evidence of an increase in the number of barriers to reproductive health services among U.S. women of reproductive age between August 2017 and December 2021,” the researchers wrote. “Although our survey did not identify the reason for this increase, there were several notable changes in the landscape toward reproductive health care and health care in general, during this period, including the onset of the COVID-19 pandemic in spring 2020 and significant reductions in the number of Title X family planning clinics in 2019.”