Background
Contraception care is essential to providing comprehensive healthcare; however, little
is known nationally about the contraception workforce. Previous research has examined
the supply, distribution, and adequacy of the health workforce providing contraception
services, but this research has faced a series of data limitations, relying on surveys
or focusing on a subset of practitioners and resulting in an incomplete picture of
contraception practitioners in the United States.
Objective
This study aimed to construct a comprehensive database of the contraceptive workforce
in the United States that provides the following 6 types of highly effective contraception:
intrauterine device, implant, shot (depot medroxyprogesterone acetate), oral contraception,
hormonal patch, and vaginal ring. In addition, we aimed to examine the difference
in supply, distribution, the types of contraception services offered, and Medicaid
participation.
Study Design
We constructed a national database of contraceptive service providers using multiple
data sets: IQVIA prescription claims, preadjudicated medical claims, and the OneKey
healthcare provider data set; the National Plan and Provider Enumeration System data
set; and the Census Bureau’s American Community Survey data on population demographics.
All statistical analyses were descriptive, including chi-squared tests for groupwise
differences and pairwise post hoc tests with Bonferroni corrections for multiple comparisons.
Results
Although 73.1% of obstetrician-gynecologists and 72.6% of nurse-midwives prescribed
the pill, patch, or ring, only 51.4% of family medicine physicians, 32.4% of pediatricians,
and 19.8% of internal medicine physicians do so. The ratio of all primary care providers
prescribing contraception to the female population of reproductive age (ages, 15–44
years) varied substantially across states, with a range of 27.9 providers per 10,000
population in New Jersey to 74.2 providers per 10,000 population in Maine. In addition,
there are substantial differences across states for Medicaid acceptance. Of the obstetrician-gynecologists
providing contraception, the percentage of providers who prescribe contraception to
Medicaid patients ranged from 83.9% (District of Columbia) to 100% (North Dakota);
for family medicine physicians, it ranged from 49.7% (Florida) to 91.1% (Massachusetts);
and for internal medicine physicians, it ranged from 25.0% (Texas) to 75.9% (Delaware).
For in-person contraception, there were large differences in the proportion of providers
offering the 3 different contraceptive method types (intrauterine device, implant,
and shot) by provider specialty.
Conclusion
This study found a significant difference in the distribution, types of contraception,
and Medicaid participation of the contraception workforce. In addition to obstetrician-gynecologists
and nurse-midwives, family medicine physicians, internal medicine physicians, pediatricians,
advanced practice nurses, and physician assistants are important contraception providers.
However, large gaps remain in the provision of highly effective services such as intrauterine
devices and implants. Future research should examine provider characteristics, programs,
and policies associated with the provision of different contraception services.
Key words
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Article info
Publication history
Published online: August 18, 2021
Accepted:
August 12,
2021
Received in revised form:
August 5,
2021
Received:
June 3,
2021
Footnotes
The authors report no conflict of interest.
This research was funded by a private foundation that wishes to remain anonymous. The funder was not involved in the study design; collection, analysis, and interpretation of data; writing of the report; or decision to submit the article for publication.
Cite this article as: Chen C, Strasser J, Banawa R, et al. Who is providing contraception care in the United States? An observational study of the contraception workforce. Am J Obstet Gynecol 2022;226:232.e1-11.
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