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Who is providing contraception care in the United States? An observational study of the contraception workforce

Published:August 18, 2021DOI:https://doi.org/10.1016/j.ajog.2021.08.015

      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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      References

        • Coffman M.
        • Wilkinson E.
        • Jabbarpour Y.
        Despite adequate training, only half of family physicians provide women’s health care services.
        J Am Board Fam Med. 2020; 33: 186-188
        • US Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis
        Projections of supply and demand for women’s health service providers: 2018–2021. 2021.
        (Available at:) (Accessed Sept. 8, 2021)
        • Vetter M.H.
        • Salani R.
        • Williams T.E.
        • Ellison C.
        • Satiani B.
        The impact of burnout on the obstetrics and gynecology workforce.
        Clin Obstet Gynecol. 2019; 62: 444-454
        • Luchowski A.T.
        • Anderson B.L.
        • Power M.L.
        • Raglan G.B.
        • Espey E.
        • Schulkin J.
        Obstetrician-gynecologists and contraception: long-acting reversible contraception practices and education.
        Contraception. 2014; 89: 578-583
        • Nisen M.B.
        • Peterson L.E.
        • Cochrane A.
        • Rubin S.E.
        US family physicians’ intrauterine and implantable contraception provision: results from a national survey.
        Contraception. 2016; 93: 432-437
        • Kumar N.
        • Brown J.D.
        Access barriers to long-acting reversible contraceptives for adolescents.
        J Adolesc Health. 2016; 59: 248-253
        • Centers for Medicare and Medicaid Services
        Who enrolls in Medicaid & CHIP? Medicaid. 2020.
        (Available at:) (Accessed Sept. 8, 2021)
        • Holgash K.
        • Heberlein M.
        Physician acceptance of new Medicaid patients. Medicaid and CHIP payment and access commission. 2019.
        (Available at:) (Accessed Sept. 8, 2021)
        • Gibbs S.E.
        • Harvey S.M.
        • Larson A.
        • Yoon J.
        • Luck J.
        Contraceptive services After Medicaid expansion in a state with a Medicaid family planning waiver program.
        J Womens Health (Larchmt). 2021; 30: 750-757
        • IQVIA
        LRx Prescription claims data. 2019.
        (Available at:) (Accessed Sept. 8, 2021)
        • IQVIA
        Dx Pre-adjudicated medical claims data. 2019.
        (Available at:) (Accessed Sept. 8, 2021)
        • IQVIA
        OneKey web. 2019.
        (Available at:) (Accessed Sept. 8, 2021)
        • Center for Medicare and Medicaid Services
        National plan and provider enumeration system data dissemination. 2020.
        (Available at:) (Accessed Sept. 8, 2021)
      1. US Census Bureau; American Community Survey, 2018. 5-year sample. Available at: https://www.census.gov/data/developers/data-sets/acs-5year.html. Accessed Sept. 8, 2021.

        • United States Department of Health and Human Services
        Projections of supply and demand for women’s health service providers: 2018–2030. 2021.
        (Available at:) (Accessed Sept. 8, 2021)
        • Tobar A.
        • Lutfiyya M.N.
        • Mabasa Y.
        • et al.
        Comparison of contraceptive choices of rural and urban US adults aged 18–55 years: an analysis of 2004 behavioral risk factor surveillance survey data.
        Rural Remote Health. 2009; 9: 1186
        • Janis J.A.
        • Ahrens K.A.
        • Kozhimannil K.B.
        • Ziller E.C.
        Contraceptive method use by rural-urban residence among women and men in the United States, 2006 to 2017.
        Womens Health Issues. 2021; 31: 277-285
        • Vaaler M.L.
        • Kalanges L.K.
        • Fonseca V.P.
        • Castrucci B.C.
        Urban-rural differences in attitudes and practices toward long-acting reversible contraceptives among family planning providers in Texas.
        Womens Health Issues. 2012; 22: e157-e162
        • Dehlendorf C.
        • Levy K.
        • Ruskin R.
        • Steinauer J.
        Health care providers’ knowledge about contraceptive evidence: a barrier to quality family planning care?.
        Contraception. 2010; 81: 292-298
        • Lunde B.
        • Smith P.
        • Grewal M.
        • Kumaraswami T.
        • Cowett A.
        • Harwood B.
        Long acting contraception provision by rural primary care physicians.
        J Womens Health (Larchmt). 2014; 23: 519-524
        • Davis S.A.
        • Braykov N.P.
        • Lathrop E.
        • Haddad L.B.
        Familiarity with long-acting reversible contraceptives among obstetrics and gynecology, family medicine, and pediatrics residents: results of a 2015 national survey and implications for contraceptive provision for adolescents.
        J Pediatr Adolesc Gynecol. 2018; 31: 40-44
        • Harper C.C.
        • Stratton L.
        • Raine T.R.
        • et al.
        Counseling and provision of long-acting reversible contraception in the US: national survey of nurse practitioners.
        Prev Med. 2013; 57: 883-888
        • Kramer R.D.
        • Gangnon R.E.
        • Burns M.E.
        Provision of immediate postpartum long-acting reversible contraceptives before and after Wisconsin Medicaid’s payment change.
        Womens Health Issues. 2021; 31: 317-323
        • National Health Service Corps
        NHSC substance use disorder workforce loan repayment program. 2021.
        (Available at:)
        • Finer L.B.
        • Zolna M.R.
        Declines in unintended pregnancy in the United States, 2008–2011.
        N Engl J Med. 2016; 374: 843-852
        • Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, US Department of Health and Human Services
        Pregnancy and childbirth. Healthy People 2030. 2020.
        (Available at:) (Accessed Sept. 8, 2021)