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Consistency of Health Insurance Coverage and Women’s Reproductive Healthcare Access During Early Adulthood

Abstract

Women’s reproductive healthcare access is crucial in preventing unplanned pregnancies, sexually transmitted infections, and certain cancers. Adult women covered by health insurance are significantly more likely to access reproductive healthcare services than those without insurance, but limited research has focused on access among youth adult women or to how changes in insurance coverage shape healthcare access. The present study extends this research by examining differences in access to gynecological exams and prescription contraceptives between young adulthood women who, during the past year, were either always insured, never insured, or only sometimes insured (for 1–11 months). We do so with data from a nationally representative sample of young adult women in Waves III (2001–2002, ages 18–26) and IV (2008–2009, ages 24–32) of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Results from multivariable logistic regression models indicate that young adult women who were always uninsured or only sometimes insured are significantly less likely than always insured women to have had a gynecological exam in the past year or to use prescription contraceptives. In addition, we find no evidence that increases in the number of months insured is associated with these outcomes among women who were only sometimes insured during the past year. These findings suggest that marginal increases in monthly insurance coverage rates will be of limited benefit to women seeking these key reproductive healthcare services, and that moving women to complete coverage is associated with the highest rate of healthcare access.

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Notes

  1. We additionally considered whether insurance coverage categories are associated with a binary indicator of having had a Pap test completed in the past year relative to all other respondents (n = 7334, 64% with a Pap test). Results from these models yield substantially identical conclusions to those presented in the “OBGYN Annual” models.

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Acknowledgements

This research is based upon work supported by the National Science Foundation Graduate Research Fellowship Program under Grant No. DGE1255832. We thank the Center for Family and Demographic Research, Bowling Green State University for providing coding support in the creation of Add Health family structure measures. This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Information on how to obtain the Add Health data files is available on the Add Health website (https://addhealth.cpc.unc.edu/). No direct support was received from grant P01-HD31921 for this analysis. The opinions and conclusions expressed herein are solely those of the authors and should not be construed as representing the opinions or policy of any agency of the Federal government.

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Correspondence to Nicolo P. Pinchak.

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Kerber, G.R., Pinchak, N.P. Consistency of Health Insurance Coverage and Women’s Reproductive Healthcare Access During Early Adulthood. Popul Res Policy Rev 41, 825–842 (2022). https://doi.org/10.1007/s11113-021-09690-3

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Keywords

  • Health insurance
  • Contraception
  • Gynecology
  • Healthcare access
  • Young adulthood