The ability to plan pregnancies is associated with better outcomes for individuals and cost savings for states—but more than half of all pregnancies are unplanned. Nearly 17% of sexually active women who are not trying to get pregnant report not using contraception due to costs, lack of insurance coverage or geographic barriers to accessing a health care professional who can prescribe birth control.
In the past two years, states have sought to reduce these barriers with legislation addressing who can prescribe and dispense contraception; the types and lengths of contraception covered through insurance; the times to increase access to contraception, such as during the postpartum period; and the locations where contraception can be accessed.
The postpartum period is a key time to reduce unintended pregnancies: About 36% of pregnancies are conceived within 18 months of a previous birth.
Who Can Prescribe, Dispense and Administer?
States have allowed certain advanced practice clinicians to prescribe, dispense and administer contraception. For example, New York passed legislation allowing nurse practitioners to prescribe and order self-administered hormonal contraceptives. Washington state passed legislation permitting licensed midwives to prescribe, obtain and administer hormonal and nonhormonal family planning methods.
Pharmacists can be a touch point with a health provider for many people. Nearly 90% of patients live within 5 miles of a pharmacist. Pharmacist prescribing may reduce barriers such as travel and scheduling considerations. In 2022-23, nine states passed legislation related to pharmacists’ prescribing, dispensing and administering of contraceptives. For example, Virginia now permits pharmacists, as well as pharmacy technicians under supervision, to initiate treatment with, dispense or administer contraceptives to patients through telehealth. In 2023, Indiana expanded pharmacists’ authority to include prescribing, ordering and administering the contraceptive shot.
Extending the Supply
Extended supply coverage of contraception can help eliminate gaps in contraceptive use by reducing the number of times prescriptions must be refilled. For example, a three-month supply is associated with a 30% reduction in unplanned pregnancies. States that have addressed supply often extend insurance coverage to six months or a year of contraceptives at one time.
In 2022-23, nine states enacted legislation expanding access to extended-supply contraception, which brings the total number of states with such laws to nearly half. Colorado now requires insurers to cover a 12-month supply of contraceptives, and Louisiana requires Medicaid plans to dispense six-month supplies, unless the patient or provider requests otherwise. Health plans in Texas must now cover an initial three-month supply of contraception and a 12-month supply for each subsequent refill.
Emergency Access
Some states have increased access to emergency contraception for certain populations, including sexual assault survivors and college students. Emergency contraception can play an important role in reducing unintended pregnancy when taken up to five days after unprotected sex. In 2023, Utah passed legislation creating a sexual assault hotline to provide information about free emergency contraception and other services. Maryland requires state colleges to develop plans to provide students with referrals or contraception, including emergency contraception.
Postpartum Access
The postpartum period is a key time to reduce unintended pregnancies: About 36% of pregnancies are conceived within 18 months of a previous birth. In 2022-23, several states increased access to postpartum contraception. Long-acting reversible contraceptives, or LARC, provide long-term pregnancy prevention and include intrauterine devices and hormonal implants. They are one of the most reliable and common birth control strategies and can make a particular impact during the postpartum period. About 40% of women do not attend their postpartum appointments. Placing a LARC postpartum while a patient is still in the hospital reduces barriers such as having to make a follow-up appointment.
Medicaid reimbursement of immediate postpartum LARC was associated with a statistically significant increase in the rate of LARC placement, according to a recent study. Nevada now requires hospitals to provide LARC to postpartum patients upon request, and all insurers, including Medicaid, must cover this care. Arkansas also requires Medicaid coverage of LARC immediately after birth and during the postpartum period.
For more on contraception legislation, see these NCSL resources: Medicaid Strategies to Improve Access to Contraception, State Contraception Policies and State Options Addressing Access to Contraception.
Kendall Speer is a policy specialist in NCSL’s Health Program.