Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Kate Lapane


Introduction: Access to family planning services is a major public health issue. State policies and funding for family planning services may increase access to contraceptive services and help women avoid unintended pregnancies. Study Design: We identified sexually active, fertile women participants of the National Survey of Family Growth (2006-2008). Women were categorized as consistent or inconsistent users of contraceptives based on self-report. States were classified based on 2006 Medicaid family planning waiver status (income expansions, limited expansions, or no Medicaid family planning expansions), 2006 public funding for family planning in dollars per woman, and insurance coverage of contraceptive mandate status (comprehensive mandate, partial mandate, or no mandate). Multi-level logistic regression was used to estimate the extent to which state-level constructs increase consistent contraceptive use among reproductive aged women at risk of unintended pregnancy. Results: Women living in states with an Medicaid family planning income expansion waiver had 44% increased likelihood of consistent contraceptive use relative to women living in states with no Medicaid expansions (adjusted odds ratio (aOR): 1.44; 95% confidence interval (CI): 1.06-1.96). Limited Medicaid expansion was also associated with consistent contraceptive use (aOR: 1.30; 95% CI: 0.91-1.87). Nationwide a median of $86 (Interquartile range: $59-$133) of total public family planning funding was spent per woman in 2006. Higher levels of total public funding per woman for family planning services were not associated with an increase in the odds of consistent contraceptive use among all women (OR:1.05; 95% CI:0.98-1.12) or among women with incomes <250% of the federal poverty level (OR:1.06; 95%CI: 0.96-1.17). Comprehensive insurance coverage of contraceptives mandates increased the likelihood of consistent contraceptive use for privately insured women (aOR: 1.64; 95% CI: 1.08-2.50). Partial mandates were not associated with consistent contraceptive use. No association was observed among uninsured women (aOR: 0.77; 95%CI: 0.38-1.55). Conclusions: Comprehensive insurance mandates and income-based Medicaid eligibility expansions are associated with increased likelihood of consistent contraceptive use. More research is needed to understand the association between public funding for family planning and contraceptive use among women in need of publicly funded services.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

May 2011

Included in

Epidemiology Commons