Nathan Hale, Director for Research in the East Tennessee State University College of Public Health Center for Applied Research and Evaluation (CARE) in Women's Health and Associate Professor in the Department of Health Services Management and Policy, is lead author of an article in Women’s Health Issues. The article is titled, “Impact of the Choose Well Contraceptive Access Initiative on Method Use Among Women Enrolled in South Carolina's Medicaid Program: A Mid-line Assessment.”
Co-authors include faculty of CARE Women’s Health Wondi Manalew, Edward Leinaar, Michael Smith, and Amal Khoury as well as Bisakha Sen of the University of Alabama at Birmingham.
The research team examined the impact of the Choose Well statewide contraceptive access initiative on contraceptive use among South Carolina Medicaid beneficiaries at midline, just prior to COVID-19. This study found that Choose Well was associated with significant increases in the levels and trends of highly effective method use among women of reproductive age enrolled in South Carolina Medicaid. The team used Medicaid claims data and employed an interrupted time series design to tease out the impact of Choose Well on observed changes. Positive trends occurred during the Choose Well implementation period beyond what would be expected given pre-Choose Well trends.
The Choose Well contraceptive access initiative is the first and largest state-wide initiative of its kind in the U.S. southeast aimed at reducing unintended pregnancy. While evaluations of statewide contraceptive access initiatives have been conducted previously, this study is novel in assessing the impact of the initiative specifically within the Medicaid program.
“State Medicaid programs across our country are the main provider of insurance coverage for reproductive health services for low-income women, yet, despite the insurance coverage, women enrolled in Medicaid face multiple barriers to accessing essential services,” said Dr. Khoury, Director of CARE Women’s Health. “This study showed that Choose Well succeeded in reducing barriers to care for this priority population. This, in turn, should support women in making their preferred reproductive health decisions, ultimately reducing unintended pregnancy and improving health outcomes.”
“This study provides really important evidence that contraceptive access initiatives can have a significant impact on a larger scale and are a good investment. That is important for informing long-term policy decisions around access to important services. But more importantly, it also suggests that individuals in the state have better access to a wider range of effective contraceptive methods and can maintain some sense of agency over if and when they want to become pregnant,” said Dr. Hale, lead author and co-Principal Investigator of the Choose Well Evaluation.
Across South Carolina, the Choose Well initiative focused on promoting equitable access to contraception by expanding and training the workforce, removing cost barriers, increasing consumer awareness, and integrating contraceptive care into primary care. These efforts have translated to changes in contraceptive utilization at the project's mid-point, which suggests that people who prefer highly effective methods of contraception enjoyed easier access to them. These findings are timely for policymakers, family planning programs, and safety net clinics seeking to expand contraceptive access.