Changes in Contraceptive Method Mix Following the Colorado Family Planning Initiative.

OBJECTIVE: To describe the changes in contraceptive method use and mix among Colorado Title X clients following the 2009 Colorado Family Planning Initiative (CFPI), which allowed Colorado Title X providers to offer all contraceptive methods without medically unnecessary barriers.

STUDY DESIGN: Using data on all visits to Colorado Title X clinics between 2007 and 2016 for women aged 10-49 years, we described trends in contraceptive method use by age group and race/ethnicity prior to and following the implementation of CFPI.

RESULTS: The implementation of CFPI saw an abrupt increase in Title X visits. Visits subsequently declined steeply for non-Hispanic White clients while visits by Hispanic clients remained at elevated levels. During CFPI, use of long-acting reversible contraceptives (LARCs) increased while use of oral contraceptive pills (OCPs) decreased. Nonetheless, OCPs remained the most common method used by Title X clients throughout the study period. Changes in method mix varied by age and race/ethnicity. Method switching was relatively uncommon among established Title X clinic users.

CONCLUSION: CFPI, which removed financial barriers to the most expensive methods, was associated with increases in the use of LARCs and changes in method mix that varied by age group and race/ethnicity.

IMPLICATIONS: CFPI removed barriers to previously inaccessible methods that contributed to changes in the method mix at Title X clinics. That these changes were not uniform across ages and race/ethnicities emphasizes that subgroup variation in family planning policy impact stems from heterogeneity in barriers to care and method-specific unmet demand.