Use of preferred contraceptive method among young adults in Texas and California: A comparison by state and insurance coverage

Background Young people’s ability to use their preferred contraceptive method is an indicator of reproductive autonomy and healthcare access. State policies can hinder or facilitate access to a preferred contraceptive method. Objective This study compared use of preferred contraceptive method in Texas and California, states with contrasting health policy contexts that impact health insurance coverage and access to subsidized family planning services. Methods We used baseline survey data from an ongoing cluster randomized controlled trial of sexually active students, assigned female at birth, ages 18–25, at 29 community colleges in Texas and California (N = 1,974). We described contraceptive preferences and use, as well as reasons for nonuse of a preferred method. We conducted multivariable-adjusted mixed-effects logistic regression analyses for clustered data, and then calculated the predicted probability of using a preferred contraceptive method in Texas and California by insurance status. Results More Texas participants were uninsured than Californians (30% vs. 8%, pConclusion These findings present new evidence that state of residence plays an important role in young people’s ability to realize their contraceptive preference. Young people in Texas, with lower insurance coverage and more limited access to safety net programs for contraceptive care than in California, have lower use of preferred contraception. It has become urgent in states with abortion bans to support young people’s access to their preferred methods.