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.