Barriers to contraceptive access after health care reform: Experiences of young adults in Massachusetts

Objective: To explore how Massachusetts' 2006 health insurance reforms affected access to sexual and reproductive health (SRH) services foryoung adults.

Study Design: We conducted 11 focus group discussions across Massachusetts with 89 women and men aged 18 to 26 in 2009.

Results: Most young adults' primary interaction with the health system was for contraceptive and other SRH services, although they knew little about these services. Overall, health insurance literacy was low. Parents were primary decision makers in health insurance choices or assisted their adult children in choosing a plan. Ten percent of our sample was uninsured at the time of the discussion; a lack of knowledge about provisions in Chapter 58 rather than calculated risk analysis characterized periods of uninsurance. The dynamics of being transitionally uninsured, moving between health plans, and moving from a location defined by insurance companies as the coverage area limited consistent access to contraception. Notably, staying on parents' insurance through extended dependency, a provision unique to the post-reform context, had implications for confidentiality and access.

Conclusions: Young adults' access to and utilization of contraceptive services in the post-reform period were challenged by unanticipatedbarriers related to information and privacy. The experience in Massachusetts offers instructive lessons for the implementation of national health carereform. Young adult-targeted efforts should address the challenges of health service utilization unique to this population.