Impediments to Access

Lack of access is an important impediment to the use of contraception. With the exception of emergency contraception, all hormonal methods in the United States are available by prescription only. More than 47 million Americans (2010) do not have health insurance and have problems accessing primary care, and even with health insurance, access to contraception may be hampered by lack of coverage. For example, in a Washington state study comparing the 91 top-selling insurance plans, almost half did not cover any contraceptive method; 37% of women had no access to sterilization; and 53% had no access to pregnancy termination (Kurth et al., 2001). Another important impediment to the use of contraception can be physician difficulty in being reimbursed for contraception services. Therefore, Table 26-1 lists common International Classification of Diseases (ICD-9) codes for contraception counseling, prescriptions, and follow-up.

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