Does precarious situtation impact contraceptive use in a context of full health insurance coverage?

Abstract

Abstract Background To promote their sexual and reproductive health and rights, women need full access to contraception and choice of contraceptive method. Precarious women may have difficulties in accessing contraception even in developed countries with widespread health insurance coverage. It is difficult to explore this issue through national surveys that often include too few precarious women. We aimed to compare contraceptive use among precarious and non-precarious women based on the exhaustive French health insurance database. Methods The French health insurance database covers 98% of the population living in France and includes all healthcare reimbursements. Contraceptives are partly reimbursed by the national health insurance. For people in a precarious situation, they are fully reimbursed by a specific system called universal health coverage. We selected all women aged 15-49 years living in metropolitan France in 2019. We compared the prevalence of use of each contraceptive method: pill, hormonal intra-uterine device (IUD), copper IUD and implant, between precarious and non-precarious women. Results Among the study population of 14 million women, 11% were in a precarious situation. Fewer precarious women used contraceptives (31%) than non-precarious women (44%, p < 0.001). When using a contraceptive, precarious women used a different method than non-precarious women: under the age of 30 years, they used the pill much less and implants more often; above 35 years, they used hormonal IUDs less often and the pill and implants more often. Conclusions Although in France contraceptives are fully reimbursed for precarious women, they used fewer and different contraceptives than non-precarious women. Social inequalities may exist even in such a favorable national context. Further research should explore barriers that precarious women may encounter in accessing and choosing their contraception. Key messages Although French national health insurance fully covers contraceptives for precarious women, their use of contraceptives is much lower (31% versus 44%), suggesting possible social inequalities. When using contraception, precarious women do not use the same methods as non-precarious women, suggesting possible differences in their contraceptive choice or differences in medical practice.