{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T10:45:48Z","timestamp":1770893148955,"version":"3.50.1"},"reference-count":17,"publisher":"Guttmacher Institute","issue":"3","license":[{"start":{"date-parts":[[2018,6,12]],"date-time":"2018-06-12T00:00:00Z","timestamp":1528761600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","award":["FPRPA006060"],"award-info":[{"award-number":["FPRPA006060"]}],"id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5 R24 HD074034"],"award-info":[{"award-number":["5 R24 HD074034"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Perspect Sexual Reproductive"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec><jats:title>CONTEXT<\/jats:title><jats:p>As federal initiatives aim to fundamentally alter or dismantle the Affordable Care Act (ACA), evidence regarding the use of insurance among clients obtaining contraceptive care at Title X\u2013funded facilities under ACA guidelines is essential to understanding what is at stake.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>A nationally representative sample of 2,911 clients seeking contraceptive care at 43 Title X\u2013funded sites in 2016 completed a survey assessing their characteristics and insurance coverage and use. Chi\u2010square tests for independence with adjustments for the sampling design were conducted to determine differences in insurance coverage and use across demographic characteristics and facility types.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Most clients (71%) had some form of public or private health insurance, and most of these (83%) planned to use it to pay for their services. Foreign\u2010born clients were less likely than U.S.\u2010born clients to have coverage (46% vs. 75%) and to use it (78% vs. 85%). Clients with private insurance were less likely than those with public insurance to plan to use their insurance (75% vs. 91%). More than one\u2010quarter of clients not planning to use existing insurance for services indicated that the reason was that someone might find out.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>Coverage gaps persist among individuals seeking contraceptive care within the Title X network, despite evidence indicating increases in health insurance coverage among this population since implementation of the ACA. Future research should explore the impact of altering or eliminating the ACA both on the Title X provider network and on the individuals who rely on it.<\/jats:p><\/jats:sec>","DOI":"10.1363\/psrh.12061","type":"journal-article","created":{"date-parts":[[2018,6,12]],"date-time":"2018-06-12T13:51:24Z","timestamp":1528811484000},"page":"101-109","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Use of Health Insurance Among Clients Seeking Contraceptive Services at Title X\u2013Funded Facilities in 2016"],"prefix":"10.1363","volume":"50","author":[{"given":"Megan L.","family":"Kavanaugh","sequence":"first","affiliation":[{"name":"Principal research scientist, at the Guttmacher Institute, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mia R.","family":"Zolna","sequence":"additional","affiliation":[{"name":"Senior research associate, at the Guttmacher Institute, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen L.","family":"Burke","sequence":"additional","affiliation":[{"name":"Senior research assistant, at the Guttmacher Institute, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"259","published-online":{"date-parts":[[2018,6,12]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"Title X Family Planning Annual Report: 2016 National Summary","author":"Fowler CI","year":"2017"},{"key":"e_1_2_6_3_1","article-title":"Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs","volume":"63","author":"Gavin L","year":"2014","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"e_1_2_6_4_1","volume-title":"Publicly Funded Contraceptive Services at U.S. Clinics, 2015","author":"Frost JJ","year":"2017"},{"key":"e_1_2_6_5_1","article-title":"Uninsured rate among women of reproductive age has fallen more than one\u2010third under the Affordable Care Act","author":"Guttmacher Institute","year":"2017","journal-title":"News in Context"},{"key":"e_1_2_6_6_1","article-title":"Through ACA implementation, safety\u2010net family planning providers still critical for uninsured\u2014and insured\u2014clients","author":"Hasstedt K","year":"2016","journal-title":"Policy Analysis"},{"key":"e_1_2_6_7_1","volume-title":"Variation in Service Delivery Practices Among Clinics Providing Publicly Funded Family Planning Services in 2010","author":"Frost JJ","year":"2012"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2017.10.011"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000509"},{"key":"e_1_2_6_10_1","volume-title":"Bridging the Gap: Continuity and Quality of Coverage in Medicaid","author":"Ku L","year":"2013"},{"key":"e_1_2_6_11_1","volume-title":"Publicly Funded Family Planning Clinics in 2015: Patterns and Trends in Service Delivery Practices and Protocols","author":"Zolna MR","year":"2016"},{"key":"e_1_2_6_12_1","volume-title":"Title X Family Planning Annual Report: 2015 National Summary","author":"Fowler CI","year":"2016"},{"key":"e_1_2_6_13_1","unstructured":"Guttmacher Institute Dramatic gains in insurance coverage for women of reproductive age are now in jeopardy News in Context 2018 https:\/\/www.guttmacher.org\/article\/2018\/01\/dramatic\u2010gains\u2010insurance\u2010coverage\u2010women\u2010reproductive\u2010age\u2010are\u2010now\u2010jeopardy."},{"key":"e_1_2_6_14_1","unstructured":"HasstedtK The case for advancing access to health coverage and care for immigrant women and families Health AffairsBlog Nov. 19 2014 http:\/\/healthaffairs.org\/blog\/2014\/11\/19\/the\u2010case\u2010for\u2010advancing\u2010access\u2010to\u2010healthcoverage\u2010and\u2010care\u2010for\u2010immigrant\u2010women\u2010and\u2010families\/."},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1700829"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.gco.0000178335.36140.49"},{"key":"e_1_2_6_17_1","first-page":"48","article-title":"How dismantling the ACA's marketplace coverage would impact sexual and reproductive health","volume":"20","author":"Hasstedt K","year":"2017","journal-title":"Guttmacher Policy Review"},{"key":"e_1_2_6_18_1","volume-title":"Contraceptive Needs and Services, 2014 Update","author":"Frost JJ","year":"2016"}],"container-title":["Perspectives on Sexual and Reproductive 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