A population-based study of US women's preferred versus usual sources of reproductive health care

Am J Obstet Gynecol. 2015 Sep;213(3):352.e1-14. doi: 10.1016/j.ajog.2015.04.025. Epub 2015 Apr 30.

Abstract

Objective: We characterized US women's preferred and usual sources of reproductive health care.

Study design: Data were drawn from the Women's Health Care Experiences and Preferences Study, an Internet survey of 1078 women aged 18-55 years randomly sampled from a national probability panel. We described and compared women's preferred and usual sources of care (women's health specialists including obstetricians-gynecologists and family-planning clinics, primary care, other) for Papanicolaou/pelvic examination, contraception, and sexually transmitted infection (STI) services using χ(2), logistic regression, and kappa statistics.

Results: Among women reporting health service utilization (n = 984, 92% overall; 77% Papanicolaou/pelvic; 33% contraception; 8% STI), women's health specialists were the most used sources of care for Papanicolaou/pelvic (68%), contraception (74%), and STI (75%) services. Women's health specialists were also the most preferred care sources for Papanicolaou/pelvic (68%), contraception (49%), and STI (35%) services, whereas the remainder of women preferred primary care/other sources or not to get care. Differences in preferred and usual care sources were noted across sociodemographic groups, including insurance status and income level (P < .05). Preference for women's health specialists was the strongest predictor of women's health specialist utilization for Papanicolaou/pelvic (adjusted odds ratio, 48.8; 95% confidence interval, 25.9-91.8; P < .001) and contraceptive (adjusted odds ratio, 194.5; 95% confidence interval, 42.3-894.6; P < .001) services. Agreement between preferred and usual-care sources was high for Papanicolaou/pelvic (85%, kappa, 0.63) and contraception (86%; kappa, 0.64) services; disagreement (range, 15-22%) was associated with insurance, employment, income, race, and religion (P < .05).

Conclusion: Women's preferences for and use of women's health specialists for reproductive health care has implications for efforts to define the role of obstetricians-gynecologists and family planning clinics in current health systems.

Keywords: health service preferences; reproductive health care; women’s health service utilization.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Ambulatory Care Facilities / statistics & numerical data*
  • Contraception / statistics & numerical data
  • Early Detection of Cancer / statistics & numerical data
  • Female
  • Gynecology / statistics & numerical data*
  • Humans
  • Income / statistics & numerical data
  • Insurance, Health / statistics & numerical data
  • Logistic Models
  • Middle Aged
  • Obstetrics / statistics & numerical data*
  • Papanicolaou Test / statistics & numerical data
  • Patient Preference*
  • Primary Health Care / statistics & numerical data*
  • Reproductive Health Services / statistics & numerical data*
  • Sexually Transmitted Diseases / diagnosis
  • Sexually Transmitted Diseases / therapy
  • Social Class
  • United States
  • Uterine Cervical Neoplasms / diagnosis
  • Vaginal Smears / statistics & numerical data
  • Women's Health Services / statistics & numerical data*
  • Young Adult