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CONTEXT: Given that substantial proportions of women of reproductive age lack health insurance coverage, it is important to assess whether lack of insurance is associated with the use of prescription contraceptives, which are the most expensive but also the most effective methods for preventing pregnancy.

METHODS: Data from 26,674 females aged 18–44 who participated in the 2002 Behavioral Risk Factor Surveillance System survey (representing more than 25 million women in the U.S. population) were used to assess risk of unintended pregnancy, prescription contraceptive use and health insurance status. Logistic regression models tested the likelihood of prescription contraceptive use among insured versus uninsured respondents after controlling for socioeconomic characteristics and self-reported overall health.

RESULTS: A significantly higher proportion of insured women than of uninsured women reported use of prescription contraceptives (54% vs. 45%). In multiple regression analysis, women lacking health insurance were 30% less likely to report using prescription contraceptive methods than were women with private or public health insurance. Results were similar across racial, age and income subgroups.

CONCLUSIONS: Lack of health insurance is associated with reduced use of prescription contraceptives. Universal insurance coverage is needed to ensure access to the most effective contraceptive methods for all women in need.