Access to Contraceptives Improves College Graduation Rates 12%

Access to contraceptives via the federal Title X Family Planning program increased the rate at which women graduated with a bachelor’s degree by between 6 and 12 percent, underscoring how accessing certain types of care can bolster other social determinants of health, the researchers said in a new Health Affairs article obtain via email.

The data also underscores how access to contraceptives can have added benefits to women’s lives, they explained.

The US created the Title X Family Planning program to improve patient access to care, including primary care, family planning, sexual and reproductive healthcare, and contraceptives. The 50-year-old program was originally pitched to improve the lives and well-being of women across the country, but those are hard outcomes to measure, the researchers wrote.

Usually, research centers on college completion rates because a bachelor’s degree is essential to attaining a middle-class lifestyle in the US. But that research usually looks at the failure of reproductive healthcare and contraceptive access, not the other way around, and the researchers said that creates some selection bias.

After all, those who face limited contraceptive access tend to come from lower socioeconomic levels, leading to lower educational attainment. It can be difficult to parse whether a lack of a college degree is due to low family income or poor contraceptive access.

The research team turned that approach on its head, instead looking at whether exposure to the Colorado Family Planning Initiative (CFPI) was linked to college completion rates.

In 2009, CFPI abruptly expanded access to low- or no-cost contraceptives, including oral contraceptives and other common, FDA-approved forms of contraceptives.

This initiative increased high school graduation rates in the state by 1.7 percentage points, the researchers said, citing separate data.

And using 11 years of data from the American Community Survey, they also found that CFPI improved college completion, as defined as obtaining a bachelor’s degree by the time an individual is between 22 and 24 years old.

The team used an intent-to-treat approach to measure how many high-school-aged girls were touched by CFPI, which helped the team estimate whether access to CFPI prevented a teenage pregnancy and helped a young woman graduate college on time.

The analysis showed that CFPI was successful in this, observing an increase in on-time college graduation rates anywhere from 1.8 to 3.5 percentage points, depending on the birth year cohort (the researchers looked at women born between 1992 and 1994). That shakes out to an overall increase in college completion rates of between 6 and 12 percent.

Moreover, young women in Colorado were more likely to graduate on time than women in the rest of the US, the researchers said.

Those impacts are sensational, the researchers argued, because CFPI only addresses contraceptive access. Low-income women and girls, the primary population who benefits from programs like CFPI, face a litany of other challenges that impact their ability to complete a four-year degree.

These findings are also critical considering the impact educational attainment has on well-being. Educational attainment is a core social determinant of health, the researchers emphasized.

“Educational attainment is a key determinant of later health and socioeconomic outcomes,” they wrote. “In demonstrating that exposure to the CFPI increased women’s on-time attainment of a bachelor’s degree, this study provides critical evidence that access to contraception not only gives women control over their fertility but also improves their lives in additional important ways.”

That point is particularly salient considering the changes Title X, of which CFPI is a part, has undergone in recent years. In 2019, a Trump Administration rule restricted funding to Title X clinics that counseled patients on abortion as a form of contraception. This prompted many Title X clinics to withdraw from the program and limited patient access to care, data has shown.

Those restrictions have since been lifted, but this latest data serves as a cautionary tale for the implications of restricting the program in the future.

“Our results suggest that policies expanding or contracting access to the full range of contraceptive methods will reverberate beyond reproductive health and fertility to affect women’s prospects for higher education,” the researchers concluded. “Policy makers should consider this breadth of consequences when considering changes to Title X policy or other policies influencing contraceptive access.”