A Research Roadmap to Advance Contraceptive Access Policy

Despite its importance for individual and public health, many Americans face barriers to quality contraception, especially people of color, people living in poverty, people with disabilities, immigrants, and others with marginalized identities. Policymaking that is evidence-informed, effective, and equitable can help to solve these access problems, but decision-makers often lack the evidence they need to design and implement effective solutions.

That’s why we at the Coalition to Expand Contraceptive Access (CECA), along with our partners, led a collaborative process to create a Priority Roadmap for Policy-Ready Contraceptive Research. The Roadmap features concrete, actionable, and feasible research recommendations that position health services researchers to carry out impactful projects that advance sexual and reproductive health equity and meet the information needs of policymakers and advocates.

To develop the Roadmap, CECA analyzed the state of the evidence, synthesized best practices for constructing a research agenda, and identified pressing problems and policy questions. We also convened a diverse expert workgroup made up of researchers, clinical experts, reproductive justice and policy advocates, and community representatives from across the country. The Workgroup translated these inputs into research and policy priorities and actions.

Research Recommendations to Advance Contraceptive Access Policy

This collaborative process resulted in three sets of recommendations:

1. A prioritized set of needed research questions that cut across three themes –
   1. Developing a Framework for Holistic, Equitable Contraceptive Access to advance sexual and reproductive health equity, wellbeing, and justice.
   2. Strengthening the Health care Infrastructure to Expand Contraceptive Access and strategically optimize resource investment.
   3. Supporting Technology and Innovation in Contraceptive Service Delivery, such as telehealth and pharmacist-prescribed contraception, to expand access to care, especially in communities that face barriers.
2. A set of equity-informed research principles that center justice, human rights, and health equity. These principles are:
   • • Ground contraceptive access research in a holistic vision of sexual and reproductive health that centers justice, equity, autonomy, and choice.
     • Interrogate and re-evaluate the research practices that have guided us.
     • Honor and embrace communities as equal partners throughout the research process. 
     • Understand and reflect the impact of the historical, sociocultural, political, and economic contexts that influence the lived experiences of community members. 
     • Design actionable research that can be used to impact the lives of individuals and communities through changes in systems, policies, and practice. 

These were designed in light of the recognition that how contraceptive access research is conducted is just as significant as the design, especially given the history of research injustices in sexual and reproductive health.

3. Several overarching themes and methodological considerations that are fundamental to the entire undertaking of contraceptive access research, including the need for:
   • A consistent and person-centered definition of access;
   • Data that advance a rigorous and detailed understanding of contraceptive access, people’s experiences of their health care, and health outcomes;
   • A deeper understanding the long-term impact of interventions. 

Health Services Researchers Play a Key Role in Advancing this Work

Health services researchers should use this Roadmap to map their research portfolios to the needed research, pursue research projects that advance these recommendations, and conduct research with equity principles at the center. With its focus on how structures and policies influence health and wellbeing, health systems research is uniquely positioned to answer many of the questions in the Roadmap. This work can ultimately support policy change to promote equity and access – this could include contraceptive equity legislation that eliminates cost-sharing or expands the scope of practice for a range of health care providers, such as nurse practitioners and pharmacists.

We each have a role to play in advancing contraceptive access research and reshaping the policy landscape – researchers, funders, policymakers, and advocates alike. For example, researchers can collaborate with policymakers and advocates to support research accessibility and effective translation of evidence to policy. Collaboration across a broad group of multidisciplinary researchers can also provide a forum to share best practices for equity-informed research, interim research findings prior to publication, and provide opportunities to disseminate research findings directly to policymakers and advocates.

We hope the Roadmap will be a tool to promote research conducted with equity principles at the center, advance strategic and diverse research investments, and improve collaboration within and between key stakeholder groups. This ambitious agenda, if carried out, can radically affect how we think about contraceptive access, research, and the relationship between research and policy.