The politics of place: Presidential voting patterns and providers' prescription of emergency contraception

Objective: The most effective forms of emergency contraception (EC) require a prescription or a medical procedure; therefore, provider willingness to offer EC remains critical to patient access. This study seeks to assess whether political alignment of a provider's county is associated with provider attitudes and behaviors regarding EC. Study design: We analyzed survey data collected from 1313 healthcare providers from February 2013 to April 2014 at 14 academic medical centers in the United States. Using logistic regression, we estimated associations between the county political alignment of a provider's practice and his or her EC-related beliefs and practices: 1) if the provider is aware of the most effective EC methods; 2) if knowing that a hypothetical EC method prevented implantation would make a provider less likely to prescribe that method because of personal ethical or religious reasons; and 3) if the provider prescribes any form of EC in his or her practice. Results: In multivariate models, a one percentage-point increase in county Republican vote share was associated with a 2.9% decrease in the odds of a provider prescribing EC, after accounting for provider knowledge and attitudes about EC. Conclusions: EC provides a critical last chance to prevent pregnancy after unprotected sex, yet women living in Republican-leaning counties may face difficulty obtaining EC from healthcare providers. Programs seeking to improve access to EC should focus on areas likely to have fewer providers willing to prescribe EC, which may be those that are more Republican-leaning. Implications: The most effective forms of emergency contraception require a prescription or a medical procedure; therefore, provider willingness to offer EC remains critical to patient access. Women living in Republican-leaning counties may face difficulty obtaining emergency contraception from healthcare providers.