Birth Control Access in Missouri


Courtney Joslin
Resident Fellow and Senior Manager, Competition Policy
Mary Louise Gilburg
Former Research Associate, Competition Policy

Key Points

Missouri has a primary care shortage that is expected to increase in the coming years.

The unintended pregnancy rate in Missouri is significant, but better contraceptive access is shown to reduce these rates.

Unintended and mistimed pregnancies are costly; the annual public cost of unintended pregnancy in Missouri is estimated to be $518 million.

Allowing pharmacists to prescribe birth control is a proven solution to reduce unintended pregnancy and its effects.


A national primary care provider shortage has made it difficult for many Americans to access primary and reproductive health care. Health Professional Shortage Areas (HPSAs) are regions where it is particularly difficult to access care due to inadequate amounts of practitioners. Missouri ranks third in the nation with 327 designated HPSAs. It is estimated that in Missouri, only 10 percent of the need for primary care is being met. Unfortunately, the shortage is expected to increase in the coming years; a 2016 estimate found that, just to maintain the existing level of access to care, Missouri would need a healthcare workforce increase of nearly 20 percent by 2035. This has serious implications for many health services, including reproductive and pregnancy care.

Adding to the primary care shortage, over 374,000 women in Missouri live in
contraceptive deserts. Contraceptive deserts are areas with limited to no access
to health clinics that provide the full range of contraceptive methods. When
women live in areas without access to contraception options, they are at risk of
an unintended or mistimed pregnancy. Lack of contraceptive use and sporadic
contraceptive use are leading causes of unintended pregnancy. In Missouri, almost 25 percent of women of reproductive age do not use any form of contraception. Research shows a contributing factor to non-use of contraception is lack of access. As a result of contraceptive deserts and access issues, unintended pregnancies—and their associated costs—are high in Missouri. Thirty-six percent of live births in Missouri are unintended. In addition, the annual cost associated with unintended pregnancy in Missouri is $518 million. Along with economic costs, the maternal mortality rate in Missouri is higher than the national average, making the high percentage of unintended and mistimed births even more significant. Rates of maternal morbidity are also high, which in turn creates healthcare spending.

One solution to the provider shortage and access problems is task-sharing,
authorizing non-physician healthcare professionals to perform tasks typically
restricted to high-level providers. An example of this is the pharmacy access model, in which pharmacists are authorized to prescribe and administer oral contraceptives and other prescription medications directly to patients. The pharmacy access model increases access by increasing the pool of health care practitioners that can provide contraception prescriptions. This model also increases access by reducing cost barriers associated with primary care visits and travel time to clinics.

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