State-level conditions and telecontraception platform availability

Objective: Telecontraception platforms are a growing market aiming to minimize barriers to obtaining contra-ception in the United States by delivering birth control directly to consumers through the mail or pharmacy pickup. However, access is not patterned equally for women due to state-level differences. This research ex-amines how social, political, and economic state conditions combine and operate with one another to pattern access to telecontraception platforms across the United States.Methods: An original dataset of state-level factors was constructed from a variety of public-use websites. Fuzzy-set qualitative comparative analysis (fsQCA) was used to examine the influence of state-level conditions (state po-litical control, proportion of women legislators, percent uninsured women, and percent rural population) on telecontraception platform availability across the United States. Results: Findings uncovered three combinations of state factors linked to telecontraception platform availability with high consistency. States with high proportions of women legislators in combination with other state-level conditions were linked to telecontraception platform availability in both Democrat and Republican-controlled states. Republican states with high proportions of uninsured women and non-rural populations were also linked to telecontraception availability. Combinations illustrated distinct groupings of geographical regions.Conclusion: Using fsQCA to examine conditions associated with telecontraception provides an informative approach for health policy because it considers diverse state-level contexts. Women legislators were associated with telecontraception platform availability regardless of the political control of a state, suggesting that the gender makeup of legislative bodies may operate as an important factor in influencing reproductive health policies.Public interest summary: Telecontraception platforms such as Nurx, Favor, and Planned Parenthood Direct aim to address barriers to obtaining birth control in the U.S. by providing contraception directly to women through the mail or pharmacy pickup. Access to telecontraception platforms can vary by state, yet less is known about what shapes these differences. This research aimed to address this gap by examining state conditions associated with telecontraception platform availability. Women legislators, state political control, uninsured women, and rural population all combined in different ways to pattern telecontraception platform availability. States with high proportions of women legislators, in combination with other conditions, were linked to telecontraception plat-form availability in both Democrat and Republican states. Gender makeup of legislative bodies thus may be an important factor in influencing reproductive health policies. Combinations were also clustered geographically, illustrating that communication and networks may operate to influence telecontraception platform availability.