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Abstract

Purpose: To characterize contraceptive provision among the Kentucky Medicaid population and assess for rural−urban disparities.

Methods: Kentucky Medicaid claims from the calendar year 2019 were used to identify females at risk for unintended pregnancy (via a modified version of the criteria defined by the US Department of Health and Human Services Office of Population Affairs). Multinomial logistic regression was used to assess the impact of rural−urban residence on contraceptive outcomes, while adjusting for relevant covariates. Outcomes for the multinomial regression model were provision of a: (1) less effective method (i.e., condoms) or no contraceptive; (2) moderately effective method (oral, transdermal, injectable, or vaginal); (3) or long-acting reversible contraceptive (LARC) method.

Findings: A total of 239,160 enrollees at risk for unintended pregnancy were included for analyses. Adjusted odds of provision of a moderately effective method (vs. a less effective method or no method) were higher among both those residing in rural-adjacent to urban (aOR 1.17; 95% CI, 1.13–1.20) and rural-nonadjacent to urban (aOR 1.15; 95% CI, 1.12–1.18) locations compared to urban. Notably, adjusted odds of provision of an LARC method (vs. a less effective method or no method) were significantly lower among those residing in rural-nonadjacent to urban locations (aOR 0.81; 95% CI 0.77–0.85) compared to those in urban locations.

Conclusions: Despite high moderately effective contraceptive provision among Kentucky Medicaid enrollees in rural-nonadjacent to urban counties, adjusted odds of LARC provision are significantly lower, signaling significant barriers to access among this population.

Document Type

Article

Publication Date

2026

Notes/Citation Information

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2026 The Author(s). The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association.

Digital Object Identifier (DOI)

https://doi.org/10.1111/jrh.70160

Funding Information

The project described was supported by the National Institutes of Health (NIH) National Center for Advancing Translational Sciences through grant number TL1TR001997. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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