In the United States, about half of pregnancies are unintended, and most women of reproductive age are at risk of unintended pregnancy. Research has explored predictors of contraceptive use and unintended pregnancy, but there is a lack of research regarding access to preferred contraceptive method(s) and the complex pathways from sociodemographic factors to these family planning outcomes. This study applied Levesque et al.'s (2013) healthcare access framework to investigate pathways from sociodemographic factors and indicators of access to family planning outcomes using secondary data. Data were collected at four time points via an online survey between November 2012 and June 2014. Participants were US women of reproductive age who were seeking to avoid pregnancy (N = 1036; M_age = 27.91, SD = 5.39; 6.9% Black, 13.6% Hispanic, 70.2% white, 9.4% other race/ethnicity). We conducted mediational path analysis, and results indicated that contraceptive knowledge (β = 0.116, p = 0.004), insurance coverage (β = 0.423, p < 0.001), and relational provider engagement (β = 0.265, p = 0.011) were significant predictors of access to preferred contraceptive method. Access to preferred contraceptive method directly predicted use of more effective contraception (β = 0.260, p < 0.001) and indirectly predicted decreased likelihood of experiencing unintended pregnancy via contraceptive method(s) effectiveness (β = −0.014, 95% confidence interval: −0.041, −0.005). This study identifies pathways to and through access to preferred contraceptive methods that may be important in determining family planning outcomes such as contraceptive use and unintended pregnancy. This information can be used to improve access to contraception, ultimately increasing reproductive autonomy by helping family planning outcomes align with patients' needs and priorities.

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生殖自主权的途径：使用路径分析预测美国的计划生育结果

在美国，大约一半的怀孕是意外怀孕，大多数育龄妇女都有意外怀孕的风险。研究探索了避孕药具使用和意外怀孕的预测因素，但缺乏关于获得首选避孕方法以及从社会人口因素到这些计划生育结果的复杂途径的研究。本研究应用 Levesque 等人 (2013) 的医疗保健可及性框架，使用二手数据调查社会人口因素和计划生育结果可及性指标的途径。通过 2012 年 11 月至 2014 年 6 月之间的在线调查在四个时间点收集数据。参与者是美国育龄妇女，他们寻求避免怀孕（N  = 1036；M_年龄 = 27.91，SD = 5.39；6.9% 黑人，13.6% 西班牙裔，70.2% 白人，9.4% 其他种族/民族）。我们进行了中介路径分析，结果表明避孕知识 ( β  = 0.116，p  = 0.004)、保险范围 ( β  = 0.423，p  < 0.001) 和相关提供者参与度 ( β  = 0.265，p  = 0.011) 是重要的预测因子获得首选避孕方法的机会。获得首选避孕方法直接预测使用更有效的避孕方法 ( β  = 0.260, p < 0.001) 并通过避孕方法的有效性间接预测意外怀孕的可能性降低 ( β  = −0.014, 95% 置信区间: −0.041, −0.005)。这项研究确定了获得首选避孕方法的途径，这些方法可能对确定避孕药具使用和意外怀孕等计划生育结果很重要。这些信息可用于改善避孕措施的获取，最终通过帮助计划生育结果与患者的需求和优先事项保持一致来提高生殖自主权。