Abstract
Objective
To compare long-acting reversible contraceptive (LARC) uptake before and after the
Affordable Care Act (ACA) contraceptive mandate among women undergoing a first trimester
surgical abortion.
Study Design
We conducted a retrospective chart review of 867 women undergoing a first trimester
surgical abortion at an academic gynecology practice between December 2010 and December
2014 (excluding August to December 2012) to evaluate intrauterine device and contraceptive
implant uptake before and after the ACA contraceptive mandate.
Results
Before the ACA contraceptive mandate, 79% of privately insured women (213 of 271)
had full LARC coverage (no out-of-pocket costs) compared with 92% (298 of 324) after
the mandate (p < .001). We found no difference in postabortal LARC uptake before and after the ACA
in women with private insurance, Medicaid, or overall. Among all women, 46% chose
a postabortal LARC method before the mandate as compared with 48% after the mandate
(p = .63). Among privately insured women, 45% used a postabortal LARC method before
the mandate as compared with 50% after the mandate (p = .25). One-half of privately insured women (268 of 534) with full or partial LARC
coverage used a postabortal LARC method compared with 32% of privately insured women
(18 of 56) with no LARC coverage after implementation of the ACA contraceptive mandate
(p = .01).
Conclusions
Despite the significant increase in full coverage of LARC among privately insured
women, there was no change in postabortal LARC use after the ACA. However, privately
insured women with full or partial LARC coverage were more likely to use a postabortal
LARC method compared with privately insured women with no LARC coverage after the
implementation of the ACA contraceptive mandate.
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Biography
Kimberly N. Bell, MD, is an obstetrics and gynecology resident at West Penn Hospital in Pittsburgh. Her areas of interest include family planning, barriers to abortion and contraception use, and government policy pertaining to abortion and contraception.
Biography
Leslie A. Meyn, PhD, is a Research Assistant Professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Pittsburgh in Pittsburgh. Her areas of research expertise include lower female genital tract infections and immune cell populations.
Biography
Beatrice A. Chen, MD, MPH, is an Associate Professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Pittsburgh in Pittsburgh. Her areas of research expertise include long-acting reversible contraception use, postpartum contraception, contraceptive development, and microbicide development.
Article info
Publication history
Published online: May 28, 2018
Accepted:
April 20,
2018
Received in revised form:
March 27,
2018
Received:
December 27,
2017
Footnotes
Conflict of interest: Dr. Chen receives research funding from Medicines360, Bayer Healthcare, and Merck, all managed through Magee-Womens Research Institute, and serves on a Merck advisory board. Dr. Bell and Dr. Meyn do not have any conflicts of interest.
Identification
Copyright
© 2018 Jacobs Institute of Women's Health. Published by Elsevier Inc.
