ACA contraception coverage increases birth control use, lowers pregnancy, abortion rates

Key takeaways:

• A provision of the Affordable Care Act that eliminated contraception cost sharing was associated with more contraceptive use.
• The change was also associated with declines in pregnancy and abortion rates.

The Affordable Care Act’s elimination of contraception cost sharing led to increased contraception use, especially for long-acting reversible methods, and lower pregnancy and abortion rates, researchers reported in Obstetrics & Gynecology.

Previous studies suggested the ACA may have lowered the rate of unintended pregnancies, according to Matthew D. Solomon, MD, PhD, FACC, a physician and adjunct investigator in the division of research at Kaiser Permanente, but the utilized methods and effect estimates have wide variation.

“Our findings underscore the critical role of accessible contraception in reducing unintended pregnancies and their social, emotional and economic impacts,” Solomon told Healio. “For clinicians, this reinforces the importance of counseling patients about effective contraceptive options, including highly effective and safe long-acting methods, which are more accessible when cost barriers are removed. Our study highlights that broad access to contraception is a key public health strategy to improve health outcomes and reduce disparities among socioeconomically disadvantaged populations. Ensuring broad access to contraception is an effective way to reduce unintended pregnancies — this is a notable public health achievement and a testament to the ACA’s impact.”

The retrospective study included 1,523,962 reproductive-aged women from a large, integrated health system who had a continuous health plan membership for at least 2 years before (2007 to 2012) and after (2013 to 2018) ACA implementation. Researchers evaluated out-of-pocket contraception costs before and after ACA’s implementation and evaluated how the elimination of out-of-pocket costs by the ACA impacted contraception use, pregnancy rates and abortion rates.

Contraception cost sharing declined from $88 to $94 before implementation of the ACA to $5 by 2018 after ACA implementation. Contraceptive use rose from 30.2% before ACA to 31.9% after ACA implementation, with a notable rise in use of long-acting reversible contraceptives.

In interrupted time-series analyses, researchers observed a drop of $67 per year in out-of-pocket costs from 2012 to 2013 (P < .0001) and continued annual decreases of $2.32 per year (P = .042). In addition, new pregnancy rates declined 5.6% and abortion rates fell 10.8% after ACA implementation.

“Even a modest increase in contraceptive use can have a significant impact on public health outcomes, including reducing unintended pregnancies,” Solomon told Healio. “Additionally, the trend from oral contraceptives to long-acting reversible contraception demonstrates that when cost barriers are eliminated, people often opt for more effective, long-term contraception solutions.”

Solomon said research should focus on understanding how socioeconomic, racial and geographic disparities influence the adoption and outcomes of contraceptive use. “Additionally, with evolving legal landscapes affecting abortion access, further studies are needed to explore how restrictions on reproductive health services impact contraception use, unintended pregnancies and broader health outcomes,” Solomon told Healio. “Evaluating long-term societal and economic effects of increased access to contraception would be valuable to inform women’s reproductive health.”

For more information:

Matthew D. Solomon, MD, PhD, FACC, can be reached at matthew.d.solomon@kp.org; X (Twitter): @MDSolomonMD.