Penn State College of Medicine, Hershey, Pennsylvania.
Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts.
Womens Health Issues. 2019 Sep-Oct;29(5):370-375. doi: 10.1016/j.whi.2019.06.004. Epub 2019 Jul 20.
The Affordable Care Act eliminated out-of-pocket costs for contraceptives, including highly effective long-acting reversible contraception (LARC), for most insured women. Patient characteristics associated with new LARC uptake after the Affordable Care Act have not been well-studied. We hypothesized that awareness of no-cost intrauterine device (IUD) coverage would be associated with new LARC use.
Data included were from 883 women not using a LARC at baseline who participated in the MyNewOptions study, a 2-year study of privately insured women in Pennsylvania. Multivariable analysis assessed whether the following baseline characteristics predicted new LARC use over 2 years: awareness of no-cost IUD coverage, future pregnancy intention, baseline contraceptive use, contraceptive attitudes, and sociodemographic characteristics.
At baseline, 54.4% of participants were using prescription methods; 21.1% nonprescription methods; 12.1% natural family planning, withdrawal, or spermicide alone; and 12.5% no method. A minority (7.2%) was aware of no-cost coverage for IUDs. Over 2 years, 7.2% of participants became new LARC users, but awareness of no-cost coverage for IUDs was not associated with new LARC use (adjusted odds ratio, 0.84; 95% confidence interval, 0.27-2.55). New LARC use was associated with already using prescription methods, not intending pregnancy within the next 5 years, prior unintended pregnancy, and desire to change method if cost were not a factor.
Among privately insured women, wanting to switch methods if cost were not a factor was associated with new LARC uptake, although awareness of no-cost IUD coverage was not. Providing women with information about their contraceptive coverage benefits may help women to seek and obtain the methods better aligned with their personal needs.
平价医疗法案取消了大多数参保女性的避孕费用，包括高效长效可逆避孕（LARC）。平价医疗法案后，新采用 LARC 的患者特征尚未得到充分研究。我们假设对免费宫内节育器（IUD）覆盖范围的认识与新采用 LARC 相关。
数据来自于参加宾夕法尼亚州私人保险女性为期 2 年的 MyNewOptions 研究的 883 名基线时未使用 LARC 的女性。多变量分析评估了以下基线特征是否预测 2 年内新采用 LARC：对免费 IUD 覆盖范围的认识、未来妊娠意向、基线避孕方法、避孕态度和社会人口学特征。
基线时，54.4%的参与者使用处方方法；21.1%使用非处方方法；12.1%单独使用自然计划生育、撤出或杀精剂；12.5%无方法。少数（7.2%）知道 IUD 免费覆盖。2 年内，7.2%的参与者成为新的 LARC 用户，但对 IUD 免费覆盖的认识与新 LARC 的使用无关（调整后的优势比，0.84；95%置信区间，0.27-2.55）。新的 LARC 使用与已经使用处方方法、未来 5 年内不打算怀孕、之前意外怀孕以及如果不考虑费用希望改变方法有关。
在私人保险女性中，如果不考虑费用因素想要更换方法与新的 LARC 采用有关，尽管对免费 IUD 覆盖范围的认识没有关系。为女性提供有关其避孕覆盖范围的信息可能有助于女性寻求和获得更符合其个人需求的方法。
