The Affordable Care Act contraception mandate & unintended pregnancy in women of reproductive age: An analysis of the National Survey of Family Growth, 2008-2010 v. 2013-2015.

OBJECTIVE(S): The Affordable Care Act contraception mandate could reduce unintended pregnancies by increasing access and affordability of contraceptive resources, e.g., long-acting reversible contraceptives (LARCs). We assessed: (1) whether unintended pregnancies decreased post-mandate, and (2) whether this decrease differed by demographic characteristics.

STUDY DESIGN

We used data from the National Survey of Family Growth (unweighted n = 7409) in logistic regression analyses to compare odds of unintended pregnancy pre-mandate (2008-2010) vs post-mandate (2013-2015), overall and stratified by demographic characteristics.

RESULTS

Paralleling an increase in long-acting reversible contraceptive use (p < 0.01), post-mandate, the odds of experiencing unintended pregnancy in the prior year decreased 15% overall (OR: 0.85, 95% CI: 0.62, 1.17), with the greatest reduction observed among women with government-sponsored insurance (OR: 0.63, 95% CI: 0.41, 0.97).

CONCLUSIONS

Unintended pregnancy decreased following the contraception mandate, although possibly due to chance. The short study period relative to the mandate could under-estimate the mandate's effect.