Department of Economics, University of Maryland, College Park, Maryland, United States of America.
Department of Health Policy and Management, University of Maryland, College Park, Maryland, United States of America.
PLoS One. 2023 Jan 23;18(1):e0280588. doi: 10.1371/journal.pone.0280588. eCollection 2023.
Many states are implementing comprehensive programs aimed at reducing persistent barriers to contraceptive care. Evidence on the effectiveness of these programs is essential for practice improvement and policy development.
To evaluate changes in the probability of initiating a contraceptive method by women with employer sponsored insurance after implementation of Delaware Contraceptive Access Now (DelCAN), a statewide initiative that aimed to increase access to long-acting reversible contraceptives (LARCs).
DESIGN, SETTING, AND PARTICIPANTS: We used a difference-in-differences design to examine contraceptive initiation rates. Data came from IBM Marketscan and covered women age 15-44 enrolled in employer sponsored insurance. The primary outcome was insertion of a LARC, both in the overall study population and in the immediate postpartum (IPP) setting. Secondary analysis examined changes to other contraceptive method types.
The cohort of 4,550,459 enrollees generated a sample of 11,888,837 person-years and 615,670 childbirth hospitalizations. Difference-in-differences estimates suggested that DelCAN was associated with a 0.3 percentage point (95% CI [0.2, 0.5], p<0.001) increase in the LARC insertion rate in the overall study population and a 0.4 percentage point increase (95% CI [0.2, 0.6], p<0.001) in the percent of births adopting IPP LARC. Associations between DelCAN and LARC insertion appeared stronger for adolescents compared to older women. Results for other method types were less consistent.
A comprehensive statewide program was associated with increased LARC insertion rates among enrollees with employer sponsored insurance. Understanding the effect of these programs is critical for on-going policy development for states engaged in contraceptive access reform.
许多州正在实施旨在减少避孕护理持续障碍的综合计划。这些计划的有效性证据对于实践改进和政策制定至关重要。
评估在实施特拉华州避孕准入计划（DelCAN）后，参加雇主赞助保险的女性开始使用避孕方法的概率的变化，该计划旨在增加长效可逆避孕（LARC）的获取途径。
设计、地点和参与者：我们使用差异法评估了避孕起始率。数据来自 IBM Marketscan，涵盖了参加雇主赞助保险的年龄在 15-44 岁的女性。主要结果是 LARC 的插入，包括在整个研究人群中和产后即刻（IPP）设置中。二级分析研究了其他避孕方法类型的变化。
4550459 名参保人员的队列产生了 11888837 人年和 615670 例分娩住院的样本。差异法估计表明，DelCAN 与总体研究人群中 LARC 插入率增加了 0.3 个百分点（95%CI[0.2,0.5]，p<0.001），IPP 中采用 LARC 的分娩比例增加了 0.4 个百分点（95%CI[0.2,0.6]，p<0.001）。与 DelCAN 与 LARC 插入之间的关联对于青少年而言，与老年女性相比似乎更强。其他方法类型的结果不太一致。
全面的全州计划与参加雇主赞助保险的参保者中 LARC 插入率的增加有关。了解这些计划的效果对于正在进行避孕获取改革的州的持续政策制定至关重要。
