Downey Amanda K, Hanna Steven E, Levine Mitchell A, Schummers Laura, Guindon G Emmanuel
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
St Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada.
JAMA Pediatr. 2025 Aug 18. doi: 10.1001/jamapediatrics.2025.2585.
Previous studies have suggested that removing financial barriers to contraception could help reduce unintended pregnancy.
To assess whether introduction of universal public funding for prescription contraception in Ontario (OHIP+) for individuals younger than 25 years and the amended program, which limited public funding to those without private insurance (OHIP-), is associated with changes in contraceptive dispensations.
DESIGN, SETTING, AND PARTICIPANTS: Interrupted time-series analyses were used to evaluate whether implementation of either policy was associated with changes in monthly contraceptives dispensed. The setting included a national database on contraceptives dispensed from retail pharmacies between September 2016 and February 2020; data analysis was performed from May 2022 to 2024. Participants included Ontario females aged 15 to 24 years to whom prescriptions were dispensed (intervention) vs controls: (1) Canadian females aged 15 to 24 years, excluding Ontario, and (2) Ontario females aged 25 to 49 years.
Implementation of free prescription contraception through OHIP+ (January 2018-March 2019) and OHIP- (April 2019-February 2020).
Monthly dispensations of intrauterine devices (IUDs) and oral contraceptive pills (OCPs) per 1000 females overall and by area-level socioeconomic status (SES).
After OHIP+, there was an immediate level increase in IUDs dispensed to Ontario females aged 15 to 24 years (intervention) of 0.50 (95% CI, 0.15-0.84) vs 0.03 (95% CI, -0.26 to 0.32) in Canadian females aged 15 to 24 years-a relative increase of 0.48 (95% CI, 0.02-0.91). There was an immediate level increase in OCPs dispensed to Ontario females aged 15 to 24 years of 22.3 (95% CI, 14.8-29.8) vs 7.57 (95% CI, 3.07-12.1) in those aged 25 to 49 years-a relative increase of 14.8 (95% CI, 6.15-23.4). There were no statistically significant changes in monthly dispensation trends after OHIP+ and no statistically significant changes after OHIP-. In areas with lower SES, there was a significant increase in the level for IUDs of 0.64 (95% CI, 0.02-1.26) and for OCPs of 13.2 (95% CI, 1.33-25.0) after OHIP+, and a significant decrease in the level for IUDs of 0.82 (95% CI, -1.55 to -0.09) after OHIP- in Ontario vs Canadian females aged 15 to 24 years. No statistically significant changes in IUD or OCP dispensations were observed in areas with higher SES vs controls.
Results reveal that providing comprehensive and confidential access to prescription contraceptives was associated with increased dispensations among Ontario youth.
先前的研究表明，消除避孕的经济障碍有助于减少意外怀孕。
评估安大略省为25岁以下个人引入免费处方避孕公共资金（OHIP+）以及修订后的项目（该项目将公共资金限制在没有私人保险的人身上，即OHIP-）是否与避孕药具发放量的变化有关。
设计、背景和参与者：采用中断时间序列分析来评估这两项政策的实施是否与每月发放的避孕药具数量变化有关。背景包括一个2016年9月至2020年2月期间零售药店避孕药具发放情况的全国数据库；数据分析于2022年5月至2024年进行。参与者包括15至24岁获得处方的安大略省女性（干预组）与对照组：（1）15至24岁的加拿大女性（不包括安大略省），以及（2）25至49岁的安大略省女性。
通过OHIP+（2018年1月至2019年3月）和OHIP-（2019年4月至2020年2月）实施免费处方避孕。
每1000名女性每月宫内节育器（IUD）和口服避孕药（OCP）的发放量，以及按地区社会经济地位（SES）划分的发放量。
在OHIP+实施后，15至24岁安大略省女性（干预组）IUD的发放量立即出现水平上升，为0.50（95%CI，0.15 - 0.84），而15至24岁加拿大女性为0.03（95%CI，-0.26至0.32）——相对增加0.48（95%CI，0.02 - 0.91）。15至24岁安大略省女性OCP的发放量立即出现水平上升，为22.3（95%CI，14.8 - 29.8），而25至49岁女性为7.57（95%CI，3.07 - 12.1）——相对增加14.8（95%CI，6.15 - 23.4）。OHIP+实施后每月发放趋势无统计学显著变化，OHIP-实施后也无统计学显著变化。在社会经济地位较低的地区，OHIP+实施后IUD发放量显著增加0.64（95%CI，0.02 - 1.26），OCP发放量显著增加13.2（95%CI，1.33 - 25.0）；与15至24岁的加拿大女性相比，安大略省OHIP-实施后IUD发放量显著减少0.82（95%CI，-1.55至-0.0）。在社会经济地位较高的地区，与对照组相比，IUD或OCP发放量未观察到统计学显著变化。
结果表明，提供全面且保密的处方避孕药具获取途径与安大略省青少年中发放量增加有关。
