Primary Submission Category: Reproductive health
Exploring insurance as a key predictor of contraception choice
Authors: Monika Nayak Elizabeth Ranson
Presenting Author: Monika Nayak*
Preventing unintended pregnancy is both essential to individual health and self-determination and increasingly salient in national policy discourse. Though the Affordable Care Act improved coverage of contraceptive services, inequities persist in insurance coverage, provider counseling, and use.
This study uniquely uses the most recent 2017-2019 National Survey of Family Growth (NSFG) to disentangle the relationships between insurance coverage and contraceptive use across the life course among those concerned with preventing pregnancy. We used multivariate multinomial logistic regression and related sensitivity analyses to understand population-wide determinants of prescribed and non-prescribed contraceptive use.
After holding influential demographics constant, we found robust evidence that insurance status and type are associated with differential contraceptive use at the population level. Insured respondents used scheduled methods, such as birth control pills, and long-acting reversible contraception (LARC), such as intrauterine devices, more often (64.4%) compared to uninsured (51.9%). Privately insured respondents used scheduled methods at higher rates (31.9%) than uninsured or Medicaid recipients (18.6% and 18%, respectively). However, Medicaid recipients used LARCs at higher rates (23.5%) than privately insured respondents (19%). While significantly more white respondents used prescribed methods overall, Black respondents reported higher LARC usage than their white counterparts or those of other racial identities. We also found disparate usage across additional demographics (age, religion, religiosity, race, Hispanic ethnicity, relationship status, and income).
Given increasing restrictions on reproductive health in the U.S., addressing inequities in contraception access is of immediate concern. And, while contraception choice is influenced by individual identities and values, insurance is one variable more amenable to policy change at the population level.