Following the 2016 presidential election, the number of American women opting for long-acting reversible contraceptive (LARC) methods, such as intrauterine devices (IUD) or implanted devices, increased by more than 20 percent, according to a new Harvard study.
Writing in JAMA Internal Medicine, the researchers cite the reason being fears over changes regarding contraceptive access should the Trump Administration repeal the Patient Protection and Affordable Care Act (ACA).
“Our findings could reflect a response to fears of losing contraceptive coverage because of President Trump's opposition to the ACA or an association of the 2016 election with reproductive intentions or LARC awareness,” wrote the authors, adding that concerns about future potential reductions in access might affect women’s contraceptive choices.
In order to control for seasonal and secular trends, researchers analyzed data from IBM MarketScan, a database of more than 250 million patient records, specifically looking at women aged 18 to 45 who were enrolled in commercial insurance for at least one year of continuous enrollment. They then compared LARC insertion rates in the 30 days following the election with the 30 days before, as well as the year previously.
Insertion rates increased by 21.6 percent in 2016, resulting in about 2.1 additional insertions per 100,000 women each day.
“If our findings were projected to the approximately 33 million women in the United States aged 18 to 45 years in 2016 with employer-sponsored health insurance, this rate would correspond to approximately 700 additional insertions per day in association with the 2016 election, above the approximately 4,716 insertions per day that would have been otherwise predicted,” wrote the authors.
LARC methods are highly effective at preventing pregnancy for around 3 to 12 years, depending on the device. In 2012, ACA eliminated cost-sharing for contraception for most women with private health insurance, decreasing out-of-pocket costs for IUDs from $40 to $0. When they did so, they saw a corresponding increase in LARC use. During his presidential campaign, Trump made promises to repeal Obamacare (though the efforts have since been stalled). A 2017 anonymous social media survey found similar results, noting that almost half of respondents had “concerns about future access to contraception following the election.”
The authors note that they only studied a short period after the election and only women with commercial insurance, so the results may not accurately reflect women with public insurance or those without any. As such, they could not determine whether the increase in insertions was sustained or “evaluate its public health significance.” They note that a repeat analysis for the following year would help remedy that.
Currently, the Health Insurance Marketplace is required to cover contraceptive methods and counseling for all women without charging a copayment or coinsurance when provided by an in-network provider – even if the deductible hasn’t been met. Those methods include implanted devices, emergency contraception, and hormonal methods, among others. It’s important to note that plans are not required to cover drugs to induce abortions.