Contraceptive Method Use and Insurance Status among U.S. Women aged 15-49 years

Purpose: Healthy People 2030 set a goal to reduce unintended pregnancies to 36.5%, from the current baseline of 43%. Different methods of contraception have varying efficacy and effectiveness for pregnancy prevention. Insurance coverage is a key determinant for contraception access. This study aimed to investigate disparities in contraceptive method choice based on insurance status.

Methods: This was a cross-sectional study of a nationally representative sample of women aged 15-49, using the 2017-2019 National Survey of Family Growth. Women not desiring pregnancy reported their insurance status and current method of contraception. Insurance status was operationalized as Private Insurance/Medi-Gap, Medicaid/CHIP, Medicare/other Government Insurance Plan, and Single-Service Plan. The outcome variable, current method of contraception, was operationalized into four categories: most effective methods (intrauterine devices (IUD), hormonal implant), moderately effective methods (pills, patch, ring, injectable), least effective methods (condoms, diaphragm, withdrawal, natural family planning, etc.)#_msocom_1, and no method of contraception. The association between insurance status and contraceptive method was assessed using multinomial logistic regression.

Results: Among the participants, reported insurance statuses were private insurance/medi-gap (56.38%), Medicaid/CHIP/State sponsored (25.16%), Medicare/Military/Other government insurance (4.77%), and Single Service Plan/Indian Health Service/Uninsured (13.69%). For current contraception method, the women self-reported using most effective methods (27.20%), moderately effective methods (27.98%), least effective methods (30.76%), and no method (14.02%). Women insured through a single service plan, the Indian Health Service, or uninsured had lower odds of using most effective methods than no method of contraception (OR=0.32, 95%CI=0.13, 0.77), and lower odds of using the moderately effective methods (OR=0.21, 95%CI=0.07, 0.58), versus no method of contraception, compared to women with private insurance. Additionally, women with Medicaid/CHIP/state-sponsored health plan have lower odds of using the moderately effective methods (OR = 0.382, 95%CI=0.18, 0.84) versus no method of contraception, compared to women with private insurance.

Conclusion: There were differences in contraceptive method choice based on insurance status. As all insurance plans are mandated to cover all FDA-approved methods of contraception, our study findings highlight the need to investigate further gaps in access, education, and freedom of choice. Future research should examine the causes underlying our findings and seek to identify potential strategies related to insurance status to improve access and reduce the risk of unintended pregnancy.