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The Affordable Care Act's (ACA) elimination of out-of-pocket costs for birth control was tied to fewer births in all income groups, but especially among poorer women, the new research found. In fact, the lowest income group had a 22% decline in births after the law was passed.
"Our findings suggest that expanded coverage of prescription contraception may be associated with a reduction in income-related disparities in unintended pregnancy rates," said lead author Dr. Vanessa Dalton. She's an obstetrician-gynecologist at Michigan Medicine Von Voigtlander Women's Hospital, in Ann Arbor.
"Reducing unintended pregnancies improves the health of women, families and society," Dalton said in a Michigan Medicine–University of Michigan news release.
For the study, the researchers examined birth rates among 4.6 million women aged 15 to 45 who had employer-sponsored health plans between 2008 and 2013, before the ACA eliminated cost-sharing for contraceptives. It compared those rates to the time period between 2014 and 2018, after the ACA (also known as Obamacare) was passed.
The investigators found lower birth rates, as well as a decrease in women not filling their birth control prescriptions.
The ACA included contraception as a preventive service that most employer-sponsored insurance plans were required to provide. This gave women access to birth control, including long-acting forms of birth control such as intrauterine devices, with no co-pays or deductible payments.
"Contraception is a clinically efficient and cost-effective strategy for reducing unintended pregnancy and helping individuals meet their reproductive life goals," Dalton said. "Mistimed births have serious, long-term, life opportunity consequences for women and children."
Nearly half of all pregnancies in the United States are unplanned, and there's a significant gap between the richest women who likely have access to the most reliable forms of birth control and poorer women, according to background notes with the study.
Costs to society include $5 billion per year for the U.S. health care system, as well as delayed prenatal care, reduced likelihood of breastfeeding, maternal depression, and higher maternal and infant death rates.
The study authors noted that recent court decisions could roll back access for some U.S. women. These include the 2020 Supreme Court decision upholding rules that expand exceptions to the contraceptive insurance requirement.
"Removing cost-related barriers for birth control may not eliminate unintended pregnancies, but it's a critical part of the strategy to address this important public health concern in the U.S.," Dalton said.
The report was published online Nov. 6 in JAMA Network Open.
Healthcare.gov offers more information on the Affordable Care Act.
SOURCE: Michigan Medicine, University of Michigan, news release, Nov. 6, 2020
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