Birth-Control Boom

Not long after Donald Trump was elected president, descriptive reports began rolling in: Demand for long-acting, reversible contraception (LARCs) such as intrauterine devices (IUDs) and implants seemed to be on the rise. But was this trend based on a real shift in women’s use of LARCs, due to normal fluctuations in interest in IUDs and implants, or due to other factors?

A new, robust study conducted by Harvard Medical School investigators at Brigham and Women’s Hospital quantifies the increase, finding that rates went up by 21.6 percent in the 30 days after the election compared to rates at the same time of year in 2015. These results are published in JAMA Internal Medicine.

“LARC methods are by far the most effective form of reversible birth control available. We have seen that when LARC is made more available to women, the rates of unintended pregnancies go down,” said corresponding author Lydia Pace, HMS assistant professor of medicine in the Divisions of Women’s Health and General Internal Medicine and director of the Women’s Health Policy and Advocacy Program for the Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s.

“Our study tells us something important about women’s health preferences in a changing political climate. Women responded to this political event by seeking out this method of contraception, perhaps because the threat of losing access expedited a decision or encouraged them to seek out a method they hadn’t previously considered.”

Pace and colleagues used the IBM/Truven MarketScan Analytics Commercial Claims and Encounters Database to study more than 3 million women aged 18 to 45 with commercial insurance. The team compared rates of LARC insertions in this population for the 30 business days before and after Nov. 8, 2015, with that same timespan before and after Election Day on Nov. 8, 2016.

The team found that the rates in 2015 changed little before and after Nov. 8, with an average of 12.9 per 100,000 women per day receiving LARC insertion before and 13.7 per 100,000 women per day receiving LARC insertion after that date.

In 2016, however, the daily rate changed from 13.4 per 100,000 women before the election to 16.3 per 100,000 women after—a 21.6 percent increase. Compared to the change noted before and after Nov. 8, 2015, there were about 2.1 additional insertions per 100,00 women per day after the 2016 election.

“If our findings were projected to the approximately 33 million women in the U.S. in this age range with employer-sponsored health insurance, this would correspond to 700 additional insertions per day in association with the 2016 election,” said Pace. “The changes in rate that we report here could reflect women’s concerns about losing contraceptive coverage under the Trump administration.”

Pace is also the author of a recent opinion piece in Women’s Health Issues on the administration’s proposed legislation on contraception.

Nancy Keating, professor of health care policy in the HMS Blavatnik Institute and HMS professor of medicine and a physician at Brigham and Women’s also contributed to the study.

Pace received funding from the Women’s Health Policy and Advocacy Program in the Connors Center for Women’s Health and Gender Biology and reported a public comment on proposed federal regulations about reproductive health care and participation in a legal brief in support of Massachusetts’ efforts to preserve mandated contraceptive coverage.

Pace and co-author Mara Murray Horwitz, research fellow in population medicine in the HMS Blavatnik Institute, reported providing written expert testimony about legislation in Massachusetts on contraceptive coverage but received no compensation for this.

Source: HMS