Photo Credit: Nadzeya Haroshka

The following is a summary of “Effects of the Affordable Care Act on Contraception, Pregnancy, and Pregnancy Termination Rates,” published in the November 2024 issue of Obstetrics and Gynecology by Solomon et al.    

The Affordable Care Act (ACA) removed cost-sharing for contraception, potentially affecting contraception use, pregnancy, and abortion rates within a large healthcare system.  

Researchers conducted a retrospective study to assess how the ACA’s elimination of contraception cost-sharing impacted contraception use, pregnancy rates, and abortion rates.  

They analyzed data from women aged 18-45 who had continuous membership in a health plan across a healthcare system with over 4.5 million members, spanning the pre-ACA (2007-2012) and post-ACA (2013-2018) periods. Out-of-pocket (OOP) contraception costs, including oral contraceptives and long-acting reversible contraception (LARC), were compared before and after ACA implementation to examine the effect on contraception use, pregnancy rates, and abortion rates.  

The results showed that for 1,523,962 women of childbearing age, contraception cost-sharing significantly dropped in 2013, with average OOP costs decreasing from $88-$94 pre-ACA to nearly zero post-ACA. Overall, contraceptive use rose from 30.2% pre-ACA to 31.9% post-ACA, with a notable increase in LARC use. Interrupted time-series analyses indicated that while contraception use continued to rise post-ACA, pregnancy rates declined at a faster rate than pre-ACA, and abortion rates decreased at a slower pace than pre-ACA (P<0.05 for all trends).  

They concluded that eliminating contraception cost-sharing under the ACA increased contraceptive use and contributed to declines in pregnancy and abortion rates.  

Source: journals.lww.com/greenjournal/abstract/9900/effects_of_the_affordable_care_act_on.1177.aspx