Racial/Ethnic Differences in Long-Acting Reversible Contraception Use Following the Affordable Care Act’s Contraceptive Coverage Mandate

Thesis (Master's)--University of Washington, 2018Women of color in the US experience disproportionately high rates of unintended pregnancy. Increasing access to long-acting reversible contraception (LARC) (implants and IUDs) is an effective strategy for reducing unintended pregnancy. We examine the impact on LARC use by race/ethnicity of the Contraceptive Coverage Mandate, which expanded access to contraception in 2012 by requiring all new private insurance plans to cover contraceptive methods, including LARC, without cost-sharing. We compared data from the 2006-2010 and 2013-2015 National Survey of Family Growth, examining associations between race/ethnicity and LARC use in 2006-2010 and 2013-2015 using logistic regression. We examined associations between race/ethnicity and LARC use by method type using multinomial logistic regression. We qualitatively compared results from 2006-2010 and 2013-2015. LARC use increased across racial/ethnic groups over time. Non-Hispanic black women were less likely than non-Hispanic white women to use LARC prior to the mandate, OR=0.56 (95% CI 0.34-0.91), but not after. Non-Hispanic black women were less likely than non-Hispanic white women to use the IUD prior to the mandate, RRR=0.59 (95% CI 0.38-0.92). There were no significant differences in use by method type following the mandate. The mandate may have contributed to a decline in LARC use disparities. Research should examine reasons for changing patterns in LARC use over time, and for racial/ethnic differences in method choice