Rates of long-acting reversible contraceptive (LARC) insertion increased following the 2016 election of President Trump, a retrospective study of commercially insured women found.
After adjusting for a variety of confounders, there was about a 22% increase in LARC insertions during the 30 days after the 2016 election, reported Lydia Pace, MD, MPH, of Brigham and Women’s Hospital in Boston, and colleagues in JAMA Internal Medicine.
“These findings suggest women’s contraceptive choices are influenced by the political climate,” Pace told MedPage Today. “They suggest women do value having access to long-acting reversible contraceptive methods and that when they fear that access may be compromised, they respond accordingly.”
Indeed, a study using athenahealth data found a nearly 19% increase in doctor’s visits related to intrauterine devices (IUDs) following the 2016 election, while a survey conducted through social media networks found that 42% of women were concerned about future access to contraception after the election.
Eve Espey, MD, of the University of New Mexico in Albuquerque, who was not involved with this study, said that despite this seasonally increasing trend, the results of the paper by Pace and colleagues still suggest that women’s contraceptive use was influenced by the contraceptive mandate under the Trump administration.
She noted that although politicians can cause short-term effects in contraceptive use trends, there is a constellation of factors that influence whether women use this form of contraception, particularly insurance coverage.
“We have heard much more fear and anxiety from patients that the current climate is much more hostile to reproductive health in general and to the contraceptive mandate under the Trump administration,” Espey told MedPage Today.
In this study, Pace and colleagues examined data from women ages 18 to 45 in the IBM/Truven MarketScan Analytics Commercial Claims and Encounters Database. Participants were required to have ≥12 months of continuous enrollment in commercial insurance during the 30 business days before and after November 8, 2015 or November 8, 2016, respectively.
Researchers compared the change in probability of LARC insertion during the 30 business days before and after November 8, 2016, and compared this difference with the change observed across the same period in 2015. They then compared the difference in daily rates before and after the election in order to account for secular trends, as well. The data was adjusted for age, region, and relationship to the insured individual.
“Doing the analysis this way allowed us to be more certain the change we observed was in fact attributable to the election as opposed to seasonal fluctuations or the background use of long-acting reversible contraceptive insertions in general,” Pace said.
In total, 3,449,455 women were included in the 2015 sample and 3,253,703 women in the 2016 sample; both groups had an average age of about 32. Around 40% in each group were ages 36 to 45, and around 40% of both groups were from the South.
Overall, the mean adjusted daily LARC insertion rate was 12.9 women per 100,000 during the 30 days before and inclusive of November 8, 2015 compared to 13.7 per 100,000 in the 30 days afterward. Comparable 2016 rates were 13.4 per 100,000 before the 2016 election and 16.3 per 100,000 after. They found the adjusted difference-in-difference rate was 2.1 insertions per 100,000 women per day (P<0.001).
Researchers noted that if projected out to U.S. women ages 18 to 45 with commercial insurance in 2016, these findings “would correspond to approximately 700 additional insertions per day in association with the 2016 election.”
This study was limited due to the lack of patient data on race/ethnicity, the lack of updated 2017 data, and the fact researchers only studied a short period after the election. In addition, only women with commercial insurance were included, so the results might not be generalizable to those with Medicaid or no insurance, the authors said.
Pace received funding from the Women’s Health Policy and Advocacy Program and the Brigham and Women’s Hospital 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.
She and one co-author have written expert testimony about legislation in Massachusetts on contraceptive coverage, but received no compensation.
Source: MedicalNewsToday.com
