Abstract
Purpose
The purpose of the study was to assess uptake of postabortion contraception across
changes in insurance regulations and insurance type used on the day of abortion, accounting
for demographic characteristics and consent type (parental vs. judicial) for abortion
among Massachusetts adolescents.
Methods
We conducted a retrospective record review of 1,375 minors (≤17 years) presenting
for their first lifetime surgical abortion at a statewide network of abortion clinics
between 2010 and 2016. Postabortion contraceptive method was defined as long-acting
reversible contraception (LARC) placed onsite, short-acting reversible contraception
(SARC) provided onsite, or no method received.
Results
The proportion of minors leaving with no method dropped from 38% in 2010 to 21% in
2016, while LARC placement increased from 19% to 45%. No difference was observed by
consent type. Both LARC and SARC were more prevalent among minors with Medicaid or
private insurance compared to those not using insurance on the day of abortion. In
a multinomial regression model accounting for consent type and demographic characteristics,
minors who received care during the final epoch of the study (relative risk ratio
[RRR] = 3.30; 95% confidence interval [CI]: 2.23–4.88) or used private insurance (RRR =
3.91; 95% CI: 2.24–6.84) or Medicaid (RRR = 5.54; 95% CI: 3.37–9.11) on the day of
service had significantly higher relative risk of receiving LARC versus no method
(p < .001), with similar results for LARC versus SARC.
Conclusions
Postabortion contraceptive uptake changed over time. Disparately low LARC uptake among
minors not using insurance to pay for their abortions highlights a need to ensure
equitable access to all methods, regardless of ability to pay.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Adolescent HealthAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Patients’ attitudes and experiences related to receiving contraception during abortion care.Contraception. 2011; 84: 585-593
- Contraceptive method use in the United States: Trends and characteristics between 2008, 2012, and 2014.Contraception. 2018; 97: 14-21
- Comparison of contraceptive method chosen by women with and without a recent history of induced abortion.Contraception. 2011; 84: 571-577
- Postabortion contraceptive use and continuation when long-acting reversible contraception is free.Obstet Gynecol. 2017; 129: 655-662
- Finding policies and postabortion long-acting reversible contraception: Results from a cluster randomized trial.Am J Obstet Gynecol. 2016; 214: 716e1-716e8
- Attitudes toward long-acting reversible contraception among young women seeking abortion.J Womens Health (Larchmt). 2011; 20: 1729-1735
- Contraception for adolescents.Pediatrics. 2014; 134: e1257-e1281
- Clinical preventive services for women: Closing the gaps.National Academy of Sciences, Washington, DC2011
- Changes in out-of-pocket costs for hormonal IUDs after implementation of the Affordable care Act: An analysis of insurance benefit inquiries.Contraception. 2016; 93: 139-144
- Impact of the federal contraceptive coverage guarantee on out-of-pocket payments for contraceptives: 2014 update.Contraception. 2015; 91: 44-48
- Early impact of the Affordable Care Act on uptake of long-acting reversible contraceptive methods.Med Care. 2016; 54: 811-817
- Are women benefiting from the Affordable care Act? A real-world evaluation of the impact of the Affordable care Act on out-of-pocket costs for contraceptives.Contraception. 2016; 93: 392-397
- The impact of the Affordable Care Act on contraceptive use and costs among privately insured women.Women’s Health Issues. 2018; 28: 219-223
- Immediate postabortal insertion of intrauterine devices.Cochrane Database Syst Rev. 2014; 2014: CD001777
Bellotti v. Baird, 443U.S. 622 (1979).
- [Internet.] Minors’ access to contraceptive services (as of February 1st, 2019).(Available at:)https://www.guttmacher.org/state-policy/explore/minors-access-contraceptive-servicesDate accessed: February 14, 2019
- [Internet.] Medicaid coverage of family planning benefits: Results from a state survey.Kaiser Family Foundation, 2016 (Available at:)
- [Internet.] MDPH-funded family planning programs.(Available at:)https://www.mass.gov/info-details/mdph-funded-family-planning-programsDate accessed: April 30, 2020
- Research electronic data capture (REDCap) – a metadata driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381
- 2013 NCHS urban-Rural Classification Scheme for Counties.Vital Health Stat 2. 2014; 166: 1-73
- Test for trend with a multinomial outcome.Am Stat. 2018; 73: 313-320
- Abortion Tables, 2011.Massachusetts Department of Public Health, Boston, MA2012
- Abortion Tables, 2016.Massachusetts Department of Public Health, Boston, MA2017
- Population group abortion rates and lifetime incidence of abortion: United States 2008-2014.Am J Public Health. 2017; 107: 1904-1909
- Affordable Care Act’s mandate eliminating contraceptive cost sharing influenced choices of women with employer coverage.Health Aff. 2016; 35: 1608-1615
- Cost effectiveness of contraceptives in the United States.Contraception. 2009; 79: 5-14
- Massachusetts’ parental consent law and procedural timing among adolescents undergoing abortion.Obstet Gynecol. 2019; 133: 978-986
- [Internet.]Interactive: How state policies shape access to abortion coverage.(Updated January 17th, 2019. Available at:)https://kff.org/interactive/abortion-coverage/Date accessed: February 14, 2019
- Health reform: Learning from Massachusetts.Inquiry. 2012; 49: 300-302
- Recommendations for intrauterine contraception: A randomized trial of the effects of patients’ race/ethnicity and socioeconomic status.Am J Obstet Gynecol. 2010; 203: E1-E19
- Immediate postabortion access to IUDs, implants, and DMPA reduces repeat pregnancy within 1 year in a New York City practice.Contraception. 2014; 89: 103-108
Article info
Publication history
Published online: July 31, 2020
Accepted:
May 22,
2020
Received:
January 21,
2020
Footnotes
Conflicts of interest: None of the authors have any conflict of interest to disclose.
Disclaimer: The viewpoints expressed are those of the authors and do not necessarily reflect the opinions of the SFPRF or of the Planned Parenthood Federation of America.
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine.
