A new study finds no change in levels of contraceptive use or in consistency of use among U.S. women at risk of unintended pregnancy between 2012 and 2015, a period that straddles the implementation of the Affordable Care Act (ACA). According to "Did Contraceptive Use Patterns Change After the Affordable Care Act? A Descriptive Analysis," by Guttmacher researchers Jonathan Bearak and Rachel Jones, national surveys conducted in fall 2012 and spring 2015 each showed that 59% of sexually active women used a prescription contraceptive method, 20–22% used condoms and 6% used no method. There was no significant change in use of long-acting reversible contraceptive (LARC) methods or in consistency of contraceptive use during this period.

"We did not find evidence that U.S. women’s contraceptive method mix changed in the period following the implementation of the Affordable Care Act," says Rachel Jones, coauthor of the analysis. "However, other studies have found that the proportion of women with insurance coverage increased under the ACA. It may take more time before the insurance coverage increase is reflected in contraceptive use patterns."

The authors note that 80% of prescription contraceptive users who were not required to pay a copayment reported that having insurance coverage without cost sharing helped them afford and use their contraceptive method. This finding suggests that increased insurance coverage of contraception under the ACA may have made it easier for women to obtain birth control, even while the mix of methods women used remained steady. Indeed, other research related to the ACA has found significant increases in the proportion of reproductive-age women who had insurance coverage and who were able to access contraceptive methods without cost sharing—including LARC methods, which tend to have high upfront costs.  

The lack of observable change in contraceptive use patterns may be surprising, given the many medical and advocacy groups hypothesizing that increased insurance coverage without cost sharing under the ACA would result in increased and improved contraceptive use. However, the authors note that cost is only one of many barriers to contraceptive access, and they highlight the need for research to identify other financial and nonfinancial barriers. Moreover, prior to ACA implementation, many women were already able to access prescription contraceptives with no cost sharing through publicly funded family planning services, including Medicaid coverage and Title X–funded family planning centers. It is possible that these preexisting safety-net services may have dampened the ACA’s potential impact on contraceptive use patterns.

One interesting and unexpected finding from the surveys pertained to young women aged 18–24 who had not had sex in the past month. The study found that pill use among these women nearly doubled between 2012 and 2015, increasing from 21% to 40%. While the majority reported using the pill to prevent pregnancy, many also cited other reasons, such as reduction of menstrual pain, help with acne and period regulation. The authors speculate that reduced costs related to the ACA’s contraceptive coverage guarantee may have facilitated consistent method use among young women who otherwise might have discontinued pill use to save money during times of sexual inactivity.

"This study provides mixed evidence about the impact of the Affordable Care Act on women’s ability to access affordable contraceptive care," says Adam Sonfield, Guttmacher senior policy manager. "Yet taken together, the larger body of evidence around the ACA and the U.S. family planning safety net document their importance for people’s health and well-being. Conservatives’ attempts to undermine this safety net—by attacking the ACA, Medicaid, the Title X national family planning program or safety-net family planning providers themselves—would inevitably cause harm to women and their families and would be unsound public health policy."