Using Real-World Data to Evaluate Trends in Female Elective Contraception Procedures Among Women of Childbearing Age Surrounding Key Legal and Policy Events From 2008 to 2022

Background: Recent legal and policy decisions have shaped access to, and costs of, essential reproductive healthcare in the United States.

Objectives: To leverage real-world data (RWD) to evaluate trends in elective contraception procedures in women of childbearing age enrolled in a commercial health plan during periods surrounding key legal and policy events.

Methods: We conducted a retrospective analysis of administrative medical claims from 01/01/2008-10/31/2022 for female, individuals aged 12-49 years in the Aetna research database. Elective contraceptive procedures, including intrauterine device insertions and surgical interventions (hysterectomies, tubal ligations, and ablations) were identified using CPT, ICD-9-CM, and ICD-10-CM codes. Time-stratified analyses described changes in procedure rates in matched-duration periods around political events of interest.

Results: During the study period, there was a mean monthly enrollment of 9,356,570 women of childbearing age. Elective contraception procedures decreased significantly following Affordable Care Act (ACA) enactment in March 2010, with mean monthly rates for IUD insertions decreasing 7.1% (Z=2.15, p=0.03) and surgical procedures decreasing 17.9% (Z=5.95, p< 0.01). During the 45th presidency beginning in January 2017, mean rates of IUD insertions increased 10.2% (Z=3.59, p< 0.01) and surgical procedures increased 102.7% (Z=20.31, p< 0.01). Finally, following the June 2022 overturning of Roe vs. Wade, IUD insertions and surgical procedures increased by 6.7% (Z=2.67, p=0.01) and 14.8% (Z=3.08, p< 0.01), respectively. These significant trends persisted across all events in an age-stratified analysis of adolescents (12-17 years), young adults (18-24 years), and adults (25-49 years).

Conclusions: This claims-based study identified significant trends in elective contraception procedures rates were identified across three key legal and policy events that marked shifting access to reproductive healthcare in the United States. Access to reproductive healthcare was threatened by two of these events – the 45th presidency and the overturning of Roe vs. Wade – and significant increases in female contraception procedures were seen during these periods. Contrastingly, in times of increased access to reproductive healthcare services, exemplified by ACA implementation, females opted for fewer elective contraception procedures. This RWD provides insight into how policies affect reproductive healthcare decisions made by American women, suggesting that policy-based restrictions on reproductive services lead to increased reliance on more permanent contraception measures.