Impact of perceived contraceptive policy changes on long acting reversible contraception dispensing trends

Abstract

Objective

We observed the long-term trend of Long Acting Reversible Contraception (LARC) usage before and after the 2016 presidential election.

Methods

We observed the rate of LARC dispensed at a university student health centre in the 18 months preceding and 27 months following the 2016 U.S. presidential election which posed threat to contraception access. We applied a segmented regression model using two linear regression line segments to evaluate whether there is a time point where the trend of LARC dispensing changed. We fit the regression models with a breakpoint at month 0 (election month) and 3 months with a Locally Estimated Scatterplot Smoothing (LOESS) estimate with parameters obtained by estimating simple linear regression models separately below and above the breakpoint ‘0’.

Results

There were a total of 2067 LARC methods dispensed from May 2015 to February 2019. The average number of LARC methods dispensed before November 2016 was 38/month and increased to 51/month post-presidential election. The LARC dispense rate significantly increased each month (0.38, 1.74; 95% confidence level, p < 0.05) until a breakpoint at 6 months (standard error 4.11) post-election followed by slower decrease (–0.59/month, 95% confidence level: −1.37, 0.20; p=not significant).

Conclusion

Our study is the first to report long-term trends (27 months post-election) in LARC uptake amidst the public discourse that suggested the end of a policy that provided LARC insurance coverage. Although this observational study cannot suggest causality, the findings could reflect actions taken to prevent unintended pregnancy in response to the event of uncertain national policy.

摘要

目的:观察2016年总统大选前后长效可逆避孕药(LARC)的长期使用趋势。

方法:我们观察了2016年美国总统大选之前的18个月和之后的27个月, LARC在一所大学学生健康中心分发药物的比率, 这对获得避孕药具构成了威胁。我们使用两个线性回归线段来应用分段回归模型, 评估是否存在LARC配药趋势改变的时间点。我们用断点0月(选举月)和3月的局部加权回归(LOSS)估计拟合回归模型, 参数分别在断点“0”下方和上方估计简单线性回归模型获得。

结果:2015年5月至2019年2月共发放2067次LARC。2016年11月之前分发的LARC的平均数量为38个/月, 在总统选举后增加到51个/月。LARC分发率每月显著增加(0.38, 1.74；95%置信水平, p<0.05), 直到选举后6个月出现断点(标准误4.11), 随后缓慢下降(–0.59/月, 95%置信水平:-1.37, 0.20;p值不显著)。

结论:我们的研究首次报告了LARC的使用在公众讨论中的长期趋势(选举后27个月), 这些公众讨论暗示了提供LARC保险的政策的终结。虽然这项观察性研究不能表明因果关系, 但研究结果可以反映出在国家政策不确定的情况下, 为防止意外怀孕而采取的措施。

Keywords:

• IUD
• implant
• contraception
• policy

Disclosure statement

No potential conflict of interest was reported by the author(s).