How do pregnancy intentions affect contraceptive choices when cost is not a factor? A study of privately insured women

Abstract

Objective: The objective was to test the hypothesis that among privately insured women who have contraceptive coverage without cost-sharing, using prescription contraception is predicted primarily by pregnancy intentions.

Study design: Participants are 987 women ages 18-40 who wish to avoid pregnancy for at least the next 12 months and are enrolled in Highmark Health plans in Pennsylvania. Data are from the baseline survey of MyNewOptions, an ongoing randomized controlled trial testing an intervention to help insured women make optimum contraceptive choices. Primary type of contraception used [categorized as long-acting reversible contraception (LARCs), other prescription methods, nonprescription methods or no method] is modeled using multinomial logistic regression, with predictors representing the timing and strength of pregnancy intentions, pregnancy history, pregnancy risk exposure and sociodemographics.

Results: LARCs were used by 8.4% of the sample; other prescription methods (primarily oral contraceptives), 49.6%; nonprescription methods (primarily condoms), 30.4%; and no method, 11.5%. Pregnancy intentions predicted use of LARCs and other prescription methods compared with no method. The most consistent predictors of using all categories of contraception were pregnancy risk exposure measures (partnership type and frequency of sexual intercourse).

Conclusions: In the absence of cost-sharing for contraception, women's choice of prescription contraception was a function primarily of pregnancy risk exposure rather than pregnancy intentions.

Implications: This study is among the first to examine privately insured women's contraception choices in the context of contraceptive coverage without cost-sharing; it shows that use of prescription contraception is predicted by pregnancy risk exposure and pregnancy intentions.

Trial registration: ClinicalTrials.gov NCT02100124.

Keywords: Contraception; Health care reform; LARCs; Pregnancy intentions.