Affordable Care Act Linked to Higher Contraceptive Use and Lower Pregnancy Rates

The Affordable Care Act (ACA) removed cost-sharing for contraceptive methods, aiming to improve access and reduce unintended pregnancies. Its impact on contraception use, pregnancy, and abortion rates has been evaluated in a retrospective cohort study.

The study included 1,523,962 women aged 18 - 45 years, and investigators compared out-of-pocket (OOP) contraceptive costs, utilization patterns, and subsequent pregnancy and abortion rates before and after ACA implementation.

Annual OOP costs for contraception fell from an average of $88–94 before the ACA to nearly zero after 2013. Overall contraceptive use rose from 30.2% before the ACA to 31.9% by the study’s end, with the most significant increase observed in long-acting reversible contraception (LARC) methods. Interrupted time-series analysis showed that contraception use continued to rise post-ACA, pregnancy rates declined at a faster pace than in the pre-ACA period, and abortion rates continued to fall, albeit at a slightly slower rate than before ACA implementation. 

The elimination of cost sharing under the ACA was associated with increased contraceptive uptake, particularly LARC use, and a concurrent decline in pregnancy and abortion rates. These findings underscore the role of accessible contraception in reducing unintended pregnancies.

Reference:

Solomon MD, Zaritsky EF, Warton M, Millman A, Huynh A, Chinnakotla B, Reed ME. Effects of the Affordable Care Act on contraception, pregnancy, and pregnancy termination rates. Obstetrics & Gynecology. 2022 May 5:10-97.

https://journals.lww.com/greenjournal/fulltext/2025/02000/effects_of_the_affordable_care_act_on.13.aspx