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Role of Insurance Coverage in Contraceptive Use After Abortion

Biggs, M. Antonia PhD; Taylor, Diana PhD, MS; Upadhyay, Ushma D. PhD, MPH
doi: 10.1097/AOG.0000000000002361
Original Research: PDF Only


To assess postaspiration abortion contraceptive use and the role of insurance coverage for abortion in a state that covers abortion and contraception for low-income women.


This is a secondary analysis of a previously published prospective study to assess the safety of abortion provision. From 2007 through 2013, women seeking first-trimester aspiration abortion were recruited at 25 clinical facilities within four Planned Parenthood affiliates and Kaiser Permanente of Northern California. Patients' medical charts were reviewed to assess the contraceptive methods received on the day of the abortion. A 4-week follow-up survey assessed contraceptive use and contraceptive-related incidents. Primary outcomes included leaving with any method on the day of the abortion and use of any method at the 4-week assessment. Secondary outcomes included intrauterine device or implant use on the day of the procedure and at 4 weeks and switching to a less effective method at 4 weeks.


A total of 19,673 women agreed to participate, and 13,904 (71%) completed the 4-week follow-up survey. Ninety-four percent (18,486/19,673) left their abortion visit with a contraceptive method: 21% (4,111/19,673) with an intrauterine device, implant, or permanent method. By the 4-week survey, 8% (1,135/13,904) switched from a high- or medium-efficacy method to a low-efficacy or no method; 0.4% (60/13,904) experienced a contraceptive incident. In adjusted regression analyses, women who paid for the abortion with Medicaid were significantly more likely to use any method (adjusted odds ratio [OR] 3.70, 95% CI 3.09–4.42) or an intrauterine device or implant (adjusted OR 2.14, 95% CI 1.92–2.38) on the day of the abortion than those who did not pay with insurance. Experiencing a contraceptive-related incident was associated with switching to a low-efficacy or no method by the 4-week survey (adjusted OR 3.98, 95% CI 2.20–7.22).


Insurance coverage for abortion is associated with postabortion contraceptive provision and use, even in settings that cover abortions and contraception for low-income women.

Corresponding author: M. Antonia Biggs, PhD, Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612; email:

Supported by grants from private foundations including the John Merck Foundation, the Educational Foundation of America, the David & Lucile Packard Foundation, and the Susan Thompson Buffet Foundation.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Tracy Weitz, PhD, MPA, Principal Investigator of the original study, for her vision and leadership, the partner organization principal investigators; Mary Gatter, MD, Katharine Sheehan, MD, Dick Fischer, MD, Jeff Waldman, MD, Debbie Postlethwaite, NP, MPH, and Amanda Calhoun, MD, for their support of the study at their institutions; Maureen E. Paul, MD, MPH, and Mary Fjerstad, RN, NP, MHS, for contributing to study planning; current and former University of California, San Francisco (UCSF)-based research coordinators and managers, Molly Batistelli, MPH, Sheila Desai, MPH, Deborah Karasek, MPH, Roula AbiSamra, MPH, and Kristin Nobel, MPH, for data coordination and management; UCSF-based project manager Patricia Anderson, MPH, former UCSF-based legal team Jennifer Dunn, JD, and Erin Schultz, JD; clinical education consultant Suzan Goodman, MD, MPH; and Amy Levi, PhD, CNM, health regulation consultant Barbara Safriet, JD; and the site-specific research coordinators for data collection.

Each author has indicated that she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.