Dual-Contraception Use Among Adolescent Girls and Young Women Before and After Implementation of the Affordable Care Act

Abstract

To assess dual-contraception use among young, sexually active contraceptive users, before and after implementation of the Affordable Care Act (ACA). Secondary data analysis using the 2006–2010 and 2013–2015 cohorts of the National Survey for Family Growth (NSFG). The NSFG was conducted in participants’ homes by a trained female interviewer. Data were included for 2,151 participants, ages 15 to 24 years, who were sexually active and had used contraception in the past 12 months. Participants were assigned to the pre-ACA (2006–2010 NSFG cohort) or post-ACA (2013–2015 NSFG cohort) group. The primary outcome was dual-contraception use in the past 12 months. The independent variable was ACA period (pre-ACA vs. post-ACA). Covariates included contraception type—categorized as short-, intermediate-, or long-acting reversible contraception (SARC, IARC, or LARC)—age, race, education, and marital status. Weights were used to estimate population-level outcomes. We assessed the relationship between dual-contraception use (never, sometimes, or always) and period (pre- or post-ACA), adjusting for covariates. Contraception Type × ACA Period and Race × ACA Period interaction terms were used to determine the association among contraception type, race, and changes in dual-contraception use. Compared with pre-ACA findings, there was a significant post-ACA decrease in SARC use (78.2% vs. 67.5%; p < .01) and a significant increase in LARC use (8.9% vs. 21.8%; p < .01) but no significant changes in the consistency of dual-contraception use among SARC users (OR, 1.88, 95% CI [0.64, 5.46], p = 0.25) or LARC users (OR = 1.62, 95% CI [0.42, 6.18], p = .48), or between White and Black women (OR, 1.45, 95% CI [0.66, 3.18], p = 0.35). There was no direct association between changes in contraception use and decreased condom use and, therefore, no indirect association between changes in contraception use and increased sexually transmitted disease rates. Health care providers should continue to promote consistent condom use among sexually active young women while realizing the public health goal of 100% condom use may not match young women’s personal health goals. Additional research is needed to further understand the post-ACA rise in sexually transmitted disease rates among Black women.