National Survey Of Family Growth Research Articles

Sexually Transmitted Infection Screening among College Women by Race/Ethnicity and Number of Male Sex Partners: National Survey of Family Growth, 2013–2015

Objectives: The purpose of this study was to assess the relationship of race/ethnicity and number of male partners with sexually transmitted infection (STI) screening among college women in the United States. Methods: Using National Survey of Family Growth data, survey-weighted multiple predictor logistic regression models were analyzed. Results: Hispanic, Black, and Other race women had higher odds of STI screening than White women. Screening odds increased by 35% with each additional partner. The effect of number of partners on STI screening differed by race/ethnicity. Conclusions: Results may provide considerations when tailoring health communication campaigns to ultimately increase STI screening rates.

Partners’ Educational Pairings and Fertility Intentions in the United States: Evidence from 2015–2017 National Survey of Family Growth

In light of the ongoing educational shift from favoring men to favoring women, this study contributes to the literature on fertility by investigating the relationship between educational pairings and fertility intentions. To test two competing hypotheses, nationally representative data from the latest wave (2015–2017) of the National Survey of Family Growth were used, and four generalized estimating equation models were estimated. Results indicate that women’s intentions for additional children were influenced by educational pairings. Specifically, when highly educated women had a highly educated partner, their fertility intentions were higher than lower-educated women, but this difference disappeared if those women were in hypogamous relationships; when lower-educated women had lower- or medium-educated partners, their intentions for additional children were significantly lower than highly educated women, but the difference disappeared when she had a highly educated partner. Findings from this study provide new insights into fertility intentions by taking into account both partners’ education.

A Research Brief on Prospective Marital Expectations among Cohabitors with Initial Marital Intentions

Having initial intentions to marry increases cohabitors’ likelihood of marriage, yet some cohabitors with such plans do not marry. One explanation for non-marriage may be that prior union experiences and the challenges of raising shared or stepchildren could temper initially strong marital intentions. Using the 2011–15 National Survey of Family Growth (NSFG), I examine prospective marital expectations among 531 current cohabitors in short-term unions (≤ 36 months) who report they were engaged or had definite plans to marry at the start of coresidence, focusing on prior union experiences, stepchildren, shared children, and pregnancy. A fifth of current cohabitors with initial marital intentions did not definitely expect to marry their partner, and the odds of definite expectations were lower if respondents’ partners had children from a prior union and higher if respondents were expecting a child. Prior union experiences, shared children, and the respondent’s own prior children were unrelated to expectations.

Pregnancy Intendedness by Maternal Disability Status and Type in the United States.

Societal views about sexuality and parenting among people with disabilities may limit these individuals' access to sex education and the full range of reproductive health services, and put them at increased risk for -unintended pregnancies. To date, however, no national population-based studies have examined pregnancy -intendedness among U.S. women with disabilities. Cross-sectional analyses of data from the 2011-2013 and 2013-2015 waves of the National Survey of Family Growth were conducted; the sample included 5,861 pregnancies reported by 3,089 women. The proportion of pregnancies described as unintended was calculated for women with any type of disability, women with each of five types of disabilities and women with no disabilities. Multivariate logistic regression analyses were conducted to examine the relationship of disability status and type with pregnancy intendedness while adjusting for covariates. A higher proportion of pregnancies were unintended among women with disabilities than among women without disabilities (53% vs. 36%). Women with independent living disability had the highest proportion of unintended pregnancies (62%). In regression analyses, the odds that a pregnancy was unintended were greater among women with any type of disability than among women without disabilities (odds ratio, 1.4), and were also elevated among women with hearing disability, cognitive disability or independent living disability (1.5-1.9). Further research is needed to understand differences in unintended pregnancy by type and extent of disability. People with disabilities should be fully included in sex education, and their routine care should incorporate discussion of reproductive planning.

Food Insecurity and Risk Indicators for Sexually Transmitted Infection Among Sexually Active Persons Aged 15-44, National Survey of Family Growth, 2011-2017.

Food insecurity is linked to poor sexual health outcomes, especially among persons engaged in sexual behaviors that are associated with the risk of acquiring sexually transmitted infections (STIs). We examined this link using nationally representative data. We used data on adolescents and adults aged 15-44 who reported sexual activity in the past year from 6 years (September 2011-September 2017) of cross-sectional, weighted public-use data from the National Survey of Family Growth. We compared data on persons who did and did not report food insecurity, accounting for demographic characteristics, markers of poverty, and past-year STI risk indicators (ie, engaged in 1 of 4 high-risk activities or diagnosed with chlamydia or gonorrhea). Respondents who reported at least 1 past-year STI risk indicator were significantly more likely to report food insecurity (females: adjusted risk ratio [ARR] = 1.63; 95% confidence interval [CI], 1.35-1.97; P < .001; males: ARR = 1.46; 95% CI, 1.16-1.85) than respondents who did not report food insecurity. This finding was independent of the association between food insecurity and markers of poverty (≤100% federal poverty level [females: ARR = 1.46; 95% CI, 1.23-1.72; P < .001; males: ARR = 1.81; 95% CI, 1.49-2.20; P < .001]; if the respondent or someone in the household had received Special Supplemental Nutrition Program for Women, Infants, and Children or Supplemental Nutrition Assistance Program benefits in the past year [females: ARR = 3.37; 95% CI, 2.81-4.02; P < .001; males: ARR = 3.27; 95% CI, 2.76-3.87; P < .001]). Sex with opposite- and same-sex partners in the past year was significantly associated with food insecurity (females: ARR = 1.44; 95% CI, 1.11-1.85; P = .01; males: ARR = 1.99; 95% CI, 1.15-3.42; P = .02). Food insecurity should be considered a social determinant of health independent of poverty, and its effect on persons at highest risk for STIs, including HIV, should be considered when planning interventions designed to decrease engagement in higher-risk sexual behaviors.

Correlates of HIV-related risk behaviors among self-identified heterosexual men who have sex with men (HMSM): national survey of family growth (2002, 2006–2010, and 2011–2017)

ABSTRACT Self-identified heterosexual men who have sex with men (HMSM) have unique sexual behaviors that may increase their risk of HIV infection. We assessed the correlates of recent sex with other men and HIV-related risk behaviors among HMSM by sex of their sex partners. We analyzed data from the 2002 and 2006–2017 National Survey of Family Growth limited to men who self-identified as heterosexual and reported any anal/oral sex with another man (N = 787). Prevalence ratios based on logistic regression models determined the association between sociodemographic and behavior variables with reporting a same-sex partner or at least one HIV-related risk behavior with a female sex partner in the last 12 months. Approximately 17.7% and 42.5% of HMSM with recent same-sex partners reported HIV-related risk behaviors with male and female sex partners, respectively. HMSM who reported a recent same-sex partner and an HIV-related risk behavior reported more annual male (Ave = 2.6:95%CI;1.6–3.7) and female (Ave = 5.0:95%CI;3.3–6.8) sex partners than HMSM with a recent same-sex partner who did not report an HIV-related risk behavior [male (Ave = 1.7:95%CI;1.2–2.1) and female (Ave = 1.6:95%CI;1.1–2.1)]. HMSM with recent same-sex partners may engage in HIV-related risk behaviors with men and women concurrently. Further studies should assess gender-specific risk of infection.

Adolescent Sexual Activity, Contraceptive Use, and Pregnancy in Britain and the U.S.: A Multidecade Comparison

PurposePregnancy rates among adolescents have declined in the U.S. and Britain but remain high compared with other high-income countries. This comparison describes trends in pregnancy rates, recent sexual activity, and contraceptive use among women aged 16–19 years in the U.S. and Britain to consider the contribution of these two behavioral factors to the decline in pregnancy rates in the two countries and the differences between them. MethodsWe use data from two rounds of the U.S. National Survey of Family Growth, conducted 2002–2003 and 2011–2015, and the British National Survey of Sexual Attitudes and Lifestyles, conducted 2000–2001 and 2010–2012, to describe population-level differences between countries and over time in sexual activity and contraceptive use. We calculate pregnancy rates using national births and abortions data. ResultsPregnancy rates declined in both countries; this began earlier in the U.S. and was steeper. There was no change in sexual activity in Britain, but in the U.S., the proportion reporting recent sex declined. In both countries, there was a shift toward more effective contraception. A higher proportion in Britain than the U.S. reported ever having had sex (65% vs. 49%) and sex in the last year (64% vs. 45%), 6 months (59% vs. 39%), and 4 weeks (48% vs. 29%). A higher proportion in Britain reported using more effective contraception (68% vs. 52%). ConclusionsIn both countries, improvements in contraceptive use have contributed substantially to declines in pregnancy rates; however, the steeper decline in the U.S. likely also reflects declines in recent sex occurring only in that country.

Intersecting Inequalities: Education, Race/Ethnicity, and Sterilization

Despite extensive evidence that fundamental causes of health, such as socioeconomic status (SES) and race/ethnicity, often interact, the potential importance of such interactions has received limited attention in the contraceptive use literature. Even fewer studies have explicitly considered how interacting systems of power may structure contraceptive use with an intersectional framework. Drawing on the female ( N = 8,744) and male ( N = 5,826) samples of the 2006–15 National Survey of Family Growth (NSFG), this study relies on an intersectional approach to examine if education gradients in female and male sterilization vary by race/ethnicity. For non-Hispanic white respondents, results confirm the negative education gradient in female sterilization, and positive gradient in male sterilization. For non-Hispanic black and Hispanic respondents, education gradients tend to be less steep for female sterilization, but steeper for male sterilization. This indicates that different forms of oppression combine, overlap, and intersect to shape individuals’ unique social positions and experiences—including their contraceptive use.

Is there evidence of weathering among women seeking fertility treatments?: Evidence and insights

Racial disparities in outcomes of assisted reproductive technologies (ART) are well-documented, and evidence of racial disparities in other forms of fertility treatments has also been observed. To date, much of the research on these disparities has focused on individual-level causes. This paper contextualizes these disparities using the weathering hypothesis. Using the National Survey of Family Growth and exploratory analyses of the National Health and Nutrition Examination Survey, this study evaluates whether there is evidence of weathering among women of color seeking fertility treatments. The study finds inconsistent evidence of weathering among these groups. However, the study is limited by weaknesses in the available data. The paper demonstrates the promise and limits of the available data to answer empirical questions regarding disparities in fertility treatments that have spurred a national public health action plan and numerous commentaries from scholars and professional organizations. The paper concludes with a discussion of other possible causes of these disparities and a description of next steps needed in the field to better understand both the “under the skin” and social processes that underlie disparities in fertility treatment outcomes.

Prevalence of Potentially Unnecessary Bimanual Pelvic Examinations and Papanicolaou Tests Among Adolescent Girls and Young Women Aged 15-20 Years in the United States

Pelvic examination is no longer recommended for asymptomatic, nonpregnant women and may cause harms such as false-positive test results, overdiagnosis, anxiety, and unnecessary costs. The bimanual pelvic examination (BPE) is an invasive and controversial examination component. Cervical cancer screening is not recommended for women younger than 21 years. To estimate prevalence of potentially unnecessary BPE and Papanicolaou (Pap) tests performed among adolescent girls and women younger than 21 years (hereinafter referred to as young women) in the United States and to identify factors associated with receiving these examinations. A cross-sectional analysis of the National Survey of Family Growth from September 2011 through September 2017 focused on a population-based sample of young women aged 15 to 20 years (n = 3410). The analysis used survey weights to estimate prevalence and the number of people represented in the US population. Data were analyzed from December 21, 2018, through September 3, 2019. Receipt of a BPE or a Pap test in the last 12 months and the proportion of potentially unnecessary examinations and tests. Responses from 3410 young women aged 15 to 20 years were included in the analysis with 6-year sampling weights applied. Among US young women aged 15 to 20 years represented during the 2011-2017 study period, 4.8% (95% CI, 3.9%-5.9%) were pregnant, 22.3% (95% CI, 20.1%-24.6%) had undergone STI testing, and 4.5% (95% CI, 3.6%-5.5%) received treatment or medication for an STI in the past 12 months (Table 1). Only 2.0% (95% CI, 1.4%-2.9%) reported using an IUD, and 33.5% (95% CI, 30.8%-36.4%) used at least 1 other type of hormonal contraception in the past 12 months. Among US young women aged 15 to 20 years who were surveyed in the years 2011 through 2017, approximately 2.6 million (22.9%; 95% CI, 20.7%-25.3%) reported having received a BPE in the last 12 months. Approximately half of these examinations (54.4%; 95% CI, 48.8%-59.9%) were potentially unnecessary, representing an estimated 1.4 million individuals. Receipt of a BPE was associated with having a Pap test (adjusted prevalence ratio [aPR], 7.12; 95% CI, 5.56-9.12), testing for sexually transmitted infections (aPR, 1.60; 95% CI, 1.34-1.90), and using hormonal contraception other than an intrauterine device (aPR, 1.31; 95% CI, 1.11-1.54). In addition, an estimated 2.2 million young women (19.2%; 95% CI, 17.2%-21.4%) reported having received a Pap test in the past 12 months, and 71.9% (95% CI, 66.0%-77.1%) of these tests were potentially unnecessary. This analysis found that more than half of BPEs and almost three-quarters of Pap tests performed among young women aged 15 to 20 years during the years 2011 through 2017 were potentially unnecessary, exposing women to preventable harms. The results suggest that compliance with the current professional guidelines regarding the appropriate use of these examinations and tests may be lacking.

Change and stability in contraceptive use patterns among US women over a 12-month period: analysis using the 2013–2015 National Survey of Family Growth life history calendar

ObjectiveTo improve understanding of contraceptive use over 1 year among women in the United States. Study designWe used the 2013–2015 National Survey of Family Growth to examine monthly contraceptive use patterns over a 12-month period. We focused on use of contraception during months in which non-sterilized women were sexually active and not pregnant; our outcomes were contraceptive use in every month, some months, and no months. We used simple and multivariate logistic regression to examine socio-demographic and method use characteristics associated with contraceptive use patterns. ResultsSome 72% of non-pregnant, non-surgically sterile women used contraception in every sexually active month. After controlling for other demographic and individual characteristics, adolescents had higher odds (aOR=2.45) of using contraception in each sexually active month compared to women aged 25–29. Other groups more likely to use contraception monthly included those with some college (aOR=1.58) compared to less than high school and non-cohabiting unmarried women (aOR=1.49) compared to married women. Those with gaps in insurance coverage during the past year (aOR=0.70), women who were not sexually active all 12 months (aOR=0.42), and those with more than two male sexual partners (aOR=0.49), were less likely to use contraception every sexually active month. Nearly half (46%) of contraceptive users in our sample used more than one type of contraceptive method over the 12-month period. ConclusionsThe majority of women use contraception every month they are sexually active, although there is variation between socio-demographic groups. However, over a one-year period, many women used dynamic contraceptive strategies. ImplicationsHealth care providers should recognize that contraceptive use patterns are dynamic and change over a relatively short time period for many women.

Understanding the extent of contraceptive non-use among women at risk of unintended pregnancy, National Survey of Family Growth 2011–2017

ObjectiveTo describe characteristics of U.S. contraceptive non-users to inform tailored contraceptive access initiatives. Study designWe used National Survey of Family Growth data from 2011 to 2017 to identify characteristics of contraceptive non-users compared to other women ages 15–44 at risk for unintended pregnancy. We also examined reasons for not using contraception by when non-users expected their next birth. We calculated unadjusted and adjusted prevalence ratios using two definitions of contraceptive non-use: (1) contraceptive non-use during the interview month, and (2) a more refined definition based on contraception use during the most recent month of sexual intercourse and expectation of timing of next birth. We considered p-values <0.05 statistically significant. ResultsApproximately 20% (n=2844) of 12,071 women at risk of unintended pregnancy were classified as standard contraceptive non-users. After adjusting for all other variables, non-users were more likely to be low-income, uninsured, never married, expect a birth within 2 years, and have zero or one parity. The top reasons for contraceptive non-use were not minding if they got pregnant (22.6%), worried about contraceptive side effects (21.0%), and not thinking they could get pregnant (17.6%). After applying the more refined non-user definition, we identified 5.7% (n=721) of women as non-users; expecting a birth within 2–5 years and having a parity of one were associated with non-use after adjustment of all other factors. ConclusionOur more refined definition of non-users could be used in future studies examining the causes of unintended pregnancy and to inform programmatic interventions to reduce unintended pregnancy. ImplicationsDescribing contraceptive non-users and reasons for contraceptive non-use could help us better understand reasons for unintended pregnancy and inform tailored contraceptive access initiatives.

Sex education and contraceptive use of adolescent and young adult females in the United States: an analysis of the National Survey of Family Growth 2011–2017

ObjectivesThe effects of the comprehensiveness of sex education on sexual health measures have not been well-studied. We compared trends in comprehensive sex education and its relation to contraceptive use at first intercourse and current contraceptive use for women ages 15–24 in the United States between 2011 and 2017. Study designAnalyses included females ages 15–24 from the 2011–2017 National Survey of Family Growth. We defined comprehensive sex education as including 6 topics queried in the NSFG (how to say no to sex, birth control methods, where to get birth control, how to use condoms, sexually transmitted infections, HIV/AIDS), and non-comprehensive sex education as including less than 6 topics. Multivariable regression models investigated associations with contraceptive indicators. ResultsAmong 5445 respondents, percentages of women receiving comprehensive sex education in 2011–2013, 2013–2015, and 2015–2017 were 35%, 40%, and 34%. Across all periods, respondents reporting comprehensive sex education before first sex were less likely to report first sexual intercourse before age 15 (aOR 0.55; 95% CI: 0.40–0.74) and non-volitional first intercourse (aOR 0.42, 95% CI: 0.26–0.72) compared to those with non-comprehensive sex education. At first intercourse, those with comprehensive sex education were more likely to have used any (aOR = 1.63; 95% CI: 1.18–2.25) and very effective (aOR = 1.35; 95% CI: 1.04–1.75) contraception. Comprehensive sex education was unrelated to current contraceptive use (aOR = 0.87; 95% CI: 0.63–1.21). ConclusionsComprehensive sex education was associated with increased odds of contraceptive use at first intercourse, but not current contraceptive use. ImplicationsPrograms that promote comprehensive sex education may have a positive impact on preventive behaviors at sexual debut.

Sexual Abstinence in the United States: Cohort Trends in Abstaining from Sex While Never Married for U.S. Women Born 1938 to 1983

In this data visualization, the authors document trends in abstaining from sex while never married for U.S. women born 1938–1939 to 1982–1983. Using data from the six most recent National Surveys of Family Growth, the authors’ estimates suggest that for women born in the late 1930s and early 1940s, 48 percent to 58 percent reported abstaining from sex while never married. Abstinence then declined rapidly among women born in the late 1940s through the early 1960s, leveling off at between 9 percent and 12 percent for more recent birth cohorts. Thus, for U.S. women born between the mid-1960s and the early 1980s, roughly one in nine abstained from sex while never married.

Visualizing 20 Years of Racial-Ethnic Variation in Women's Ages at Sexual Initiation and Family Formation.

This data visualization uses several cycles of the National Survey of Family Growth to compare trends in median ages at first sex, birth, cohabitation, and marriage between 1995 and 2015 across non-Hispanic white, non-Hispanic black, native-born Hispanic, and foreign-born Hispanic women aged 40 to 44 years. Generally, women’s ages at first sex declined, ages at first cohabitation remained stable, and ages at marriage and birth increased. However, there were substantial race-ethnicity-nativity differences in the timing and sequencing of women’s reproductive and family experiences, and these differences grew over time. These descriptive findings point to the importance of identifying the larger social forces that contribute to differential experiences while underscoring the fundamental problems inherent with defining whites’ reproductive and family behaviors as “normal.”

The Relationship Between Insurance Coverage and Use of Prescription Contraception by Race and Ethnicity: Lessons From the Affordable Care Act.

We describe contraception use by race and ethnicity before and after the Affordable Care Act (ACA) and assess the relationship between insurance coverage and prescription contraception use in both periods. Using data for women ages 15 to 45 at risk of unintended pregnancy from the 2006-2010 and 2015-2017 National Surveys of Family Growth, we examined changes in patterns of contraception use over time by race and ethnicity. We also examined changes in insurance coverage over the same period and considered how the relationship between insurance coverage and prescription contraception use has changed over time within each racial and ethnic group using both descriptive and multivariate regression methods. Before the ACA, Black and Hispanic women were less likely than White women to use prescription contraception by 13.2 and 9.9 percentage points, respectively. After the ACA Medicaid and Marketplace coverage expansions, all groups experienced a decrease in uninsurance, but only Black women experienced a significant increase in prescription contraception use. As a result, the post-ACA Black-White difference in prescription contraception use narrowed to 3.9 percentage points, and the Hispanic-White gap remained unchanged. Our results suggest that, despite significant declines in uninsurance under the ACA, there was no increase in use of prescription contraception for White or Hispanic women. Moreover, the decrease in uninsurance among Black women did not fully explain the large increase in use of prescription contraception for this population.

Race and Length of Time Pursuing Pregnancy Among Women Who Utilized Medical Help to Get Pregnant

Objective: The evaluation of racial disparities in access to and use of infertility services in the U.S. has been documented. The aims of this study were to: 1) investigate racial differences in length of time women report attempting to become pregnant until seeking medical help; and 2) determine the predictors of seeking medical help to achieve pregnancy. Materials and methods: The National Survey of Family Growth 2011-2015 was used to analyze the duration women attempted to get pregnant among those who sought medical help. Results: 563 women reported seeking medical help to achieve pregnancy. The majority 422 (81%) were white. Multiple linear regression showed that age (β = .93; p = .00), having less than high school education (β = 14.64; p = .01), and higher body mass index (β = .59; p = .00) are significantly associated with an increased length of time for seeking medical help to get pregnant. Religions other than Catholic or Protestant (β = -8.63; p = .04) is significantly associated with a decreased length of time for seeking medical help to get pregnant. Race was not associated with a significant difference in the length of time attempting to become pregnant (β = -1.80; p = .44). Conclusion: Age, education attainment, religious affiliation, and body mass index are significantly associated with the length of time pursuing pregnancy. Once women have utilized medical resources, racial differences in the length of time pursuing pregnancy are not apparent.

Awareness of breast cancer risk related to a positive family history and alcohol consumption among women aged 15-44years in United States.

Awareness of the link between breast cancer and risk factors such as family history of breast cancer and alcohol consumption may help modify health behaviors. To reduce risk factors for breast cancer among young women, it is important to understand overall levels of risk awareness and socioeconomic differences in awareness. Data from the National Survey of Family Growth 2011-2015 were used to examine awareness of two risk factors for breast cancer, positive family history and alcohol consumption, among women aged 15-44years (n=10,940) in the United States by presence of risk factors and by socioeconomic characteristics. Prevalence of positive family history, non-binge, and binge drinking was 30%, 29%, and 31%, respectively among women aged 15-44. Awareness of positive family history of breast cancer as a risk factor for breast cancer was 88%, whereas for alcohol consumption it was 25%. Awareness of family history as a risk factor was higher among women with positive family history of breast cancer compared to those without. Current drinkers were more likely to believe that alcohol was not a risk factor for breast cancer compared to those who did not drink. Racial/ethnic minority women and those with lower education and income had lower awareness of family history as a risk factor. Awareness of alcohol consumption as a risk factor for breast cancer was low across all socioeconomic groups. Evidence-based interventions to increase risk awareness and decrease excessive alcohol use among young women are needed to reduce the risk of developing breast cancer.

Asthma and/or hay fever as predictors of fertility/impaired fecundity in U.S. women: National Survey of Family Growth

This study addresses whether asthma and/or hay fever predict fertility and impaired fecundity. The lifetime number of pregnancies (fertility) and spontaneous pregnancy losses (impaired fecundity) in 10,847 women representative of the U.S. population 15 to 44 years of age with histories of diagnosed asthma and/or hay fever are analyzed in the 1995 National Survey of Family Growth using multivariable Poisson regression with multiple covariates and adjustments for complex sampling. Smokers have significantly increased fertility compared to nonsmokers. Smokers with asthma only have significantly increased fertility compared to other smokers. Higher fertility is associated with impaired fecundity (ectopic pregnancy, miscarriage, stillbirth). Women with asthma (with and without hay fever) have significantly higher pregnancy losses than women without asthma. With increasing number of pregnancies, smokers have increased pregnancy losses compared to nonsmokers. Smokers, especially those with asthma only, have increased fertility and require special attention as to their family planning needs, reproductive health, and smoking cessation. Women with asthma, regardless of number of pregnancies, and smokers with higher numbers of pregnancies have high risk pregnancies that require optimal asthma/medical management prenatally and throughout pregnancy. Whether a proinflammatory asthma endotype underlies both the increased fertility and impaired fecundity associated with age and smoking is discussed.

The Affordable Care Act contraception mandate & unintended pregnancy in women of reproductive age: An analysis of the National Survey of Family Growth, 2008–2010 v. 2013–2015,

Objective(s)The Affordable Care Act contraception mandate could reduce unintended pregnancies by increasing access and affordability of contraceptive resources, e.g., long-acting reversible contraceptives (LARCs). We assessed: (1) whether unintended pregnancies decreased post-mandate, and (2) whether this decrease differed by demographic characteristics. Study designWe used data from the National Survey of Family Growth (unweighted n = 7409) in logistic regression analyses to compare odds of unintended pregnancy pre-mandate (2008-2010) vs post-mandate (2013-2015), overall and stratified by demographic characteristics. ResultsParalleling an increase in long-acting reversible contraceptive use (p < 0.01), post-mandate, the odds of experiencing unintended pregnancy in the prior year decreased 15% overall (OR: 0.85, 95% CI: 0.62, 1.17), with the greatest reduction observed among women with government-sponsored insurance (OR: 0.63, 95% CI: 0.41, 0.97). ConclusionsUnintended pregnancy decreased following the contraception mandate, although possibly due to chance. The short study period relative to the mandate could under-estimate the mandate’s effect.