Employment Status in the United States and Use of Long-Acting Reversible Contraception or Moderately Effective Contraception before and after the Affordable Care Act: An Analysis of the National Survey of Family Growth 2006-2010 and 2015-2017 公开

Abstract

Objective. Employment status has been historically associated with contraceptive use among women of reproductive age; however, the Affordable Care Act (ACA), introduced in the US in 2010, may have influenced this association. We assessed the association between employment status and long-acting reversible or moderately effective contraception use before and after the passage of the Affordable Care Act.

Methods. We used data from the 2006-2010 and 2015-2017 cycles of the National Survey of Family Growth (NSFG) indicating pre- and post-ACA periods, respectively. Women aged 15-44 years and at risk for unintended pregnancy were included in our analysis. Employment at the time of the survey was measured as a dichotomous variable. Multivariable logistic regression was used to estimate adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (CI) of use of long-acting reversible or moderately effective contraception as compared to least effective or no methods of contraception. Further, effect modification for the main association was assessed by race/ethnicity.

Results. Overall, the study analyzed 5,572 women pre-ACA, and among them 53.2% were using long-acting or moderately effective contraception; post-ACA (n=2,340) the distribution was 54.7%. We found significant interaction for the main effect by race/ethnicity, and results were stratified by non-Hispanic White, non-Hispanic Black, Hispanic, and Other groups. Pre-ACA, non-Hispanic White women who were employed were significantly more likely to use long-acting reversible or moderately effective contraception (aPOR=1.66; 95% CI=1.28, 2.14). Post-ACA, there was no significant relationship between employment status and long-acting reversible or moderately effective contraceptive use in non-Hispanic white women (aPOR=0.94; 95% CI=0.67, 1.33). For other race/ethnic groups, we found no statistically significant association for the main effect during pre-ACA or post-ACA study periods.

Conclusions. Contrary to our expectation, we found no significant association between employment and use of long-acting reversible or moderately effective contraceptives by race/ethnicity during post-ACA period in a study sample generalizable to the US. Future studies should examine how short-term loss or interruption of employment impacts contraception use in the target population. We recommend that any modifications to the ACA should be scrutinized for the impact it may have on women’s access to long-acting reversible or moderately effective contraception. 

Table of Contents

CHAPTER 1. 1

PUBLIC HEALTH SIGNIFICANCE.. 1

CHAPTER 2. 3

LITERATURE REVIEW... 3

Contraception. 4

Contraceptive use, preferences, and barriers to use. 5

Association between contraception, income and employment. 7

ACA and contraception. 8

Study rationale. 9

CHAPTER 3. 10

METHODS. 10

Data source. 10

Study Subjects. 10

Primary outcome, primary exposure & covariables. 10

Statistical Analysis. 11

CHAPTER 4. 13

RESULTS. 13

CHAPTER 5. 16

DISCUSSION.. 16

REFERENCES. 22

TABLES AND FIGURES. 27

FIGURE 1A.. 27

FIGURE 1B.. 28

TABLE 1A.. 29

TABLE 1B.. 31

TABLE 2. 33

TABLE 3. 34

SUPPLEMENTAL TABLE A.. 35

SUPPLEMENTAL TABLE B.. 36

SUPPLEMENTAL TABLE C.. 37

SUPPLEMENTAL TABLE D.. 38

SUPPLEMENTAL TABLE E.. 40

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health - MPH
Subfield / Discipline	Applied Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology Health Sciences, Obstetrics and Gynecology
关键词	National Survey of Family Growth Contraception Employment Affordable Care Act
Committee Chair / Thesis Advisor	Kancherla, Vijaya, Emory University
Committee Members	Hailstorks, Tiffany, Emory University

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