January 26, 2017

Did Trump's election drive a surge in IUD prescriptions?

Daily Briefing

    Prescriptions for intrauterine devices (IUDs) surged 19 percent between October and December, with some women saying they opted for long-acting birth control because they worried that the Trump administration would repeal the Affordable Care Act's (ACA) birth control coverage mandate.

    The ACA mandated that individual and group health insurance plans cover all types of FDA-approved birth control without charging a copayment or coinsurance.

    During the presidential campaign, President Trump said he wanted to repeal and replace the ACA. And while it isn't clear whether Republican replacement plans would continue to require insurers to cover contraception at no out-of-pocket cost, many women assumed that Trump's victory would eventually reduce access to contraception, Sarah Kliff writes for Vox.

    Following the election, there were anecdotal reports that women were rushing to have IUDs implanted to capitalize on the ACA's contraceptive coverage requirement before it could be rolled back. IUDs are effective for between three and 12 years. But the upfront cost of a hormonal IUD—without insurance—can be substantial, ranging between $176 and $736 depending on where a woman lives, according to data from Amino Health.

    Gretchen Borchelt, VP for reproductive rights and health at the National Women's Law Center, told Vox, "The morning after the election we had an immediate uptick in calls from women who were concerned about the election. They didn't know if they were going to lose coverage, whether they should go out and get an IUD."

    Separately, Planned Parenthood President Cecile Richards said since the election, the number of women trying to get an IUD at Planned Parenthood increased by 900 percent. While Richards did not specify the overall number of women seeking IUDs, she said, "They are desperately concerned that they might lose their access to health care."

    New analysis

    A new analysis suggests those anecdotal reports reflected a real trend.

    For the analysis, which was commissioned by Vox, athenahealth mined its EHR data from 2,500 doctor offices across the country that provided IUDs over the past 15 months and looked at month-by-month trends. The analysis found that visits coded for IUD management or insertion climbed 19 percent between October and December 2016—from 10,850 IUD-related appointments in October to 12,938 in December. According to Kliff, the increase was apparent in both liberal and conservative areas of the country, but it was steeper in regions that voted for Hillary Clinton in the 2016 presidential election.

    The analysis also found that the proportion of birth control appointments involving IUDs increased from 9.8 percent in October 2015 to 11.1 percent in December 2016. "There are likely two explanations for that shift," Kliff writes. First, women may be seeking out IUDs because they prevent pregnancy for a long time—"Long enough, in other words, to last through Trump's entire presidency," Kliff writes—and second, in absence of the ACA's contraceptive coverage requirements, women might not be able to afford the cost of an IUD, which tends to be significantly higher upfront than the cost of other forms of contraception.

    CDC: Women who don't use birth control shouldn't drink

    Researchers said no similar increases in IUD-related visits were observed last year, and they stated that it was the first time in five years that visits for IUD procedures and follow-ups had climbed in both November and December. "Our data really complements the anecdotes," said Josh Gray, VP at athenaResearch. "I do think we're capturing a national trend."

    The research aligns with an earlier analysis released by Amino Health in December that tracked an increase in IUD-related care following the election. But Amino data scientist Sohan Murthy was a bit more cautious in interpreting the data. "We think it's too early to tell if this increase was due to post-election interest in IUDs, given season variation over the last three years," he said (Kliff, Vox, 1/25; Rice, AthenaHealth, Rice, athenainsight, 1/25; 1/25; Cohen, CNN, 1/25; Ryan, "The Cut," New York Magazine, 1/25).

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