How Costs Limit Contraceptive Use among Low-Income Women in the U.S.: A Randomized Control Trial

Martha Bailey, Vanessa Wanner Lang, Alexa Prettyman, Iris Vrioni, Lea J. Bart, Daniel Eisenberg, Paula Fomby, Jennifer Barber and Vanessa Dalton

No 31397, NBER Working Papers from National Bureau of Economic Research, Inc

Abstract: The Affordable Care Act eliminated cost-sharing for contraception for Americans with health insurance, but substantial cost sharing remains for uninsured individuals who seek care through Title X—a national family planning program that provides patient-centered, subsidized contraception and reproductive health services in the U.S. This paper uses a randomized control trial (RCT) to examine how cost-sharing at Title X providers affects the choice of contraceptive method. The study randomizes vouchers that cover any contraceptive method up to the cost of 50% or 100% of a name-brand intra-uterine device (IUD). The results show that Title X clients are highly constrained by the out-of-pocket costs of contraception. The offer of free contraception is associated with a 40% increase in the use of any birth control method (ITT effect), a 94% increase in the value of birth control purchased, a 328-day (226%) increase in the period covered by contraceptives purchased, and a 324% increase in the likelihood of choosing a long-acting, reversible method (an IUD or implant). The results imply that eliminating the costs of contraception for Title X clients nationwide would reduce undesired pregnancies by 5.3%, birth rates by 3.9%, and abortions by 8.3%, and save $1.43 billion in the first year of the program.

JEL-codes: I18 J13 J18 (search for similar items in EconPapers)
Date: 2023-06
New Economics Papers: this item is included in nep-hea
Note: CH EH LS PE
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