The Impact of State Contraceptive Insurance Mandates

In 1997, U.S. states began passing mandates for health insurance to cover reversible contraceptives, leading to a large increase in insurance coverage (Sonfield et al. 2002).  Contraceptive insurance may reduce the cost of having sex, potentially increasing sexual activity and pregnancy.  It may encourage women to substitute away from the use of condoms and towards other, non-barrier methods of contraceptive now covered by insurance, raising the risk and prevalence of sexually transmitted infections. By reducing the out-of-pocket cost to women of avoiding unintended pregnancies, contraceptive insurance may allow women to better time their pregnancies, increasing the rate of intended pregnancies, prenatal care, and infant health.  Our study investigates the impact of state contraceptive insurance mandates on each of these sex-related outcomes including sexual activity, contraceptive use, sexually transmitted diseases, abortions, births, and delivery complications.  Our analysis is conducted using a differences-in-differences strategy that controls for state-specific trends.  We compare outcomes for women that reside in states that passed contraceptive insurance mandates and women residing in states that did not. Data permitting, we allow estimated effects to differ for women of varying age, race, ethnicity, and communities.  Diverse social costs of abortion or out-of-wedlock childbearing across demographic groups imply disparate impacts of contraception mandates on pregnancy rates and birth rates.  We find that the insurance mandates increased sexual activity among teenaged women as well as increased their overall contraceptive use.  This translates to fewer births, particularly among Hispanics, as well as some possible reductions in delivery complications.   The results suggest that the reduced out-of-pocket cost of contraceptives improved birth timing for women.