The Effect of Changes in Emergency Contraception Availability on Pregnancy Intendedness: Evidence from the PRAMS

Emergency contraception, also known as the morning-after pill, is a type of birth control that can prevent a pregnancy from occurring if taken within 72 hours after sexual activity. Historically, access to emergency contraception was controlled through prescriptions by physicians. On August 24, 2006, the FDA approved sales of emergency contraception behind-the-counter (BTC) through pharmacies to individuals over the age of 18. However, not all state Medicaid programs reimburse nonprescription coverage of emergency contraception. Thus, the cost of emergency contraception available to low-income women on Medicaid differs both by state as well as age. Using data from the Pregnancy Risk Assessment and Monitoring System (PRAMS), this study aims to understand the effects of changes in access to emergency contraception on the likelihood of unintended pregnancy. Increased access to emergency contraception could reduce unintended pregnancies by making access easier and faster. But if improved physical access is offset by reduced financial access (through higher out of pocket costs), then any effect of the policy change for Medicaid women may be mitigated. We estimate these effects using a difference-in-difference methodology for Medicaid women aged 18 and older and Medicaid women by specific age group.