Access to birth control through ACA drives down abortion rate

ANN ARBOR — When young women were able to better access birth control as part of their parents' insurance plans, a provision of the Affordable Care Act, the abortion rate in this age group fell by about 10 percent.

That's according to a study in the Journal of Population Economics by University of Michigan researcher Joelle Abramowitz, Ph.D., who wanted to study how the young adult provision of the ACA affected how young women made decisions about starting their own families. The provision, enacted in 2010, allowed young people to stay on their parents' insurance until age 26.

What she found is telling. When women ages 20-24 were able to stay on their parents' insurance, the rate of abortions in this age group fell by between 9 and 14 percent compared to women who weren't able to access that eligibility.

The women's use of long-term hormonal birth control such as the shot and the implant increased by 68 percent—the jump appears large because previous use of this type of birth control was so low—and the rate of babies born in this age group also fell by 10 percent.

In short, if the young women had access to insurance, they were able to better plan when they might want to start having children.

"The findings suggest that women can better optimize their ability to plan families when they have access to insurance coverage," said Abramowitz, a researcher at the Institute for Social Research's Survey Research Center.

To get a clear picture of how this provision affected these young women's family planning, Abramowitz compared groups of women during the periods before and after the provision to a control group of slightly younger and slightly older women, who did not gain new eligibility. She drew on data from the American Community Survey, abortion surveillance data from the Centers for Disease Control and Prevention, and the National Survey of Family Growth.

The American Community Survey samples about 3 million households each year in every U.S. county and Puerto Rico municipios, and Abramowitz combed the survey to find instances of women who had given birth in the last year. The CDC data tallies every time a legal abortion is induced in every state in the country, and the National Survey of Family Growth interviews approximately 5,000 men and women per year about their family-related behaviors and outcomes, including their contraceptive use.

"Other papers have found decreases in fertility after the Affordable Care Act young adult provision was implemented, but they didn't examine what was driving this decrease. That's really where this paper fills in the gap," Abramowitz said.

However, the results were true largely only for non-Hispanic white women. Women of color tended to see fewer benefits. That's likely because these effects only occur for women who are able to access health insurance through their parents' plans.

According to the Census Bureau, in 2010 when the young adult provision was enacted, about 73 percent of white people had private coverage while only 48 percent of black people and about 42 percent of Hispanic people had private coverage.

"This suggests some people are unable to optimize their ability to plan families because they don't have access to insurance," Abramowitz said. "The unaffordability of these sorts of birth control methods without insurance appears to be one factor that has contributed to unplanned pregnancies.