Nov. 6 (UPI) -- The elimination of out-of-pocket costs for contraception under the Affordable Care Act resulted in an increase in birth control use and a corresponding decline in birth rates of up to 20%, according to an analysis published Friday by JAMA Network Open.
This is particularly true among women in low-income households.
Births also dropped by nearly 10% among women in middle-income households and by roughly 2% among women in high-income households, the data showed.
The result most likely has meant a decline in unintended pregnancies among women covered by insurance plans under the legislation, researchers said.
"Removing out-of-pocket costs for contraception was associated with increases in prescription contraception use and faster declines in births among lower-income women than higher-income women," study co-author Dr. Vanessa K. Dalton told UPI.
"These findings are consistent with the idea that the ACA regulations on health plans may have addressed income-related disparities in contraception use and unintended births," said Dalton, director of the University of Michigan's Program on Women's Health Care Effectiveness Research.
Signed into law in 2010 by then-President Barack Obama and fully implemented in 2014, the ACA -- which is also known as Obamacare -- included contraception on its list of preventive care services required for coverage, without consumer cost sharing, by most insurers.
Nearly half of all pregnancies in the United States, and unintended pregnancies, are associated with delayed prenatal care, reduced likelihood of breastfeeding, maternal depression, physical violence, and higher maternal and infant mortality, according to Dalton and her colleagues.
These pregnancies also cost the U.S. healthcare system an estimated $5 billion annually in direct and indirect costs to finance the treatment of both bothers and newborns, the researchers said.
Dalton and her colleagues reviewed data on 4.6 million women in the United States enrolled in employer-based health plans between 2008 and 2018.
Just over 40% -- or roughly 500,000 -- of them lived in households with incomes lower than 400% of the federal poverty level in 2013, classifying them as "low income."
Birth rates for women in low-income households declined to 6.2% in 2018, a 22% drop from 8% in 2014, the data showed.
The birth rates for women in middle-income households declined by 9.4% over the same period, to 5.8% in 2018 from 6.4% four years earlier, the researchers said.
In high-income households, the birth rate fell to 5.5% in 2018 from 5.6% in 2014, they said.
"The timing of the ... decline around 2014 is consistent with the timing of the ACA benefit regulations generally, so it may not just be the contraceptive mandate but other aspects of the ACA" that influenced these trends, Dalton said.