The Impact of Health Insurance and Abortion Policy on Women’s Choice of Contraceptive Intensity in the United States

Abstract: Understanding the contraceptive decision making process of women has been the subject of a number of studies. However, few have employed economic models that explored the role that future costs may play in a woman’s choice of contraception. The objective of this paper is to use an economic framework that takes into account contraceptive costs at the time of consumption (i.e. the presence of health insurance) and future costs in the event of contraceptive failure (i.e. expected abortion costs) to explain the choice of contraceptive intensity for women at risk for an unintended pregnancy. The paper uses Medicaid funding restrictions to proxy the cost of abortion across four regions in the United States. Using a multinomial logit regression, I determine the relative risk of using hormonal contraceptives and other contraceptives compared with a base category of using no contraceptive method. I use the 1995 cycle of the National Survey of Family Growth, and control for a woman’s age, partnership status, education, religiosity, race, labour force status, and income. The results indicate a positive and significant association between having insurance and using hormonal contraceptives, and a negative and significant association between using hormonal contraceptives and living in a region where abortion access is less restricted.