Enthoven Dr. Clair, El Marroun Prof. Hanan, Labrecque Dr. Jeremy, Lucassen Prof. Nicole, Varkevisser Prof. Marco, Truijens Dr. Femke, Bijma Hilmar, Jansen Prof. Pauline

(324) HEALTH INSURANCE COVERAGE AND OTHER BARRIERS TO CONTRACEPTIVE USE AMONG WOMEN WITH UNPLANNED PREGNANCY

  • Urology
  • Reproductive Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Psychiatry and Mental health
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Abstract Objectives In 2004, contraception was removed from the national public health insurance fund for women aged >21 years in the Netherlands. The objectives of this study were: 1) to determine the association of birth control coverage on contraceptive use and unplanned pregnancies; 2) to assess the sociodemographic characteristics of women with unplanned pregnancy who did and did not use contraception five years preceding pregnancy; and 3) to explore what role women themselves attribute to the use of contraception in unplanned pregnancies. Methods Data from the population-based birth cohort Generation R of pregnant women with delivery dates between 2002 and 2006 (N=7424), and data from 10 semi-structured interviews among women with (a history of) an unplanned pregnancy was used. Logistic, multinomial regression analyses and thematic analyses were performed. Results Of the women with unplanned pregnancy (29.3%), 80.4% used contraception in the five years prior to pregnancy, and 13.8% used contraception in the month of conception. Age ≥35 years, migration background, being married and a household income of ≤€2000/month were associated with not using contraception in the last five years. The prevalence of unplanned pregnancy did not differ before and after the policy change in 2004, but women with unplanned pregnancy less likely used contraception after the policy change (OR=0.59; 95%CI=0.35-0.97) in sensitivity analyses. Thematic analyses revealed that resistance against (hormonal) contraception because of side effects or negative stories, not being able to take hormonal contraception due to medical reasons or currently not having a partner were prominent arguments for not using contraception. Conclusions Within our sample of pregnant women, health insurance coverage did not affect the prevalence of unplanned pregnancy, but it may influenced the use of contraception. Dissatisfaction with the current available birth control options may be an important argument that needs more attention in future studies. Conflicts of Interest The authors do not have any conflict of interest regaring this study.

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