Concerning Trends in Hormonal Birth Control Use among Adolescent Females between Politically Conservative versus Liberal States

Abstract

Introduction: Unintended teen pregnancies are associated with adverse health consequences. Strategies effective in preventing unintended pregnancy include comprehensive sexual education programs and access to hormonal contraception. Given the widening divide at the state level in access, funding, education, and sociopolitical context surrounding birth control, we explored how hormonal birth control use for the prevention of pregnancy in 2019 may have differed compared with prior years between liberal vs conservative states. Methods: State support for Donald J. Trump vs. Hillary R. Clinton in the 2016 US Presidential election was our exposure. The primary outcome was reported use of hormonal birth control among female students from the Youth Risk Behavior Surveillance System (YRBSS) in 2013-2019. A weighted adjusted linear regression model evaluated whether there was a change in the reported use of hormonal birth control in 2019 by election result status. Results: We analyzed data from 7,714 females from 39 states; of these, 2,425 reported having used hormonal birth control to prevent pregnancy. In 2019, the proportion of hormonal birth control use in Clinton-supporting states was 41.9% compared with 30.2% in Trump-supporting states (p=0.01; no difference between these states in 2013-2017). In 2019, hormonal birth control use decreased by 9.8% (95% CI: -0.187, -0.010) among females from Trumpsupporting states. Discussion: Our study highlights a dramatic shift in reported hormonal birth control use among teens in a short period of time between politically conservative vs. liberal states. This mirrored a change in the sociopolitical environment related to support for family planning. This suggests potential for a significant increase in unintended pregnancies among teens who live in politically conservative compared with liberal states. It is important for public health officials not to shy away from confronting the sociopolitical context in which health-related decisions are made, and protect our children's health and health equity.