Receipt of Prescription Contraception by Commercially Insured Women With Chronic Medical Conditions

Abstract

Objective To assess differences in receipt of prescription contraception among women with and without chronic medical conditions. Methods This observational study used 3 years of administrative claims records for insured women aged 21–45 years who were enrolled in a commercial insurance company in Michigan between 2004 and 2009. Women were considered to have a chronic medical condition if they had at least two claims for one of the following conditions, in order of prevalence in our study population: hypertension, asthma, hypothyroidism, diabetes, obesity, rheumatoid arthritis, inflammatory bowel disease, or systemic lupus erythematosus. Our primary outcome was receipt of prescription contraception, defined by a pharmacy claim or diagnostic or procedural code. We used multivariable logistic regression to estimate the association of chronic condition status with the odds of receiving prescription contraception within 3 years, adjusting for age, community-level socioeconomic status, total outpatient visits, and cervical cancer screening. Results Of 11,649 women studied, 16.0% (n=1,862) had at least one of the chronic conditions we considered. Of those with a chronic condition, 33.5% (n=623) received prescription contraception during the 3-year study period compared to 41.1% (n=4,018) of those without a chronic condition (p<0.001). After adjusting for covariates, women with a chronic condition remained less likely than women without a chronic condition to have received prescription contraception (adjusted odds ratio=0.85; 95% CI 0.76, 0.96; p=0.010). Conclusion Despite a greater risk for adverse outcomes with an unplanned pregnancy, women with these chronic conditions were less likely to receive prescription contraception.

Chronic Diseases and Use of Contraception Among Women at Risk of Unintended Pregnancy

“…20,22 Unlike our study, Perritt et al 20 found no association between heart disease and any contraception use in a representative Maryland sample of recent mothers. They also reported lower odds of contraception use at conception among women with prepregnancy hypertension compared with non-hypertensive women (odds ratio [OR] = 0.5; 95% CI: 0.3, 0.8) and lower odds for postpartum contraception use among women with prepregnancy diabetes compared to women without (OR = 0.5; 95% CI: 0.1, 0.9).…”

“…We examined data among all women at risk of unintended pregnancy in the general population and not only among recent mothers. In another study that examined eight chronic medical conditions, 22 women with at least one chronic condition were less likely to receive prescription contraception than women who had no chronic condition (OR = 0.85; 95% CI: 0.76, 0.96). Notably, effect estimates for asthma and diabetes were comparable to ours and CVD was not assessed.…”

“…17,18 Few studies have examined the relation between prepregnancy chronic disease status and contraceptive use. 15,19–22 Of these, two have shown some associations between chronic disease and contraceptive use with results varying depending on the chronic disease examined. 20,22 No published studies have examined associations between chronic disease and contraceptive use by effectiveness of contraception.…”

Stressful Life Events Around the Time of Unplanned Pregnancy and Women’s Health: Exploratory Findings from a National Sample

“…Lack of education, low socioeconomic status, reduced employment, limited access to health care, disrupted family dynamics, and intimate partner issues like violence, are a few outcomes noted among women who experience unplanned pregnancies (Brown & Eisenberg; Gipson et al; Sonfield et al). Health-related research has largely focused on physical and mental conditions that can precede unplanned pregnancy, for instance the influence of depression, stress, and chronic disease (CD) on sexual and contraceptive behaviors, rather than the health outcomes that follow it (Denobles et al, 2014; Chor, Rankin, Harwood, & Handler, 2011; Holing, Beyer, Brown, & Connell, 1998; Davis, Pack, Kritzer, Yoon, & Camus, 2008; Hall, Kusunoki, Gatny, & Barber, 2014; Hall, Moreau, Trussell & Barber, 2013; Hall, Reame, O’Connell, Rickert, & Westhoff, 2012; Chen, Stiffman, Cheng, & Dore, 1997; Steinberg et al, 2013). Some literature exists to describe unplanned pregnancy-related perinatal and postpartum depression (Cheng, Schwarz, Douglas, & Horon, 2009; CDC, 2007) and on whether induced abortion causes mental health (MH) morbidity (APA, 2008; Charles, Polis, Sridhara, & Blum, 2008; Steinberg & Finer, 2012; Steinberg & Finer, 2011; Foster, Steinberg, Roberts, Neuhaus, & Biggs, 2015).…”

Women's Preferred Sources for Primary and Mental Health Care: Implications for Reproductive Health Providers

“…While common chronic disease and mental health conditions are recognized as leading causes of morbidity and mortality, their implications for women’s reproductive health (reproductive health) and family planning have been given less attention. A growing number of research studies have shown that chronic diseases, depression, anxiety, and stress are linked with decreased fertility, perinatal and infant morbidity, “risky” sexual and contraceptive behaviors, and increased rates of unintended pregnancy and sexually transmitted infections (Williams, March, & Rasgon, 2007; Grote et al, 2010; Adler et al, 2007; Denobles et al, 2014; Chor et al, 2011; Holing et al, 1998; Davis et al, 2008; Hall et al, 2014; Hall et al, 2013). Within current public health systems and policies, however, women’s general and mental health and healthcare needs have been largely marginalized from their reproductive health and family planning issues.…”