{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T03:44:02Z","timestamp":1789530242239,"version":"build-2803163510"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T00:00:00Z","timestamp":1674432000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["P2C-HD041041"],"award-info":[{"award-number":["P2C-HD041041"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Private Philanthropic Foundation"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Many states are implementing comprehensive programs aimed at reducing persistent barriers to contraceptive care. Evidence on the effectiveness of these programs is essential for practice improvement and policy development.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To evaluate changes in the probability of initiating a contraceptive method by women with employer sponsored insurance after implementation of Delaware Contraceptive Access Now (DelCAN), a statewide initiative that aimed to increase access to long-acting reversible contraceptives (LARCs).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Design, setting, and participants<\/jats:title>\n<jats:p>We used a difference-in-differences design to examine contraceptive initiation rates. Data came from IBM Marketscan and covered women age 15\u201344 enrolled in employer sponsored insurance. The primary outcome was insertion of a LARC, both in the overall study population and in the immediate postpartum (IPP) setting. Secondary analysis examined changes to other contraceptive method types.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>The cohort of 4,550,459 enrollees generated a sample of 11,888,837 person-years and 615,670 childbirth hospitalizations. Difference-in-differences estimates suggested that DelCAN was associated with a 0.3 percentage point (95% CI [0.2, 0.5], p&lt;0.001) increase in the LARC insertion rate in the overall study population and a 0.4 percentage point increase (95% CI [0.2, 0.6], p&lt;0.001) in the percent of births adopting IPP LARC. Associations between DelCAN and LARC insertion appeared stronger for adolescents compared to older women. Results for other method types were less consistent.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>A comprehensive statewide program was associated with increased LARC insertion rates among enrollees with employer sponsored insurance. Understanding the effect of these programs is critical for on-going policy development for states engaged in contraceptive access reform.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0280588","type":"journal-article","created":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T18:29:26Z","timestamp":1674498566000},"page":"e0280588","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["The effect of contraceptive access reform on privately insured patients: Evidence from Delaware Contraceptive Access Now"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3827-3648","authenticated-orcid":true,"given":"Maranna","family":"Yoder","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Boudreaux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,1,23]]},"reference":[{"key":"pone.0280588.ref001","doi-asserted-by":"crossref","DOI":"10.1363\/2021.33141","article-title":"Pregnancies and Pregnancy Desires at the State Level: Estimates for 2017 and Trends Since 2012 [Internet].","author":"K Kost","year":"2021"},{"key":"pone.0280588.ref002","author":"A Sonfield","year":"2013"},{"key":"pone.0280588.ref003","first-page":"218","volume-title":"The Oxford Handbook of Women and the Economy [Internet].","author":"MJ Bailey","year":"2018"},{"key":"pone.0280588.ref004","article-title":"Moving Forward: Family Planning in the Era of Health Reform [Internet].","author":"A Sonfield","year":"2014","journal-title":"Guttmacher Institute"},{"issue":"11","key":"pone.0280588.ref005","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1097\/MLR.0b013e3182a97b5d","article-title":"The Impact of Out-of-Pocket Costs on the Use of Intrauterine Contraception Among Women With Employer-sponsored Insurance","volume":"51","author":"LE Pace","year":"2013","journal-title":"Med Care"},{"key":"pone.0280588.ref006","article-title":"How Subsidies Affect Contraceptive Use among Low-Income Women in the U.S.: A Randomized Control Trial.","author":"MJ Bailey","year":"2021"},{"issue":"6","key":"pone.0280588.ref007","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.contraception.2012.05.011","article-title":"A missed opportunity for care: two-visit IUD insertion protocols inhibit placement.","volume":"86","author":"A Bergin","year":"2012","journal-title":"Contraception"},{"issue":"1","key":"pone.0280588.ref008","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1001\/jama.2019.6854","article-title":"Association Between South Carolina Medicaid\u2019s Change in Payment for Immediate Postpartum Long-Acting Reversible Contraception and Birth Intervals","volume":"322","author":"MW Steenland","year":"2019","journal-title":"JAMA"},{"issue":"4","key":"pone.0280588.ref009","doi-asserted-by":"crossref","first-page":"S886.e1","DOI":"10.1016\/j.ajog.2019.11.1282","article-title":"Coverage of immediate postpartum long-acting reversible contraception has improved birth intervals for at-risk populations","volume":"222","author":"A Liberty","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"4","key":"pone.0280588.ref010","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.whi.2021.02.009","article-title":"Provision of Immediate Postpartum Long-Acting Reversible Contraceptives Before and After Wisconsin Medicaid\u2019s Payment Change","volume":"31","author":"RD Kramer","year":"2021","journal-title":"Womens Health Issues"},{"issue":"2","key":"pone.0280588.ref011","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1377\/hlthaff.2020.00254","article-title":"Medicaid Payments For Immediate Postpartum Long-Acting Reversible Contraception: Evidence From South Carolina","volume":"40","author":"MW Steenland","year":"2021","journal-title":"Health Aff (Millwood)."},{"key":"pone.0280588.ref012","article-title":"Association of Medicaid Reimbursement for Immediate Postpartum Long-acting Reversible Contraception With Infant Birth Outcomes","author":"MW Steenland","year":"2022","journal-title":"JAMA Pediatr [Internet]."},{"key":"pone.0280588.ref013","article-title":"Medicaid reimbursement program for immediate postpartum long-acting reversible contraception improves uptake regardless of insurance status","author":"SK Koch","year":"2022","journal-title":"Contraception"},{"key":"pone.0280588.ref014","unstructured":"Medicaid Reimbursement for Postpartum LARC | ACOG [Internet]. [cited 2022 Jun 20]. Available from: https:\/\/www.acog.org\/programs\/long-acting-reversible-contraception-larc\/activities-initiatives\/medicaid-reimbursement-for-postpartum-larc."},{"key":"pone.0280588.ref015","first-page":"36","article-title":"Preventing Unplanned Pregnancy: Lessons from the States [Internet].","author":"IV Sawhill","year":"2019","journal-title":"Economic Studies at Brookings"},{"issue":"S5","key":"pone.0280588.ref016","doi-asserted-by":"crossref","first-page":"S473","DOI":"10.2105\/AJPH.2022.306824","article-title":"Scaling Up Evidence-Based Practices in Contraceptive Access Initiatives.","volume":"112","author":"NM Malcolm","year":"2022","journal-title":"Am J Public Health"},{"key":"pone.0280588.ref017","article-title":"Summary Description of the Initiative [Internet].","author":"YS Choi","year":"2021","journal-title":"DelCAN Initiative Evaluation"},{"issue":"5","key":"pone.0280588.ref018","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1111\/1475-6773.13698","article-title":"An evaluation of the Be Your Own Baby public awareness campaign","volume":"56","author":"D Marthey","year":"2021","journal-title":"Health Serv Res"},{"key":"pone.0280588.ref019","unstructured":"Author\u2019s calculations. See Prevalence of Selected Maternal and Child Health Indicators for Alaska, Pregnancy Risk Assessment Monitoring System (PRAMS), 2016\u20132019 [Internet]. p. 2. Available from: https:\/\/www.cdc.gov\/prams\/prams-data\/mch-indicators\/states\/pdf\/2019\/Alaska_PRAMS_Prevalence-of-Selected-Indicators_2016-2019_508.pdf."},{"key":"pone.0280588.ref020","unstructured":"Author\u2019s calculations. See Hamilton B, Martin J, Osterman M. Births: Provisional Data for 2020 [Internet]. National Center for Health Statistics; 2021 May [cited 2021 Dec 24]. Available from: https:\/\/stacks.cdc.gov\/view\/cdc\/104993."},{"issue":"2","key":"pone.0280588.ref021","first-page":"83","article-title":"The cost of unintended pregnancies for employer-sponsored health insurance plans","volume":"8","author":"G Dieguez","year":"2015","journal-title":"Am Health Drug Benefits."},{"key":"pone.0280588.ref022","unstructured":"IBM Marketscan Commercial Claims and Encounters Database [Internet]. Merative; 2012. 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comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples","volume":"28","author":"PC Austin","year":"2009","journal-title":"Stat Med"},{"issue":"1","key":"pone.0280588.ref029","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.jeconom.2020.06.003","article-title":"Doubly robust difference-in-differences estimators.","volume":"219","author":"PHC Sant\u2019Anna","year":"2020","journal-title":"J Econom"},{"issue":"S5","key":"pone.0280588.ref030","doi-asserted-by":"crossref","first-page":"S537","DOI":"10.2105\/AJPH.2022.306938","article-title":"Delaware Contraceptive Access Now and Contraceptive Initiation Among Medicaid Enrollees, 2015\u20122020","volume":"112","author":"M Boudreaux","year":"2022","journal-title":"Am J Public Health"},{"key":"pone.0280588.ref031","doi-asserted-by":"crossref","first-page":"104288","DOI":"10.1016\/j.jpubeco.2020.104288","article-title":"The power of the IUD: Effects of expanding access to contraception through Title X clinics","volume":"192","author":"A Kelly","year":"2020","journal-title":"J Public EconDec"},{"issue":"2","key":"pone.0280588.ref032","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.contraception.2021.03.015","article-title":"Delaware Contraceptive Access Now (DelCAN) initiative: A qualitative analysis of site leaders\u2019 implementation recommendations","volume":"104","author":"I Skra\u010di\u0107","year":"2021","journal-title":"Contraception"},{"key":"pone.0280588.ref033","article-title":"Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use.","author":"ML Caudillo","year":"2022","journal-title":"Matern Child Health J [Internet]"},{"issue":"2","key":"pone.0280588.ref034","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.contraception.2019.03.053","article-title":"Implementing best practices for the provision of long-acting reversible contraception: a survey of 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Eliminating Contraceptive Cost Sharing Influenced Choices Of Women With Employer Coverage.","volume":"35","author":"CS Carlin","year":"2016","journal-title":"Health Aff (Millwood)."},{"issue":"10","key":"pone.0280588.ref038","doi-asserted-by":"crossref","first-page":"1762","DOI":"10.1377\/hlthaff.2017.0610","article-title":"Deductible Health Plans Reduce Health Care Cost And Utilization, Including Use Of Needed Preventive Services","volume":"36","author":"R Agarwal","year":"2017","journal-title":"Health Aff (Millwood)."}],"container-title":["PLOS 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