Volume 51 | Number 1 | February 2016

Abstract List

Amy J. Graves S.M., M.P.H., Katy B. Kozhimannil Ph.D., M.P.A., Ken P. Kleinman Sc.D., J. Frank Wharam M.B., B.Ch., B.A.O., M.P.H.


To evaluate the association between employer‐mandated enrollment into high‐deductible health plans (s) and contraception and birth rates among reproductive‐age women.

Data Sources/Study Setting

Using data from 2002 to 2008, we examined 1,559 women continuously enrolled in a Massachusetts health plan for 1 year before and after an employer‐mandated switch from an to a , compared with 2,793 matched women contemporaneously enrolled in an .

Study Design

We used an individual‐level interrupted time series with comparison series design to examine level and trend changes in clinician‐provided contraceptives and a differences‐in‐differences design to assess annual birth rates.

Data Collection/Extraction Methods

Employer, plan, and member characteristics were obtained from enrollment files. Contraception and childbirth information were extracted from pharmacy and medical claims.

Principal Findings

Monthly contraception rates were 19.0–24.0 percent at baseline. Level and trend changes did not differ between groups ( = .92 and  = .36, respectively). Annual birth rates declined from 57.1/1,000 to 32.7/1,000 among members and from 61.9/1,000 to 56.2/1,000 among controls, a 40 percent relative reduction in odds of childbirth (odds ratio = 0.60;  = .02).


Women who switched to s experienced a lower birth rate, which might reflect strategies to avoid childbirth‐related out‐of‐pocket costs under s.