What Happened in Delaware? Unintended Births and Unplanned Births among All Women and among Medicaid-Insured Women following a Statewide Contraceptive Initiative

Michael S. Rendall, University of Maryland College Park
Constanza Hurtado, Carolina Population Center, UNC Chapel Hill

The 2015-2020 Delaware Contraceptive Access Now (DelCAN) Initiative was motivated by Delaware’s having among the highest rates of unintended births in the United States, being those resulting from pregnancies that were ‘wanted later’ or ‘unwanted’. The expectation of the DelCAN Initiative was that by providing greater contraceptive access, especially to long-acting reversible contraception (LARC), Delaware’s unintended pregnancy rates could be substantially reduced. We assess the role of the DelCAN in explaining, for live births, changes in women’s pregnancy intentions around the time of conception. We use Pregnancy Risk Assessment Monitoring System data with difference-in-difference estimators to compare Delaware to six states in 2007-2020 with respect to the planned status of births, and to 14 states in 2012-2020 with respect to the intended status of births. We find that the DelCAN was not associated with reductions in unintended childbearing in Delaware relative to comparison states, but was associated with an increase in births ‘wanted sooner.’ DelCAN was also associated with an increase in planned births, concentrated among lower-income women and produced through reductions in pregnancies occurring when not using contraception. We conclude that pregnancy intentions and pregnancy planning should be treated as distinct concepts in contraceptive-access program design and evaluation.

Keywords: Family Planning and Contraception, Sexual and Reproductive Health and Rights

See paper.