State abortion context and U.S. women's contraceptive choices, 1995-2010.

CONTEXT: The number of women in the United States exposed to restrictive abortion policies has increased substantially over the past decade. It is not well understood whether and how women adjust their contraceptive behavior when faced with restrictive abortion contexts.

METHODS

Data from 14,523 women aged 15-44 were drawn from the 1995 and 2010 cycles of the National Survey of Family Growth. A difference-in-differences approach was employed to examine the relationship between state-level changes in women's access to abortion and their contraceptive choices. Multinomial logistic regression analysis was used to determine the relative risk of using highly effective or less effective methods rather than no method for women exposed to varying levels of restrictive abortion contexts.

RESULTS

Women who lived in a state where abortion access was low were more likely than women living in a state with greater access to use highly effective contraceptives rather than no method (relative risk ratio, 1.4). Similarly, women in states characterized by high abortion hostility (i.e., states with four or more types of restrictive policies in place) were more likely to use highly effective methods than were women in states with less hostility (1.3). The transition to a more restrictive abortion context was not associated with women's contraceptive behavior, perhaps because states that introduced restrictive abortion legislation between 1995 and 2010 already had significant limitations in place.

CONCLUSION

To prevent unwanted pregnancies, it is important to ensure access to highly effective contraceptive methods when access to abortions is limited.