Impact of Contraceptive Coverage Policies on Adolescent Contraceptive Use and Risky Sexual Behaviors

Background and Purpose: Over the past three decades while there have been changes in state and federal laws aimed at increasing access to contraceptive options, limited studies have used nationally-representative data to examine the impact of these changes in contraceptive coverage policies on contraceptive use and risky sexual behaviors among adolescents.

Methods: Using 2003-2017 Youth Risk Behavior Survey data on 224,032 adolescents from 34 states, we conducted difference-in-differences models to examine changes in contraceptive use and risky sexual behaviors before and after implementation of contraceptive coverage policies, separately for females and males. We also tested interactions between age and pharmacy access to emergency contraception.

Results: Over the study period, reported condom use decreased and use of birth control pills and injectables/IUDs increased. Adolescents reporting early age at first sexual intercourse and multiple sexual partners decreased, while use of no contraceptive method increased. Access to emergency contraception was associated with a 4.2% increase in condom use among 18-year-old males and 3.8% decrease in use of birth control pills among their partners. None of the policies were associated with changes in risky sexual behaviors among females. However, effect of pharmacy access to emergency contraception was concentrated among 18-year-old males with increased likelihood of reporting multiple sexual partners and early age at first sexual intercourse.

Conclusions and Implications: Among contraceptive coverage policies, policy on increased access to emergency contraception had no associations with changes in contraceptive use and did not lead to risky sexual behaviors among females, but there was some evidence of increased risk among males.