How Costs Limit Contraceptive Use among Low-Income Women in the U.S.: A Randomized Control Trial

The Affordable Care Act eliminated cost-sharing for contraception for Americans with health insurance, but substantial cost sharing remains for uninsured individuals who seek care through Title X—a national family planning program that provides patient-centered, subsidized contraception and reproductive health services in the U.S. This paper uses a randomized control trial (RCT) to examine how cost-sharing at Title X providers affects the choice of contraceptive method. The study randomizes vouchers that cover any contraceptive method up to the cost of 50% or 100% of a name-brand intra-uterine device (IUD). The results show that Title X clients are highly constrained by the out-of-pocket costs of contraception. The offer of free contraception is associated with a 40% increase in the use of any birth control method (ITT effect), a 94% increase in the value of birth control purchased, a 328-day (226%) increase in the period covered by contraceptives purchased, and a 324% increase in the likelihood of choosing a long-acting, reversible method (an IUD or implant). The results imply that eliminating the costs of contraception for Title X clients nationwide would reduce undesired pregnancies by 5.3%, birth rates by 3.9%, and abortions by 8.3%, and save $1.43 billion in the first year of the program.