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“Repeal and replace”: increased demand for intrauterine devices following the 2016 presidential election

      Abstract

      Objective

      To evaluate public's interest in contraceptive options following heightened focus on a repeal of the Affordable Care Act (ACA) since the 2016 United States presidential election.

      Study design

      We monitored the fraction of Google searches emerging from the United States for the three most popular reversible contraceptive methods — oral contraceptives, intrauterine devices (IUDs) and condoms — from January 1, 2004, through October 31, 2017 (1 year after the presidential election).

      Results

      IUD searches were cumulatively 15% (95% CI: 10 to 20) higher than expected the year following the 2016 election, reflecting 10 to 21 million excess searches. IUD searches were statistically significantly higher in all states, except NV, and were consistent across states won by Trump or Clinton (Welch t test=0.60, p=.548). Conversely, searches for oral contraceptives and condoms remained stable (0%; 95% CI: −2 to 1) or declined (−4%; 95% CI: −5 to −2), respectively, following the election.

      Conclusions

      The etiology of increased searches for IUDs is likely multifaceted. However, it may largely be because IUDs will confer continued protection even after an ACA repeal, thereby providing a medical hedge against a possible repeal. Regardless, these data suggest the heightened focus on an ACA repeal is a concern to the record number of Americans seeking out information about IUDs.

      Keywords

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      References

        • Finer L.B.
        • Zolna M.R.
        Shifts in intended and unintended pregnancies in the United States, 2001–2008.
        Am J Public Health. 2014; 104: S43-S48
        • Guttmacher Institute
        Public costs from unintended pregnancies and the role of public insurance programs in paying for pregnancy-related care: national and state estimates for 2010.
        ([Published February 2015])
        • Richards C.
        Protecting and expanding access to birth control.
        N Engl J Med. 2016; 374: 801-803
        • Becker N.V.
        • Polsky D.
        Women saw large decrease in out-of-pocket spending for contraceptives after ACA mandate removed cost sharing.
        Health Aff. 2015; 34: 1204-1211
        • Fox J.
        • Barfield W.
        Decreasing unintended pregnancy opportunities created by the Affordable Care Act.
        JAMA. 2016; 316: 815-816
        • Gostin L.O.
        • Hyman D.A.
        • Jacobson P.D.
        The Affordable Care Act: moving forward in the coming years.
        JAMA. 2017; 317: 19-20
        • Ayers J.W.
        • Althouse B.M.
        • Dredze M.
        Could behavioral medicine lead the web data revolution?.
        JAMA. 2014; 311: 1399-1400
        • Ayers J.W.
        • Althouse B.M.
        • Leas E.C.
        • Dredze M.
        • Allem J.P.
        Internet searches for suicide following the release of 13 Reasons Why.
        JAMA Intern Med. 2017; 177: 1527-1529
        • Ayers J.W.
        • Althouse B.M.
        • Dredze M.
        • Leas E.C.
        • Noar S.M.
        News and internet searches about human immunodeficiency virus after Charlie Sheen's disclosure.
        JAMA Intern Med. 2016; 176: 552-554
        • Allem J.P.
        • Leas E.C.
        • Caputi T.L.
        • et al.
        The Charlie Sheen effect on rapid in-home human immunodeficiency virus test sales.
        Prev Sci. 2017; 18: 541-544
        • Santillana M.
        • Zhang D.W.
        • Althouse B.M.
        • Ayers J.W.
        What can digital disease detection learn from (an external revision to) Google flu trends?.
        Am J Prev Med. 2014; 47: 341-347
        • Hyndman R.J.
        • Khandakar Y.
        Automatic time series forecasting: the forecast package for R.
        J Stat Softw. 2008; 27: 1-22
        • Carney Jordain
        Trump health chief: Senate will vote on ObamaCare repeal by August The Hill.
        ([Published May 12, 2017])
        • Williams D.R.
        • Medlock M.M.
        Health effects of dramatic societal events — ramifications of the recent presidential election.
        N Engl J Med. 2017; 376: 2295-2299
        • Division of Reproductive Health
        Centers for Disease Control and Prevention.
        ([Updated February 9, 2017])
        • McNicholas C.
        • Madden T.
        • Secura G.
        • Peipert J.F.
        The contraceptive CHOICE project round up: what we did and what we learned.
        Clin Obstet Gynecol. 2014; 57: 635-643
        • Durante J.C.
        • Woodhams E.J.
        Patient education about the affordable care act contraceptive coverage requirement increases interest in using long-acting reversible contraception.
        Womens Health Issues. 2017; 27: 152-157