Socioeconomic Differences in Long-Acting Reversible Contraceptive Use for Achieving U.S. Women's Family Planning Goals: "Right Time" Births.

Steep increases in the use of long-acting reversible contraceptives (LARCs) have occurred during the past two decades in the United States, driven in part by LARC-focused contraceptive access programs and policies designed to reduce early and unintended pregnancies and births. These outcomes have long been concentrated among women of lower socioeconomic status (SES). LARC use has been positively associated with subsequent intended fertility, but the frequency of this post-LARC outcome has not been compared among SES groups in national studies. Using health insurance type to proxy for SES, we combine data from two nationally representative surveys to compare Medicaid-insured and privately insured women's ages at LARC discontinuation, their risk of a post-LARC birth by age, and their reports of whether the post-LARC birth was at the "right time." We find that Medicaid-insured women discontinue LARC use at much younger ages than do privately insured women and have a much higher likelihood of giving birth soon after LARC discontinuation at these younger ages. Consequently, similar overall proportions of women in the two groups report post-LARC births occurring at the "right time." We conclude that the alignment of achieved and desired birth timing following LARC use is similar between these two SES groups.