Health Insurance Coverage and Unplanned Births in Rotterdam, the Netherlands: A Natural Experiment in the Generation R Study.

Abstract

Objectives: Starting January 1 2004, contraception was removed from the Dutch social health insurance for people aged 21 years and over. This study investigated the effect of social health insurance coverage for contraception on unplanned births.

Methods: Data from the Generation R Study was used, a population-based birth cohort of pregnant people with delivery dates between 2002 and 2006 (N = 2516) in Rotterdam, the Netherlands. Logistic regression models were constructed with a pre-post policy variable, date of the last menstruation relative to January 12,004 and the interaction between them to allow the model to change over time with unplanned births as outcome, adjusted for age, migration background, educational level, household income and financial difficulties.

Results: Removing contraception coverage from the social health insurance in 2004 showed a small increase in the odds ratio for unplanned birth, which was not statistically significant (OR = 1.18; 95% CI = 0.79-1.75). When participants with the last menstruation between January 1, 2004 and July 1, 2004 were excluded, a significant increase in the odds ratio for unplanned birth was found (OR = 2.69; 95% CI = 1.09-6.66).

Conclusions: In our population of pregnant participants aged 21 years and older, we found tentative evidence that removal of contraception from the social health insurance may have led to a small increase in unplanned births with a time lag of 6 months. As this study only included pregnant people who gave birth, our results should be interpreted with caution and further research is needed for a definite conclusion on the effect of health insurance coverage on unplanned pregnancies.