title: Did increasing use of highly effective contraception contribute to declining abortions in Iowa?
abstract: BACKGROUND
  Between 2006 and 2008, Iowa increased access to family planning services through a Medicaid expansion and a privately funded initiative. During this same time, Iowa expanded access to abortion through telemedicine provision of medical abortion. Despite increased access to abortion services, abortions in Iowa have declined. This study assessed whether increased provision of long-acting reversible contraception (LARC) may have contributed to the abortion decline.
  
  
  METHODS
  We analyzed abortion data from Iowa vital statistics and LARC use data from 14 family planning agencies' records (N=544,248) for the years 2005 to 2012. Mixed-effects logistic regression analyses assessed whether changes in the percentage of LARC users were associated with subsequent reductions in abortion across the state.
  
  
  RESULTS
  From 2005 to 2012, the number of family planning clients using LARC increased from 539 to 8603 (less than 1% to 15%); the number of resident abortions decreased from 5198 to 3887 (8.7 per 1000 women aged 15-44 to 6.7). There were reduced odds of abortion (adjusted odds ratio, 0.96; 95% confidence interval: 0.94-0.97) with increased LARC use.
  
  
  CONCLUSIONS
  Declines in abortion followed increases in LARC use in Iowa.
authors.affiliation: Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA. Electronic address: Antonia.biggs@ucsf.edu.
authors.forename: M A
authors.initials: MA
authors.lastname: Biggs
authors.affiliation: Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA.
authors.forename: C H
authors.initials: CH
authors.lastname: Rocca
authors.affiliation: Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA.
authors.forename: C D
authors.initials: CD
authors.lastname: Brindis
authors.affiliation: Philliber Research Associates, Accord, NY.
authors.forename: H
authors.initials: H
authors.lastname: Hirsch
authors.affiliation: Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA; Ibis Reproductive Health, Oakland, CA.
authors.forename: D
authors.initials: D
authors.lastname: Grossman
mesh_terms: D000028:Abortion, Induced / Q000191:economics; D000293:Adolescent; D000328:Adult; D003268:Contraception Behavior / Q000639:trends; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000191:economics; D004343:Drug Implants; D016656:Family Planning Policy; D005193:Family Planning Services / Q000191:economics / Q000639:trends; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000639:trends; D006801:Humans; D007434:Intrauterine Devices / Q000191:economics; D007484:Iowa; D008137:Longitudinal Studies; D008484:Medicaid; D011203:Poverty; D011247:Pregnancy; D011275:Pregnancy, Unwanted; D017216:Telemedicine / Q000191:economics / Q000639:trends; D014481:United States; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants
keywords: Abortion; Family planning; Iowa; Long-acting reversible contraception