title: The cost of unintended pregnancies for employer-sponsored health insurance plans.
abstract: BACKGROUND
  Pregnancy is associated with a significant cost for employers providing health insurance benefits to their employees. The latest study on the topic was published in 2002, estimating the unintended pregnancy rate for women covered by employer-sponsored insurance benefits to be approximately 29%.
  
  
  OBJECTIVE
  The primary objective of this study was to update the cost of unintended pregnancy to employer-sponsored health insurance plans with current data. The secondary objective was to develop a regression model to identify the factors and associated magnitude that contribute to unintended pregnancies in the employee benefits population.
  
  
  METHODS
  We developed stepwise multinomial logistic regression models using data from a national survey on maternal attitudes about pregnancy before and shortly after giving birth. The survey was conducted by the Centers for Disease Control and Prevention through mail and via telephone interviews between 2009 and 2011 of women who had had a live birth. The regression models were then applied to a large commercial health claims database from the Truven Health MarketScan to retrospectively assign the probability of pregnancy intention to each delivery.
  
  
  RESULTS
  Based on the MarketScan database, we estimate that among employer-sponsored health insurance plans, 28.8% of pregnancies are unintended, which is consistent with national findings of 29% in a survey by the Centers for Disease Control and Prevention. These unintended pregnancies account for 27.4% of the annual delivery costs to employers in the United States, or approximately 1% of the typical employer's health benefits spending for 1 year. Using these findings, we present a regression model that employers could apply to their claims data to identify the risk for unintended pregnancies in their health insurance population.
  
  
  CONCLUSIONS
  The availability of coverage for contraception without employee cost-sharing, as was required by the Affordable Care Act in 2012, combined with the ability to identify women who are at high risk for an unintended pregnancy, can help employers address the costs of unintended pregnancies in their employee benefits population. This can also help to bring contraception efforts into the mainstream of other preventive and wellness programs, such as smoking cessation, obesity management, and diabetes control programs.
authors.affiliation: Principal and Consulting Actuary, Milliman, Inc, New York, NY.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Dieguez
authors.affiliation: Principal and Consulting Actuary, Milliman, Inc, New York, NY.
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Pyenson
authors.affiliation: Deputy Director, Health Economics and Outcomes Research, Bayer HealthCare Pharmaceuticals, Whippany, NJ.
authors.forename: Amy W
authors.initials: AW
authors.lastname: Law
authors.affiliation: Medical Director, Bayer HealthCare Pharmaceuticals, Whippany, NJ.
authors.forename: Richard
authors.initials: R
authors.lastname: Lynen
authors.affiliation: Professor of Economics and Public Affairs, Office of Population Research, Princeton University, NJ.
authors.forename: James
authors.initials: J
authors.lastname: Trussell
keywords: PRAMS questionnaire; contraception; costs; delivery; employee benefits; employer-sponsored health insurance; unintended pregnancy