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Study: Trump's 'Repeal and Replace' debate already impacting women's health

April 09, 2019

Trump recently renewed the "repeal and replace" battle cry promising to make the 2020 election a referendum on Obamacare. While many speculate about the impacts of potentially repealing the Affordable Care Act (ACA), a new study published in the journal Contraception by Drs. Alicia Nobles and John W. Ayers of UC San Diego, found the debate is already impacting women's health across the United States, namely their contraceptive choices.

Study finds link between politics and women's health

Under the ACA, Americans gained access to prescription contraception without out-of-pocket costs. This included intrauterine devices (IUDs) that had long been favored by doctors because of their effectiveness, but shunned by women because of their historically high out-of-pocket costs.

Studies have shown that uptake of IUDs under the ACA both reduced women's total out-of-pocket health care costs by 40% and reduced unintended pregnancies. However, given the "repeal and replace" debate is heating up again, how are women responding to potentially losing this birth control benefit?

For the new study, the team -who often weigh in on current events with data (such as #MeToo, the opioid crisis, or Netflix's 13 Reasons Why)- turned to Google Trends, a public archive of aggregate internet searches, where searches often mirror what the public is thinking and doing with their health. The team monitored the fraction of Google searches emerging from the United States for the three most popular reversible contraceptive methods between January 1, 2004 through October 31, 2017, one year following the 2016 presidential election. This included searches for IUDs (those mentioning "IUD" or IUD brands "ParaGard", "Mirena", "Skyla", "Liletta", and "Kyleena") contrasted against searches for oral contraceptives and condoms.

Searches for IUDs were cumulatively 15 percent higher than expected the year following the 2016 election, reflecting 10 to 21 million more searches than normal. Searches for IUDs were significantly higher in all states, except Nevada, and the increase was consistent regardless whether the state was won by Trump or Clinton.

Moreover, patterns in search trends mirrored the political debate on Capital Hill, revealing for the first time that just the conversation on Capitol Hill is impacting women's choices. For instance, "searches for IUDs reached a record high in May 2017, with 8.3 million total searches that month, when an ACA repeal advanced in the House" said Nobles, a data scientist at UC San Diego and first author of the study.

At the same time, the team found searches for oral contraceptives and condoms remained stable or declined, respectively, the year following the election; reinforcing the finding that women's increased interest in IUDs is uniquely related to the ACA debate.

A quandary for women

"Trump often extols his support of women and their health on Twitter. Surprisingly by threatening to take away their birth control benefits, Trump is prompting more women to consider IUDs, the most effective and long-term cost-efficient form of reversible birth control," said Ayers, the vice chief of innovation at UC San Diego Medicine and study coauthor.

The team attributes this contradictory and puzzling result to women's fears of losing access to birth control without the financial burden. "Women's interest in IUDs appears to be a hedge against ACA repeal by providing long-term family planning," added Nobles.

Implications for the most recent political debate

Based on these results one might hypothesize that more women are turning to IUDs as the ACA debate once again heats up, and you'd be right. "Extending our analyses strategy to the week of March 25, 2019, when Trump urged congress to repeal and the Supreme Court to nullify the ACA, we found searches were 15% higher than the previous week," said Nobles.

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. "With millions more than ever voicing their interest in IUDs it is critically important that health policy makers ensure that IUDs remain affordable," concluded Ayers.
-end-
Dr. Mark Dredze, the John C. Malone associate professor of computer science at Johns Hopkins University, also contributed to the study.

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