Contraception & pregnancy complication diagnosis before and after the contraception mandate

Longitudinal study on

VT women’s health

Rosaria Chiang & Mukul Anapindi

Introduction

In Vermont, half of all pregnancies are unintended, which correlates with both short- and long-term negative health consequences for mothers and babies.

To address the problem, the state of Vermont proposed Women’s Health Initiative in 2016. One of the initiative is the same-day access to effective birth control -- improving ease of access.

On August 2012, the Affordable Care Act of 2010 mandated that contraceptives be provided free. The act improves access to birth control by alleviating financial burden.

The question is: Does improving access to birth control correlate with increased usage of contraceptives and fewer pregnancy complications?

The hypothesis is: Free access to birth control correlates with increased usage of contraceptives and fewer pregnancy complications.

To test the hypothesis, Vermont hospital discharge record data from 2009-2016 was examined.

2

Method

Most records are of normal pregnancy

Positive diagnosis Negative diagnosis Preventative diagnosis

• Normalized # of records were added to calculate the total for positive, negative, and preventative diagnosis (dx) records from 2009-2016.

​

• Most records (74.65%) pertain to normal pregnancy with 15.36% on negative diagnosis (pregnancy complications) and 9.99% on preventative diagnosis (contraceptives).

3

Import VT Hospital Discharge Data from 2009-2016 (inpatient, outpatient, expanded outpatients)

Using python, filter for women’s records with diagnosis code related to contraception, pregnancy, and birth

Normalize number of discharge records by number of women age between 15 and 45

Visualize on Tableau

CCSDX code

Preventative diagnosis increases after 2012

• There is an increase in preventative diagnosis, which closely coincides with when contraceptive mandate went into effect (August 2012).

​

• 2016 is the most recent available data, and thus the data may not be not “mature,” i.e. the records may not be complete. This could explain the dips in 2016 Q3 & Q4 for preventative and positive diagnosis.

4

Conclusions

• Preventative diagnosis increases after 2012 when contraceptive mandate goes into effect. While it is unknown whether the mandate or other factors caused the increase, it suggests that more contraceptive and procreation management services may be used when the financial burden is alleviated. VT Women’s Health Initiative may further the trend by providing same-day service.

​

• The number of positive or negative diagnosis related to pregnancy remains relatively constant from 2009-2016. However, given that the policy went into effect in 2012, there might not have been enough time to see an effect. It could also be that combined effect with community engagement aspect of VT Women’s Health Initiative could lessen the number of pregnancy complications.

​

• The analysis was restricted to Vermont. Further analysis on hospital records of more states would help determine if the trend is similar across the country and identify additional factors correlated with women’s reproductive health records.

​

• The next logical step would be to forecast number of different diagnosis (and hopefully we will be able to do that after Phase 2!).

5

Team DataExplorers

6

References

Geographical Atlas of America, Vermont mapFree maps of US. Accessed 8/4/18; http://us-atlas.com/vermont-map.html

State of Vermont, Women’s Health Initiative | Blueprint for Health. Accessed 8/5/18; http://blueprintforhealth.vermont.gov/about-blueprint/womens-health-initiative

National Women’s Law Center, Contraceptive Coverage in the New Health Care Law: Frequently Asked Questions. Accessed 8/5/18; https://www.nwlc.org/sites/default/files/pdfs/contraceptive_coverage_faq_11.9.11.pdf

Vermont Department of Health, Hospital Discharge Data | Vermont Department of Health. Accessed 8/3/18; http://www.healthvermont.gov/health-statistics-vital-records/health-care-systems-reporting/hospital-discharge-data

Data Access and Dissemination Systems (DADS), American FactFinder. Accessed 8/4/18. https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml

Google drive with analysis files: https://drive.google.com/drive/folders/1eDKpmBOxDZPQzjMR9uJtZ5L63GG5jJTz?usp=sharing

Hospital discharge data for use in this study were supplied by the Vermont Association of Hospitals and Health Systems-Network Services Organization (VAHHS-NSO) and the Vermont Green Mountain Care Board (GMCB). All analyses, interpretations or conclusions based on these data are solely that of the authors (Rosaria Chiang and Mukul Anapindi). VAHHS-NSO and GMCB disclaim responsibility for any such analyses, interpretations or conclusions. In addition, as the data have been edited and processed by VAHHS-NSO, GMCB assumes no responsibility for errors in the data due to coding or processing by hospitals, VAHHS-NSO or any other organization, including the authors.

7