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OBJECTIVE(S): The contraception mandate of the Affordable Care Act (ACA) could reduce unintended pregnancies by increasing access and affordability of contraceptive resources, such as long-acting reversible contraceptives (LARCs). The objective of this study was to assess: (1) whether unintended pregnancies decreased following the contraception mandate, and (2) whether this decrease differed by demographic characteristics (race/ethnicity, insurance, or relationship status). STUDY DESIGN: We used data on sexually active, fecund women of reproductive age from the National Survey of Family Growth (NSFG) (unweighted n=7,409). We used logistic regression to compare odds of unintended pregnancy between pre-mandate (2008–2010) and post-mandate (2013–2015) periods, both overall and stratified by demographic characteristics. RESULTS: Paralleling an increase in LARC use (p<0.01), the percentage of women experiencing unintended pregnancy in the prior year decreased from 5.5% to 4.9% (p=0.45), and the percentage of pregnancies that were unintended in the prior year decreased from 44.7% to 37.9% (p=0.21) following the mandate. Overall, the odds of experiencing unintended pregnancy decreased 15% from the pre-mandate to post-mandate period (OR: 0.85, 95% CI: 0.62, 1.17; p=0.32), with the greatest reduction in odds observed in women with government-sponsored insurance (OR: 0.63, 95% CI: 0.41, 0.97; p=0.04). CONCLUSIONS: Unintended pregnancy decreased in NSFG respondents in the two years following the contraception mandate, but this observation may have been due to chance. The current study, however, is limited by its early study period which could under-estimate the mandate's full effect. More effort is required to identify and address additional barriers to contraception and reproductive autonomy.

The black-white disparity in preterm birth has been well documented in the USA. The racial/ethnic composition of a neighborhood, as a marker of segregation, has been considered as an underlying cause of the racial difference in preterm birth. However, past literature using cross-sectional measures of neighborhood racial/ethnic composition has shown mixed results. Neighborhoods with static racial/ethnic compositions over time may have different social, political, economic, and service environments compared to neighborhoods undergoing changing racial/ethnic compositions, which may affect maternal health. We extend the past work by examining the contribution of neighborhood racial/ethnic composition trajectories over 20 years to the black-white difference in preterm birth. We used natality files (N = 477,652) from birth certificates for all live singleton births to non-Hispanic black and non-Hispanic white women in Texas from 2009 to 2011 linked to the Neighborhood Change Database. We measured neighborhood racial/ethnic trajectories over 20 years. Hierarchical generalized linear models examined relationships between neighborhood racial/ethnic trajectories and preterm birth, overall and by mother's race. Findings showed that overall, living in neighborhoods with a steady high proportion non-Hispanic black was associated with higher odds of preterm birth, compared with neighborhoods with a steady low proportion non-Hispanic black. Furthermore, while black women's odds of preterm birth was relatively unaffected by neighborhood proportions of the Latinx or non-Hispanic white population, white women had the highest odds of preterm birth in neighborhoods characterized by a steady high proportion Latinx or a steady low proportion non-Hispanic white. Black-white differences were the highest in neighborhoods characterized by a steady high proportion white. Findings suggest that white women are most protected from preterm birth when living in neighborhoods with a steady high concentration of whites or in neighborhoods with a ...