266740 Reducing teen birth rates and increasing contraceptive use in Arkansas: A success story

Tuesday, October 30, 2012

Loretta Alexander, MHSA , Fay W. Boozman COPH, Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR
Songthip Ounpraseuth, PhD , Fay W. Boozman COPH, Biostatistics, Univ. of Arkansas for Medical Sciences, Little Rock, AR
Ruth L. Eudy, MSW, PhD , Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
Judy Bennett, MS , Fay W. Boozman COPH, Health Policy & Mgmt., University of Arkansas for Medical Sciences, Little Rock, AR
The Arkansas Medicaid Women's Health Waiver (WHW) expansion has provided family planning services to women in Arkansas with incomes up to 200% of the Federal Poverty Level since 2003. Two of the stated WHW objectives are increased contraceptive use and reduction of pregnancy during an important developmental phase of the life cycle, adolescence. The study presented here evaluates the outcomes for those objectives. Using de-identified linked data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) survey and Medicaid claims from the years 2003-2009 (N=22,665), the evaluation team was able to identify WHW participants and non-participants. This linkage, coupled with use of propensity score matching, allowed us to conduct more rigorous testing of earlier findings of improved teen pregnancy rates and contraceptive use. After controlling for confounders, WHW participants were significantly less likely to have teen births than non- participants (5.20% vs. 10.03%, Rao-Scott Chi Square = 40.83, p<0.0001). They were also significantly more likely to be using birth control when surveyed (88.30% vs. 85.66%, Rao-Scott Chi Square = 7.67, p<0.01). Trend analyses (to be illustrated graphically in the presentation) revealed that rates for the WHW participants ranged from half those of non-participants to 1/3 those of non-participants during the six year period. The most substantial drops in teen pregnancy rates for WHW participants occurred during the first two years of expanded eligibility.

These significant decreases in teen births and increases in contraceptive use indicate that the WHW program has consistently met two of its primary objectives.

Learning Areas:
Clinical medicine applied in public health
Provision of health care to the public

Learning Objectives:
Demonstrate differences in teen pregnancy rates between Medicaid Women's Health Waiver participants and nonparticipants Demonstrate greater Medicaid Women's Health Waiver participants'contraception use between a matched sample of participants and non participants

Keywords: Family Planning, Adolescent Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Research Associate working directly with the Principal Investigator responsible for preparing the Arkansas Medicaid Women’s Health Waiver Evaluation Report to CMS. I am Director involved with the development of the Evaluation Design of the WHW application. Additionally, I have served as the Program directly of a federal research grant which provided direct services to a cohort of 120 families with a caseload of over 40% teen mothers.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.