The Effects of Contraceptive Access on Women’s Health and Wellbeing: Evidence from a Randomized Control Trial at Five Years - Modified Project Summary/Abstract Section The project will conduct a follow-up study of an NIH-funded randomized control trial (RCT) that made contraception more affordable for U.S. women seeking care at Title X providers--a federal program that has offered subsidized, patient-centered reproductive health services since 1970. From 2018-23, the Michigan Contraceptive Access, Research, and Evaluation Study (M-CARES) randomly assigned vouchers making any method of contraception highly discounted or free and has followed participants for two years in administrative and survey data. The proposed project extends the scope of M-CARES to consider a comprehensive set of health and well-being outcomes measured three to five years after study enrollment. The project's specific aims are to: (1) Link M-CARES participants to administrative records three to five years after enrollment, including (a) birth records, (b) credit reports, (c) IRS tax and Census data, and (d) health care records to be used for research. We have executed data use agreements (DUAs) with relevant agencies, and our preliminary studies project almost universal link rates with these records. (2) Develop and field a year-five follow-up survey (Y5FU), which will focus on information missing or incomplete in administrative records, including (a) contraceptive use; (b) retrospective pregnancy outcomes and desire/intendedness; (c) physical and mental health; (d) relationship stability and quality; (e) education and labor-market outcomes; (f) financial stability; (g) parenting; and (h) overall well-being. (3) Quantify the cumulative causal effects of reducing the costs of contraception on outcomes measured three to five years later, using the trial’s random assignment and outcomes from data in Aims 1 and 2. Achieving these aims will contribute novel and rigorous evidence regarding how the affordability of contraception affects a comprehensive set of health and well-being outcomes at three to five years. The combination of administrative and survey data maximizes the information collected per dollar spent and minimizes attrition and measurement error. Achieving this study's aims would provide a more complete cost-benefit accounting of public programs subsidizing contraceptives, such as Title X and Medicaid.
