Prescribed by Policy: State-Level Gestational Age Limit Policies and Contraceptive Utilization among Women on Medicaid

• In Event: Sociology of Reproduction

Abstract

Abortion access in the United States has declined sharply over the past decade, driven largely by the proliferation of state-level gestational age limit laws. Although often framed as medically neutral regulations, these policies function as administrative burdens that narrow the window for legal abortion and disproportionately constrain access for socioeconomically disadvantaged populations. Medicaid recipients, who are disproportionately low-income and women of color. face additional barriers due to the long-standing restrictions imposed by the Hyde Amendment, which limits federal funding for abortion services. While prior research has examined the relationship between abortion policy and contraceptive use, less attention has been paid to how evolving state abortion restrictions intersect with Medicaid coverage to shape contraceptive utilization over time.
This study examines whether state-level gestational age limit policies influence contraceptive use among Medicaid beneficiaries. Drawing on a longitudinal panel dataset spanning 2010–2019, the analysis integrates Medicaid State Drug Utilization Data from the Centers for Medicare & Medicaid Services with state-level abortion policy data from the Guttmacher Institute and contextual socioeconomic and health system indicators. Using a difference-in-differences event study framework, the study exploits staggered policy adoption across states to estimate the causal impact of gestational age restrictions on Medicaid-covered contraceptive prescriptions, including intrauterine devices, oral contraceptives, patches, and rings.
Grounded in an administrative burden framework, this research conceptualizes gestational age limits not merely as legal constraints but as mechanisms of bureaucratic gatekeeping that shift implementation costs onto individuals. I hypothesize that the enactment of restrictive gestational age laws will be associated with increased contraceptive utilization among Medicaid recipients, particularly in long-acting reversible contraceptive methods, as individuals respond to narrowing abortion access by adjusting preventive behaviors. By illuminating how reproductive policy environments shape health-seeking behavior within publicly insured populations, this study contributes to scholarship on reproductive justice, health inequality, and the governance of care.

Author

• Bhumi P. Shah, Brown University