Health Insurance Coverage and Unplanned Births in Rotterdam, the Netherlands

A Natural Experiment in the Generation R Study

Bibliographic Data

ID7994476
AuthorsClair A Enthoven (0000-0003-0812-8765, Erasmus MC), Jeremy A Labrecque (0000-0002-1028-2158, Erasmus MC), Nicole Lucassen (0000-0002-3432-0382, Erasmus University Rotterdam), Marco Varkevisser (0000-0001-6078-3586, Erasmus University Rotterdam), Hilmar H Bijma (0000-0002-5800-8051, Erasmus MC - Sophia Children’s Hospital), Hanan El Marroun (0000-0002-9763-5015, Erasmus MC), Pauline W Jansen (0000-0001-7747-5803, Erasmus MC, corresponding author)
Year2025
Volume57
Issue3
Pages293-300
Publication date2025-06-21
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePerspectives on Sexual and Reproductive Health (JOURNAL)
Journal identifiersISSN: 1538-6341 • E-ISSN: 1931-2393
PublisherWiley (PUBLISHER • GB)
DOI10.1111/psrh.70020
PMID40542595
OpenAlexW4411504673
LanguageEN
References cited22

Objectives Starting January 1 2004, contraception was removed from the Dutch social health insurance for people aged 21 years and over. This study investigated the effect of social health insurance coverage for contraception on unplanned births. Methods Data from the Generation R Study was used, a population‐based birth cohort of pregnant people with delivery dates between 2002 and 2006 ( N = 2516) in Rotterdam, the Netherlands. Logistic regression models were constructed with a pre‐post policy variable, date of the last menstruation relative to January 12,004 and the interaction between them to allow the model to change over time with unplanned births as outcome, adjusted for age, migration background, educational level, household income and financial difficulties. Results Removing contraception coverage from the social health insurance in 2004 showed a small increase in the odds ratio for unplanned birth, which was not statistically significant (OR = 1.18; 95% CI = 0.79–1.75). When participants with the last menstruation between January 1, 2004 and July 1, 2004 were excluded, a significant increase in the odds ratio for unplanned birth was found (OR = 2.69; 95% CI = 1.09–6.66). Conclusions In our population of pregnant participants aged 21 years and older, we found tentative evidence that removal of contraception from the social health insurance may have led to a small increase in unplanned births with a time lag of 6 months. As this study only included pregnant people who gave birth, our results should be interpreted with caution and further research is needed for a definite conclusion on the effect of health insurance coverage on unplanned pregnancies

Cohort study · Environmental health · Live birth · Logistic regression · Odds · Odds ratio · Population · Pregnancy · Demography · Global Maternal and Child Health · Maternal and Perinatal Health Interventions · Medicine · Reproductive Health and Contraception

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