Objectives: To understand immediate postpartum long-acting reversible contraception (IPP LARC) desire and utilization trends among publicly insured patients delivering at one academic hospital in a state with health care barriers and high short-interval birth rates.
Study Design: We conducted a retrospective cohort study of electronic delivery records between March 2018 and June 2023 for publicly insured patients. Patient demographics, IPP LARC desire and utilization trends were compared using χ or Fisher exact tests. Binary logistic regression explored the relationship between IPP LARC utilization and demographics. Multivariable logistic regression was performed on all statistically significant variables.
Results: Analysis included 10,472 delivery encounters; 2459 (23.5%) requested IPP LARC on admission and 464 (4.4%) changed contraception to IPP LARC after admission. Among those obtaining IPP LARC (n = 2523, 24.1%), 1224 (48.5%) selected arm implants and 1299 selected intrauterine devices (IUDs). Patients who self-reported as non-Hispanic Black and non-Hispanic Other or multiple races utilized IPP LARC less (adjusted Odds Ratio (aOR)=0.84, 95% CI: 0.72-0.98, aOR=0.68, CI 95%: 0.48-0.97, respectively). Patients with cesarean delivery (aOR=1.45, 95% CI: 1.31-1.61) or inadequate prenatal care (aOR=1.54, CI 95%: 1.35-1.75) were more likely to utilize IPP LARC. Maternal age and years of education were inversely associated with utilization. Primiparous patients were less likely to utilize IPP LARC.
Conclusions: Long-acting reversible contraception (LARC) utilization was 24.1% during the immediate postpartum period; higher than the 11% nationally reported interval LARC use among publicly insured patients. Understanding the demographics of those desiring IPP LARC could highlight accessibility gaps. The impact of IPP LARC utilization on rates of short-interval birth is being evaluated.
Implications: Understanding the demographics of IPP LARC utilizers may contribute to understanding accessibility gaps and facilitate discernment of factors impacting patient initiation. Evidence suggests that comprehensive contraception access during delivery admission is feasible, patient-desired, and essential.
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| http://dx.doi.org/10.1016/j.contraception.2024.110721 | DOI Listing |
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Tennessee Medicaid patient immediate postpartum long-acting reversible contraception utilization.
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October 2024
Department of Obstetrics and Gynecology, The University of Tennessee Graduate School of Medicine, Knoxville, TN, United States. Electronic address:
Objectives: To understand immediate postpartum long-acting reversible contraception (IPP LARC) desire and utilization trends among publicly insured patients delivering at one academic hospital in a state with health care barriers and high short-interval birth rates.
Study Design: We conducted a retrospective cohort study of electronic delivery records between March 2018 and June 2023 for publicly insured patients. Patient demographics, IPP LARC desire and utilization trends were compared using χ or Fisher exact tests.
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Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, United States; Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, United States.
Objectives: This study aimed to determine the factors contributing to racial and ethnic disparities in the use of immediate postpartum, long-acting reversible contraception (IPP LARC) and permanent contraception among Medicaid recipients.
Study Design: We conducted a cross-sectional study using 3 years of national Medicaid claims data to examine the rates of IPP LARC use alone and a composite measure of postpartum permanent contraception and IPP LARC within 7 days of delivery by race and ethnicity. We used a Blinder-Oaxaca model to quantify the extent to which medical complexity, age, rurality, mode of delivery, and year explained differences in outcomes among different minoritized groups in comparison to non-Hispanic White women.
Medicaid Policy Change and Immediate Postpartum Long-Acting Reversible Contraception.
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Center for Health Systems Effectiveness, Emergency Medicine, Oregon Health & Science University, Portland.
Importance: Improving access to the choice of postpartum contraceptive methods is a national public health priority, and the need is particularly acute within the Medicaid population. One strategy to ensure individuals have access to the full range of contraceptive methods is the provision of a method prior to hospital discharge following a birth episode. Beginning in 2016, some states changed their Medicaid billing policy, allowing separate reimbursement for intrauterine devices and contraceptive implants to increase the provision of long-acting reversible contraceptive (LARC) methods immediately postpartum (IPP).
View Article and Find Full Text PDFState variations in insertion of long-acting reversible contraception during delivery hospitalization.
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Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
Objectives: This study aimed to describe immediate postpartum long-acting reversible contraception (IPP LARC) insertion rates during delivery hospitalizations at the state level and by payor type.
Study Design: This is a cross-sectional study of 26 states and District of Columbia using 2020 State Inpatient Database.
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Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland, USA.
Objectives: To examine the effects of a comprehensive, multiyear (2015-2020) statewide contraceptive access intervention in Delaware on the contraceptive initiation of postpartum Medicaid patients. The program aimed to increase access to all contraceptives, including long-acting reversible contraceptives (LARC). The program included interventions specifically targeting postpartum patients (Medicaid payment reform and hospital-based immediate postpartum (IPP) LARC training) and interventions in outpatient settings (provider training and operational supports).
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