INTRODUCTION: Over one third of women have unfulfilled contraceptive needs during their first year postpartum, and women without health insurance are 30% less likely to use contraception. As states have begun to reimburse for immediate postpartum LARC placement (immediate post-placental IUD insertion and implant insertion before discharge), the objective of this study was to determine if LARC uptake increased in the Medicaid population after immediate postpartum reimbursement was instated. METHODS: Women receiving Medicaid were prospectively recruited from a postpartum service of a large, urban hospital before and after immediate postpartum reimbursement. They completed a survey regarding their contraceptive choices, and additional information was gathered from the medical record. A binary logistic regression was performed to determine if women receiving Medicaid were more likely to choose LARC as a contraceptive method after the policy took effect, adjusting for race, mode of delivery, and primiparity. RESULTS: 178 women were included in the analysis (70 before reimbursement, 108 after reimbursement). Women were 2.5 times more likely to use LARC as postpartum birth control after immediate postpartum reimbursement was instated (95% CI: 1.26-4.79). Of the 49 women who chose LARC after immediate postpartum reimbursement, 42 (86%) received their method before hospital discharge. CONCLUSION: Immediate postpartum reimbursement resulted in women being more than twice as likely to choose LARC as their postpartum contraceptive method. Removing this barrier to cost and access is particularly important in a population vulnerable to unintended pregnancy and loss of healthcare coverage.

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INTRODUCTION: Unintended pregnancies are associated with maternal depression, limited access to prenatal care, financial burden and in the case of short interval unintended pregnancies, increased risk of preterm delivery. Medicaid reimbursement for immediate postpartum LARC placement (immediate post-placental IUD insertion and implant insertion before discharge) lowers the risk of being lost to follow-up using no contraceptive method. The objective of this study was to investigate the uptake of immediate postpartum LARC among women lost to follow-up who are consequently at high risk for unintended pregnancy. METHODS: Women receiving Medicaid were prospectively recruited from a postpartum service of a large, urban hospital after immediate postpartum reimbursement took effect. Women completed a survey regarding their contraceptive choices, and additional information was gathered from the medical record. Lost to postpartum follow-up was defined as missing postpartum appointments or being unreachable via phone. RESULTS: 65 women were classified as lost to postpartum follow-up. Of these, 24 were discharged with LARC in place, 23 without any form of contraception and 18 with a non-LARC contraceptive. 96% of women who had immediate postpartum LARC had been informed about the availability of immediate postpartum LARC during prenatal care or during labor compared to 56% of women who chose an alternate method. CONCLUSION: Immediate postpartum LARC ensures that women who are lost to follow-up after discharge may receive reliable, long acting contraception. Educating women during prenatal appointments and throughout the course of their labor about this option is associated with increased use of immediate postpartum LARC.