Medicaid and receipt of interval postpartum long-acting reversible contraception

Wilkinson, Barbara; Ascha, Mustafa; Verbus, Emily; Montague, Mary‐Louise; Morris, Jane; Mercer, Brian M.; Arora, Kavita Shah

doi:10.1016/j.contraception.2018.08.017

Cited by 16 publications

(7 citation statements)

References 18 publications

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“…This confirms the importance of antenatal contraceptive counseling and reducing disparities in contraceptive care as previously demonstrated. 16,19 Furthermore, as less than one in four women requesting LARC or sterilization after hospital discharge achieved fulfillment, LARC or sterilization fulfillment during inpatient postpartum care should be prioritized.…”

Section: Discussionmentioning

confidence: 99%

Role of Bridge Contraception in Postpartum Long-Acting Reversible Contraception and Sterilization Fulfillment Rates

Montague

Ascha

Wilkinson

et al. 2018

Obstetrics &Amp; Gynecology

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Section: Discussionmentioning

confidence: 99%

Role of Bridge Contraception in Postpartum Long-Acting Reversible Contraception and Sterilization Fulfillment Rates

Montague

Ascha

Wilkinson

et al. 2018

Obstetrics &Amp; Gynecology

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“…Women who receive more prenatal care, as well as in women who received LARC-intensive or specialized family planning counseling, have higher rates of postpartum contraception initiation. [25][26][27] Prenatal and postpartum contraception counseling appears to be a consistent predictor in postpartum contraception use. 8,28,29 Prenatal care is also a positive predictor for postpartum follow-up.…”

Section: Discussionmentioning

confidence: 99%

Initiation of Postpartum Contraception by 90 Days at a Midwest Academic Center

Eisenach

Uvodich

Wolff³

et al. 2020

kjm

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Introduction. Contraception is a critical component of addressing the health needs of women in the postpartum period. We assessed contraception initiation by 90 days postpartum at a large, academic medical center in the Midwest. Methods. In this retrospective cohort study, 299 charts were randomly sampled and 231 were analyzed from deliveries between May 1 to July 5, 2018. Contraceptive method, maternal demographics, and obstetric characteristics at hospital discharge were collected, as well as contraceptive method at the postpartum follow-up appointment. Methods and strata of contraception were categorized as follows: 1) highly effective methods (HEM) defined as sterilization, intrauterine device, or implant, 2) moderately effective methods (MEM) defined as injectable contraception, progestin-only pills, and combined estrogen/progestin pills, patches, and rings, and 3) less effective methods (LEM) defined as condoms, natural family planning, and lactational amenorrhea. Women lost to follow-up who had initiated a HEM or injectable contraception were coded as still using the method at 90 days. We used logistic regression to identity factors associated with HEM use. Results. Of the 231 included patients, 118 (51%) received contraception before hospital discharge and 166 (83%) by 90 days postpartum. Postpartum visits were attended by 74% (171/231) of patients. Before hospital discharge, 28% (65/231) obtained a HEM and 41% (82/200) were using a HEM by 90 days postpartum. Patients obtaining HEM or injectable contraception before hospital discharge attended a follow-up visit less often than those who did not receive HEM before discharge (RR = 0.68, 95% CI: 0.54 - 0.86, p ≤ 0.01). Conclusion. When readily available, many women will initiate contraception in the postpartum period. Health systems should work to ensure comprehensive access to contraception for women in the postpartum period.

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“…Fewer patients desired highly effective methods of contraception at time of the outpatient postpartum visit than at hospital discharge after delivery. It is unclear whether this is due to changing reproductive goals and contraceptive preferences, or due to external barriers to receipt of highly effective methods such as requirements for a separate procedural visit for LARC insertion, inability to complete sterilization during delivery admission, and waiting period for patients with Medicaid insurance prior to sterilization completion [18,22,23].…”

Section: Discussionmentioning

confidence: 99%

Variation in effectiveness of planned postpartum contraception at two time points from prenatal to postpartum care

et al. 2020

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Objective: To identify characteristics of women who have consistent plans in terms of contraceptive effectiveness from antepartum to postpartum care and whether consistency affects contraceptive outcomes.Study Design: This is a secondary analysis of a retrospective chart review of women who delivered at a single tertiary care center from 2012-2014. Preferred postpartum contraceptive plan was abstracted at three time points (prenatal care, hospital discharge, and outpatient postpartum care) and categorized into three tiers of effectiveness. We then examined consistency between the first two time points for the effectiveness in postpartum contraceptive method planned.Results: Of the 8,394 women in the study cohort, 2,642 (31.5%) had a consistent postpartum contraceptive tier planned at the first two time points. Women who had consistent contraceptive preferences were more likely to have higher parity (aOR 2.36, 95% CI 2.06-2.70 for parity 2+), delivered via cesarean section (aOR 1.50, 95% CI 1.34-1.68), and have received adequate prenatal care (aOR 1.93, 95% CI 1.66-2.24). Women who had a consistent choice were more likely to choose highly effective methods of contraception (p < 0.001) and more likely to achieve their contraception plan (adjusted odds ratio [aOR] 2.16, 95% confidence interval [95% CI] 1.85-2.52), but not more likely to have a subsequent pregnancy within 365 days of delivery (aOR 0.92, 95% CI 0.81-1.05).

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Medicaid and receipt of interval postpartum long-acting reversible contraception

Abstract: While insurance-related barriers have been reduced given recent policy changes, access to care remains an important determinant of postpartum LARC provision and subsequent unintended pregnancy.

Cited by 16 publications

References 18 publications

Role of Bridge Contraception in Postpartum Long-Acting Reversible Contraception and Sterilization Fulfillment Rates

Role of Bridge Contraception in Postpartum Long-Acting Reversible Contraception and Sterilization Fulfillment Rates

Initiation of Postpartum Contraception by 90 Days at a Midwest Academic Center

Variation in effectiveness of planned postpartum contraception at two time points from prenatal to postpartum care

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