Coverage of immediate postpartum long acting reversible contraception has improved birth intervals for at risk populations

Abstract Background In 2012, South Carolina revised Medicaid policy to cover reimbursement for immediate postpartum long acting, reversible contraception. Immediate postpartum long acting. reversible contraception may improve health outcomes for populations at risk with a subsequent short interval pregnancy. Objectives We examined the impact of the Medicaid policy change on initiation of long acting and reversible contraception (immediate postpartum and postpartum) within key populations. We determined whether immediate postpartum long acting and reversible contraception use varied by adequate prenatal care (>7 visits), metropolitan location, and medical comorbidities. We also tested the association of immediate postpartum and postpartum long acting, reversible contraception on inter-pregnancy interval of less than 18 months. Study Design We conducted a historical cohort study of live births among Medicaid recipients in South Carolina between 2010-2017, two years before and five years after the policy change. We used birth certificate data linked with Medicaid claims. Our primary outcome was immediate postpartum long acting and reversible contraception and our secondary outcome was short interpregnancy interval. We characterize trends in long acting and reversible contraception use and interpregnancy interval over the study period). We used logistic regression models to test the association of key factors (rural, inadequate prenatal care and medical comorbidities) with immediate and outpatient post-partum long acting and reversible contraception following the policy change and to test the association of immediate postpartum and postpartum long acting and reversible contraception with short interpregnancy interval. Results Our sample included 187,438 births to 145,973 women. Overall, 44.7% of the sample was white with a mean age of 25.0 years. A majority (61.5%) of the sample was multiparous and resided in metropolitan areas (79.5%). The odds of receipt of immediate postpartum long acting and reversible contraception use increased post-policy change (aOR 1.39, 95% CI 1.34-1.43). Women with inadequate prenatal care (aOR 1.50, 95% CI 1.31, 1.71) and medically complex pregnancies had higher odds of receipt of immediate postpartum long acting and reversible contraception following the policy change (aOR 1.47, 95% CI 1.29-1.67) compared with women with adequate prenatal care and normal pregnancies. Women residing in rural areas were less likely to receive immediate postpartum long acting and reversible contraception (aOR 0.36, 95% CI 0.30-0.44) than women in metropolitan areas. Utilization of immediate postpartum long acting and reversible contraception was associated with decreased odds of a subsequent short interpregnancy interval (aOR 0.62, 95% CI 0.44-0.89). Conclusion Women at risk of subsequent pregnancy and complications (inadequate prenatal care and medical comorbidities), are more likely to receive immediate postpartum long acting and reversible contraception following the policy change. Efforts are needed to improve access in rural areas.