Change in Contraceptive Use Within South Carolina Medicaid Following the Choose Well Contraceptive Access Initiative: Did COVID-19 Alter the Trends?

Abstract

COVID-19 hit at the midpoint of Choose Well, a statewide contraceptive access initiative commenced in South Carolina (SC) in 2017. This study assessed whether the pandemic altered the trends in contraceptive use among SC Medicaid during the first half of Choose Well. Contraception use among 333,253 women was analyzed from 2017 to 2022, divided into prepandemic (January 2017-February 2020) and pandemic (March 2020-December 2022) periods. Bivariate differences in contraceptive use were examined using Pearson's Chi square test across these periods, including the first, first two, and first three quarters of the pandemic. Interrupted time-series analysis assessed changes in trends for intrauterine devices (IUDs) and implants during pandemic compared with prepandemic levels. IUD and implant use dropped during the first two quarters of the pandemic. While IUD use matched the prepandemic levels by the end of the first three quarters, implant use slightly lagged. The use of injections and pills decreased from 16.6% and 26.2% during the prepandemic period to 13.6% and 21.7% during the pandemic period, respectively (p < 0.001). The trends in IUD and implant use in the pandemic period were higher by 0.01 (95% confidence interval [CI]: 0.01, 0.02) and 0.04 (95% CI: 0.03, 0.05) percentage points per month relative to the prepandemic trends, respectively. The pandemic's initial impact quickly stabilized, and overall, the gains in contraceptive use among Medicaid beneficiaries associated with Choose Well remained largely unaffected, with some methods showing increased trends.