Immediate Postpartum LARC Reimbursement Increases Uptake of Effective Contraception After Pregnancy [22G

Abstract

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.