Influence of Medicaid Expansion on Short Interpregnancy Interval Rates in the US [OP03-1C

Abstract

INTRODUCTION: To assess the impact of improved access to contraception through Medicaid expansion (ME) on the rate of short interpregnancy intervals (IPIs) in the US. METHODS: Population-based retrospective cohort study using US live birth data of multiparous women with data on IPI in 2012 and 2016 (pre and post expansion in 2014). Rate differences of short IPI (<12 months) from 2012 to 2016 were compared between ME vs non-ME states. RESULTS: The rate of short IPI in the US was slightly lower in 2016 (17.3%) compared to 2012 (17.4%), p=0.0006; rate difference 0.13% (95% CI 0.05-0.20). Short IPIs occurred more frequently in non-ME states compared to ME states in both 2012 (18.08% vs 16.55%, p<.001) and 2016 (18.12% vs 16.44%, p<.001). The rate of short IPI decreased 0.11% (95% CI 0.01%-0.22%) in ME states vs increased 0.04% (95% CI 0.09-0.17) in non-ME states over the time period. CONCLUSION: The rate of short interpregnancy interval increased over time in non-expansion states but decreased in the states that adopted Medicaid expansion. If non-ME states had experienced the same rate of decrease in short IPI as ME states, 1122 fewer women would have experienced a short IPI in the US in 2016. Considering the known association between short IPI and adverse maternal and infant outcomes, these findings indicate Medicaid expansion could have an impact on improvement of perinatal outcomes in the US.