Medicaid Patients With Immediate Postpartum Contraceptive Implants: Continuation & Rapid Repeat Pregnancy Rates [38A

Abstract

INTRODUCTION: To determine the 6 and 12-month rates of contraceptive continuation and rapid repeat pregnancy (RRP) for publicly insured patients receiving an immediate postpartum etonogestrel contraceptive implant. METHODS: This prospective cohort study recruited Medicaid insured women, who delivered between April 2014 and 2015, and received a postpartum etonogestrel contraceptive implant prior to discharge from a safety-net institution. Patients were surveyed at placement regarding contraceptive decision-making and counseling. Medical records were reviewed at 6 and 12 months to assess implant continuation and if RRP had occurred. If this information was unable to be ascertained by medical record review, the participant was contacted by telephone. RESULTS: Of the 413 eligible participants, 223 (54%) enrolled. Data were available for 198 patients (89%) at 6 months where 14 (7%) discontinuations and 1 RRP (0.5%) occurred. Data were available for 168 participants (75%) at 12 months, where 40 (24%) discontinuations and 7 RRPs (4.2%) occurred. There were not any pregnancies among participants who retained their implant. Overall, black participants were more likely to discontinue the implant and have a RRP than non-black women (16% versus 2%, p < 0.009). Participants who continued their implant at 12 months were more likely to report at enrollment prior use of a hormonal implant (OR 2.91, CI 1.04-8.17) and plans to keep the implant for all 3 years (OR 2.42, CI 1.04-5.66). CONCLUSION: Among Medicaid patients receiving an immediate postpartum etonogestrel implant at a safety-net hospital, continuation rates were high and rapid repeat pregnancy rates were low.