Prescribing Patterns for Postpartum Contraception Among Breastfeeding Patients Insured Under Medicaid [ID: 1375071

Abstract

INTRODUCTION: The United States has a long history of reproductive coercion with people of color and lower socioeconomic status more likely to receive contraception/sterilization counseling than White, affluent patients. Contraceptive choice is important postpartum, particularly among people who plan to breastfeed. This study assessed postpartum contraception/sterilization prescription among breastfeeding people in Rhode Island insured under Medicaid compared to other insurances. METHODS: Secondary analysis of data from the Rhode Island Pregnancy Risk Assessment Monitoring System (PRAMS) from 2016 to 2019 was performed. Participants who answered yes to “having ever breastfed” were included and dichotomized based on insurance into “Medicaid” or “other insurances.” Primary outcome was postpartum contraception/sterilization prescription. Stata 15 was used to perform multivariable logistic regression accounting for complex survey design and weighting. RESULTS: Of 3,686 participants, 868 (24.4%) were insured under Medicaid. Medicaid participants were younger, had higher body mass indexes, and were more likely to identify as Black or mixed race or Hispanic ethnicity than those with other insurers. Those insured under Medicaid were 1.5 times more likely to be prescribed postpartum contraception than those with other insurers (95% CI: 1.26, 1.78). After adjusting for race and ethnicity, education level, marital status, and preterm delivery, those with Medicaid were 1.34 times more likely to be prescribed contraception (95% CI: 1.05, 1.72). Postpartum contraception prescription was inversely related to length of breastfeeding (P<.04). CONCLUSION: In this study, breastfeeding participants with Medicaid were more likely to be prescribed postpartum contraception than those with other insurances. Future research should be focused on assessing provider bias and initiatives to provide equitable and patient-centered counseling in this population.