Abstract
BackgroundSeveral state Medicaid agencies have recently started reimbursing for long-acting reversible contraception (LARC) placement immediately postpartum. Women’s perspectives are critical for ensuring that this change increases access to LARC while empowering women to choose the method and timing of contraception that best meets their needs. We conducted a pilot study in Georgia, which recently changed its Medicaid reimbursement policy, to assess women’s informed choice and satisfaction with immediate postpartum LARC.MethodsWe sampled all women with a live birth paid for by Georgia Medicaid during November 2015 through February 2017 who received an immediate postpartum LARC. We then used a one-to-one match to sample women who did not receive immediate postpartum LARC. Women were contacted via telephone for a 25–30 min interview regarding their knowledge, attitudes, and behaviors related to immediate postpartum LARC and their satisfaction with postpartum contraception. We calculated descriptive statistics and components of informed choice overall and by receipt of immediate postpartum LARC, using chi-square tests to calculate differences by group.ResultsWe approached 470 women and completed interviews with 51; 25 (49%) received immediate postpartum LARC (24 implants, 1 intrauterine device). Two-thirds reported their provider discussed the option of receiving immediate postpartum LARC during prenatal care, with over 90% reporting they received all the information they needed to make a decision. Most women believed the ideal time to begin using birth control postpartum is in the hospital immediately after delivery, although this differed significantly by women’s receipt of immediate postpartum LARC. Most women who received immediate postpartum LARC reported they are very or extremely happy with their device, although 40% also reported wanting their device removed at some point.ConclusionsWomen on Medicaid in Georgia report making informed choices regarding immediate postpartum LARC. Among those who received immediate postpartum LARC, women report high levels of satisfaction.
Highlights
Several state Medicaid agencies have recently started reimbursing for long-acting reversible contraception (LARC) placement immediately postpartum
Providing access to long-acting reversible contraception (LARC), which includes subdermal implants and intrauterine devices (IUDs), in the immediate postpartum period before hospital discharge has been recently promoted as a strategy for preventing unintended and rapid repeat pregnancies
Several state Medicaid agencies have recently changed their policies to reimburse providers for LARC placement at the time of delivery [4], which may expand access given that Medicaid pays for approximately half of all deliveries across the nation [5] and Medicaid policies may later be adopted by private insurance plans
Summary
Several state Medicaid agencies have recently started reimbursing for long-acting reversible contraception (LARC) placement immediately postpartum. Providing access to long-acting reversible contraception (LARC), which includes subdermal implants and intrauterine devices (IUDs), in the immediate postpartum period before hospital discharge has been recently promoted as a strategy for preventing unintended and rapid repeat pregnancies. This practice is considered safe by the Centers for Disease Control and Prevention [1] and the American Congress of Obstetricians and Gynecologists [2] and may be convenient for women [3]. In light of past reproductive rights abuses against disadvantaged women in the U.S [10], the recent documentation of women feeling coerced in their contraceptive decision making after undergoing abortion [11], and the fact that this initiative is targeted to low-income women served by Medicaid, it is important to ensure that women’s choice and reproductive justice are central when developing and implementing these policies
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