Contraception After Delivery Among Publicly Insured Women in Texas (original) (raw)
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Unmet Demand for Highly Effective Postpartum Contraception in Two Cities in Texas
Contraception, 2013
The postpartum period represents a key opportunity for women to learn about and obtain effective contraception. We assess women's contraceptive preferences and use in the first 6 months after delivery. We conducted a prospective cohort study of 800 postpartum women, recruited from 3 hospitals in Austin and El Paso, Texas. Women age 18-44 who wanted to delay childbearing for at least 24 months were eligible for the study and completed interviews following delivery and at 3 and 6 months postpartum. At each interview, participants were asked what contraceptive method they would like to be using, as well as what method they were actually using. This study found considerable interest in LARC and permanent methods. However, there is substantial discordance between method preference and actual use. At 6 months postpartum, many more women would like to be using a highly effective method than have been able to do so.
Contraception and Reproductive Medicine
Background: Several 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. Methods: We 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. Results: We 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. Conclusions: Women 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.
Barriers to Postpartum Contraception in Texas and Pregnancy Within 2 Years of Delivery
Obstetrics & Gynecology, 2016
To assess pregnancies that could have been averted through improved access to contraceptive methods in the 2 years after delivery. METHODS: In this cohort study, we interviewed 403 postpartum women in a hospital in Austin, Texas, who wanted to delay childbearing for at least 2 years. Followup interviews were completed at 3, 6, 9, 12, 18, and 24 months after delivery; retention at 24 months was 83%. At each interview, participants reported their pregnancy status and contraceptive method. At the 3-and 6-month interviews, participants were also asked about their preferred contraceptive method 3 months in the future. We identified types of barriers among women unable to access their preferred method and used Cox models to analyze the risk of pregnancy from 6 to 24 months after delivery.
Contraception, 2019
The postpartum period presents an opportunity to improve maternal health through assessing immediate pregnancyrelated concerns such as physical recovery from birth, infant feeding, and mood disorders, as well as addressing long-term health through chronic disease management, contraception and birth spacing, and health maintenance. 1 Yet, postpartum care is underutilized; risk factors for failure to attend postpartum visits include younger age, increased parity, minority race or ethnicity, lower household income, public or no insurance, and poor prenatal care. 2-5 Most of these factors are nonmodifiable and potentially interrelated. In theory, programs that address modifiable factors could improve health outcomes and decrease health disparities. 6 The postpartum visit for women without high-risk medical issues has traditionally been scheduled 6 weeks after delivery; though, some women may perceive this timing as too late for their health care needs. 7,8 With an earlier postpartum visit, women have the opportunity to discuss physical and mental health concerns that arise in the first Keywords ► postpartum visit ► breastfeeding ► patient satisfaction ► maternal health
Women’s Birth Choice Request Changes in Ten Years: A Single Primary Care Center Experience
Erciyes Medical Journal
Objective: Normal birth is the most cost-effective and healthiest form of birth for mother and baby, but it has become less preferable in recent years. This study has two goals: first, to examine the change in the rate of women's normal birth requests, and second, to examine the changes in factors that may affect this request within a ten-year time period.
Contraceptive policies affect post-abortion provision of long-acting reversible contraception
Contraception, 2011
Background: Placement of long-acting reversible contraceptives (LARC)intrauterine devices (IUDs) and the implantdirectly after an abortion provides immediate contraceptive protection and has been proven safe. Study Design: We conducted a survey of National Abortion Federation member facilities (n=326; response rate 75%) to assess post-abortion contraceptive practices. Using multivariable logistic regression, we measured variations in provision of long-acting contraception by clinic factors and state contraceptive laws and policies. Results: The majority (69%) of providers surveyed offered long-acting methods, but fewer offered immediate post-abortion placement of intrauterine devices (36%) or implants (17%). Most patients were provided with contraception; 6.6% chose LARC methods offering the highest level of protection. Post-abortion provision of these methods was lower in stand-alone abortion clinics (p≤.001), but higher with recent clinician training (p≤.001) and in the absence of clinic flow barriers (p≤.001). State policies had a significant impact on how women paid for contraception and the likelihood of LARC use. Patient use was higher in states with contraceptive coverage mandates (p≤.01) or Medicaid family planning expansion programs (p≤.05). Conclusions: Use of the most effective contraceptives immediately post-abortion is rare in the United States. State policies, high cost to patients, and the ongoing need for clinician training in the methods hinder provision and patient uptake. Contraceptive policies are an important component of abortion patient access to the most effective methods.
Journal of Womens Health, 2017
Background: In 2007, high-deductible plans were added to the primarily nondeductible Kaiser Permanente Northern California (KPNC) integrated health plan, which had covered 100% of device and procedure costs of long-acting reversible contraception (LARC) for members regardless of prescription/visit copay amount. We hypothesized that nondeductible plans and prior LARC use decreased unintended pregnancy. Objective: The purpose of this study was to determine if health plan design (nondeductible vs. deductible) and LARC use before pregnancy were associated with pregnancy intention. Methods: In this retrospective cohort study, women aged 15-44 as of the index date of June 30, 2010 were followed from January 1, 2010 to December 31, 2012 for evidence of pregnancy (n = 65,989). Health plan design, copays, contraceptive method used most recently before the pregnancy, and self-reported pregnancy intention status (intended, mistimed, unwanted) were obtained from electronic medical records. Logistic regression models were developed to determine if various health plan designs, copays, or prior LARC use were associated with pregnancy intention, controlling for potential confounders such as age, race/ethnicity, marital status, education/income, parity, and comorbidities. Results: In all models, LARC use before pregnancy versus non-LARC use was significantly related to intended pregnancies (all models: odds ratio [OR] = 2.26, 95% confidence interval [CI] 2.06-2.48). Women with deductible plans with healthcare spending accounts (HSA) were more likely to report intended pregnancies versus women with nondeductible plans (all models: OR = 1.2, 95% CI 1.04-1.30). In stratified analyses, high income/ high education was a significant predictor of intended pregnancy regardless of race/ethnicity. Conclusion: LARC use before pregnancy and having an HSA were associated with intended pregnancy.
Scientific African , 2023
There is low LARC uptake in Nigeria and not much is documented about Nigerian women‟s preferences for these products and how these preferences affect women‟s choices. Therefore, the purpose of this study is to provide empirical evidence on the decision-making behavior of Nigerian women regarding LARCs. Three hypothetical LARCs were presented. Informed by results obtained from the review of relevant literature and focus group discussion held with selected family planning services providers, the identified attributes were effect on weight, cost, LARC effectiveness and effect on bleeding patterns, each at three levels. A D-optimal design was used to construct nine choice sets. An additional choice set was included to conduct the testretest stability test. The choice sets and other socio-demographic questions formed the discrete choice experiment questionnaire. A random sample of 150 eligible women was selected from women who enrolled and attended family planning clinics in public healthcare facilities in Ibadan, Nigeria through a three-stage sampling technique. Mixed logit modelling was used to obtain estimates of the parameters and willingness to pay (WTP) for each attribute was calculated. The test-retest stability result showed that 76.7% of the respondents responded in a consistent and rational manner. The women preferred LARCs that have no effect on their weights compared to LARCs that cause either slight weight loss or gain. Also, they preferred LARCs that offer 1/1000 level of effectiveness in a year. The most preferred attribute level, „women experience infrequent bleeding‟, increases WTP by NGN 13,984.584 (USD 33.68) while the least preferred level, „women experience frequent/prolonged bleeding‟, has a negative mean WTP (-NGN 19,598.378 (-USD 47.20)) indicating dispreference for the level. Furthermore, women derived higher utilities from very cheap LARCs. Evidence-based information on women‟s preferences regarding LARC usage would help policymakers in the deployment of strategies that would ensure that preferred LARCs are procured and made readily available to women.
The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2016
The purposes were to determine contraceptive methods pregnant adolescents intend to use postpartum and to understand factors that predispose intention to use less effective birth control than long-acting reversible contraception (LARC). Participants were 247 pregnant minority adolescents in a prenatal program. Intention was assessed by asking "Which of the following methods of preventing pregnancy do you intend to use after you deliver?" Multinomial logistic regression analysis was used to determine factors associated with intent to use nonhormonal (NH) contraception (male/female condoms, abstinence, withdrawal and no method) or short-/medium-acting hormonal (SMH) contraception (birth control pill, patch, vaginal ring, injectable medroxyprogesterone acetate) compared with LARC (implant and intrauterine device) postpartum. Twenty-three percent intended to use LARC, 53% an SMH method, and 24% an NH method. Participants who intended to use NH or SMH contraceptive methods over...