Abstract
Background
Closely spaced, unintended pregnancies are common among Medicaid beneficiaries and
create avoidable risks for women and infants, including preterm birth. The Strong
Start for Mothers and Newborns Initiative, a program of the Center for Medicare and
Medicaid Innovation, intended to prevent preterm birth through psychosocially based
enhanced prenatal care in maternity care homes, group prenatal care, and birth centers.
Comprehensive care offers the opportunity for education and family planning to promote
healthy pregnancy spacing.
Methods
As of March 30, 2016, there were 42,138 women enrolled in Strong Start and 23,377
women had given birth. Individual-level data were collected through three participant
survey instruments and a medical chart review, and approximately one-half of women
who had delivered (n = 10,374) had nonmissing responses on a postpartum survey that asked about postpartum
family planning. Qualitative case studies were conducted annually for the first 3 years
of the program and included 629 interviews with staff and 122 focus groups with 887
Strong Start participants.
Results
Most programs tried to promote healthy pregnancy spacing through family planning education
and provision with some success. Group care sites in particular established protocols
for patient-centered family planning education and decision making. Despite program
efforts, however, barriers to uptake remained. These included state and institutional
policies, provider knowledge and bias, lack of protocols for timing and content of
education, and participant issues such as transportation or cultural preferences.
Conclusions
The Strong Start initiative introduced a number of successful strategies for increasing
women's knowledge regarding healthy pregnancy spacing and access to family planning.
Multiple barriers can impact postpartum Medicaid participants' capacity to plan and
space pregnancies, and addressing such issues holistically is an important strategy
for facilitating healthy interpregnancy intervals.
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Biography
Caitlin Cross-Barnet, PhD, is a social science research analyst at the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services.
Biography
Brigette Courtot, MPH, is a senior research associate in the Health Policy Center at the Urban Institute.
Biography
Ian Hill, MPA, MSW, is a senior fellow in the Health Policy Center at the Urban Institute.
Biography
Sarah Benatar, PhD, is a senior research associate in the Health Policy Center at the Urban Institute.
Biography
Morgan Cheeks, BA, is a medical school student and former research assistant in the Health Policy Center at the Urban Institute.
Biography
Jenny Markell, BA, is a research assistant in the Health Policy Center at the Urban Institute.
Article Info
Publication History
Published online: January 12, 2018
Accepted:
December 11,
2017
Received in revised form:
December 1,
2017
Received:
July 21,
2017
Footnotes
This work was funded by the Centers for Medicare and Medicaid Services, Center for Medicare and Medicaid Innovation, through the authority of Section 3021 of the Affordable Care Act.
Identification
Copyright
Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.
