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Concordance of Desired and Administered Postpartum Contraceptives among Emergency and Full Scope Medicaid Patients

Published:March 08, 2022DOI:https://doi.org/10.1016/j.whi.2022.01.008

      Abstract

      Objective

      To determine if concordance of contraceptive preference and uptake differ between postpartum recipients of emergency versus full scope Medicaid.

      Study Design

      We performed a historical cohort study of patients who delivered at a safety-net hospital in Denver, Colorado in 2016. In our public system, all patients had access to immediate postpartum tubal ligation and all forms of reversible contraception in outpatient clinics. We used data from electronic health records to compare contraceptive preferences and uptake between patients with full scope and emergency Medicaid at hospital discharge and by 12 weeks postpartum. We then compared contraceptive concordance (use of the same method as desired during delivery admission) between the groups at time of postpartum discharge and by 12 weeks postpartum.

      Results

      We examined 693 women; 349 (50.1%) had emergency Medicaid and 344 (49.9%) had full scope Medicaid. The mean age at delivery was 27.9 years, and most patients were Hispanic (74%). Women with emergency Medicaid were less likely to receive their desired method of postpartum contraception before hospital discharge (53.6% vs. 66.9%; p < .01). One-half of the patients with emergency Medicaid who did not receive their desired method of immediate postpartum contraception were unable to obtain it based on insurance ineligibility. By 12 weeks postpartum, the rates of concordance did not differ by insurance status: 52.4% of patients with emergency Medicaid and 55.2% of patients with full scope Medicaid received their desired method of contraception (p = .46).

      Conclusions

      Emergency Medicaid recipients, largely recent and/or unauthorized immigrants, have high demand for highly effective postpartum contraceptives. Although emergency Medicaid recipients initially had lower rates of receipt of their desired contraceptive during the hospital stay compared with those with full scope Medicaid, they ultimately had similar concordance rates by 12 weeks postpartum. We suspect this finding was in part due to free access to all methods of contraception in our outpatient clinics during the postpartum course. Systemic barriers should be reduced to ensure better access to postpartum contraceptives for all patients, regardless of insurance coverage, to improve reproductive equity.
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      Biography

      Carrie H. Wilson, MD, MPH, is an attending physician in the Department of Obstetrics, Midwifery and Gynecology at Alameda Health System in Oakland, California. She recently completed residency in obstetrics and gynecology at the University of Colorado. Her research interests include family planning, health policy, and disparities in reproductive health care.

      Biography

      Aaron Lazorwitz, MD, is board certified in obstetrics and gynecology and currently an Assistant Professor in the division of Family Planning in the department of OB/GYN at the University of Colorado. He completed a fellowship in family planning at the University of Colorado and also received a master's in clinical science during that time. In addition to providing complex family planning clinical services, Dr. Lazorwitz also spends a large portion of his time involved in research activities and is interested in better understanding how genetic differences influence hormonal contraception.

      Biography

      Jennifer Hyer, MD, FACOG, is an Associate Professor of Clinical Practice in Obstetrics and Gynecology at the University of Colorado School of Medicine. Her clinical activities include full scope practice of obstetrics and gynecology at Denver Health Medical Center as an attending physician in the Department of Obstetrics and Gynecology. Her special interests include family planning, perinatal mood and anxiety disorders, and gender affirming surgery for transgender and gender non-conforming people.

      Biography

      Maryam Guiahi, MD, MSc, is the Chief Medical Officer at Planned Parenthood California Central Coast, where she oversees clinical services including improved access to abortion services. Her research focuses on the implications of religious restrictions to care in Catholic health settings. She lives in Santa Barbara with her husband and son.