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

Published:March 08, 2022DOI:



      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.


      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).


      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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        • Amaral G.
        • Foster D.G.
        • Biggs M.A.
        • Jasik C.B.
        • Judd S.
        • Brindis C.D.
        Public savings from the prevention of unintended pregnancy: a cost analysis of family planning services in California.
        Health Services Research. 2007; 42: 1960-1980
        • Ambegaokar S.
        Facts about federal funding for states to provide health coverage to immigrant children and pregnant women [Press release].
        National Immigration Law Center, Washington, DC2010
        • Baldwin M.K.
        • Rodriguez M.I.
        • Edelman A.B.
        Lack of insurance and parity influence choice between long-acting reversible contraception and sterilization in women postpregnancy.
        Contraception. 2012; 86: 42-47
        • Biggs M.A.
        • Foster D.G.
        • Hulett D.
        Cost-benefit analysis of the California Family PACT program for calendar year 2007.
        Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA2010
        • Block-Abraham D.
        • Arora K.S.
        • Tate D.
        • Gee R.E.
        Medicaid Consent to Sterilization forms: Historical, practical, ethical, and advocacy considerations.
        Clinical Obstetrics and Gynecology. 2015; 58: 409-417
        • Borrero S.
        • Zite N.
        • Potter J.E.
        • Trussell J.
        Medicaid policy on sterilization–Anachronistic or still relevant?.
        New England Journal of Medicine. 2014; 370: 102-104
        • Capps R.B.
        • James D.
        • Fix M.
        • Van Hook J.
        A Demographic, socioeconomic, and health coverage profile of unauthorized immigrants in the United States.
        Migration Policy Instittue, Washington, DC2013
      1. Centers for Disease Control and Prevention (CDC). (n.d.). Effectiveness of family planning methods. Washingtn, DC: Author.

        • Centers for Disease Control and Prevention (CDC)
        Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Revised recommendations for the use of contraceptive methods during the postpartum period.
        MMWR Morbidity and Mortality Weekly Reports. 2011; 60: 878-883
        • Colorado Department of Health Care Policy & Financing
        Modified adjusted gross income monthly maximum income guidelines.
        2016 (Available: Accessed March 15, 2021.)
        • Committee on Health Care for Underserved Women
        Health care for unauthorized immigrants.
        2015 (Available:)
        • Committee on Obstetric Practice
        Immediate postpartum long-acting reversible contraception.
        2016 (Available:)
        • Committee on Practice Bulletins - Gynecology
        Benefits and risks of sterilization.
        2019 (Available:)
        • Damle L.F.
        • Gohari A.C.
        • McEvoy A.K.
        • Desale S.Y.
        • Gomez-Lobo V.
        Early initiation of postpartum contraception: Does it decrease rapid repeat pregnancy in adolescents?.
        Journal of Pediatric and Adolescent Gynecology. 2015; 28: 57-62
        • DuBard C.A.
        • Massing M.W.
        Trends in emergency Medicaid expenditures for recent and undocumented immigrants.
        JAMA. 2007; 297: 1085-1092
        • Foster D.G.
        • Klaisle C.M.
        • Blum M.
        • Bradsberry M.E.
        • Brindis C.D.
        • Stewart F.H.
        Expanded state-funded family planning services: Estimating pregnancies averted by the Family PACT program in California, 1997–1998.
        American Journal of Public Health. 2004; 94: 1341-1346
        • Gariepy A.M.
        • Duffy J.Y.
        • Xu X.
        Cost-effectiveness of immediate compared with delayed postpartum etonogestrel implant insertion.
        Obstetrics and Gynecology. 2015; 126: 47-55
        • Gordon S.H.
        • Sommers B.D.
        • Wilson I.B.
        • Trivedi A.N.
        Effects of Medicaid expansion on postpartum coverage and outpatient utilization.
        Health Aff (Millwood). 2020; 39: 77-84
        • Guiahi M.
        Religious refusals to long-acting reversible contraceptives in Catholic settings: A call for evidence.
        American Journal of Obstetrics and Gynecology. 2020; 222: S869.e861-S869.e865
        • Han L.
        • Teal S.B.
        • Sheeder J.
        • Tocce K.
        Preventing repeat pregnancy in adolescents: Is immediate postpartum insertion of the contraceptive implant cost effective?.
        American Journal of Obstetrics and Gynecology. 2014; 211: 24.e21-27
        • Harris P.A.
        • Taylor R.
        • Minor B.L.
        • Elliott V.
        • Fernandez M.
        • O'Neal L.
        • Duda S.N.
        The REDCap consortium: Building an international community of software platform partners.
        Journal of Biomedical Informatics. 2019; 95: 103208
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap)–A metadata-driven methodology and workflow process for providing translational research informatics support.
        Journal of Biomedical Informatics. 2009; 42: 377-381
        • Hasstedt K.
        • Desai S.
        • Ansari-Thomas Z.
        Immigrant womens’ access to sexual and reproductive health coverage and care in the United States.
        • Kilpatrick S.J.
        • Papile L.-.A.
        • Macones G.A.
        Guidelines for perinatal care.
        8th ed. American Academy of Pediatrics, Itasca, IL2017
        • Kramer R.D.
        • Gangnon R.E.
        • Burns M.E.
        Provision of immediate postpartum long-acting reversible contraceptives before and after Wisconsin Medicaid's payment change.
        Women's Health Issues. 2021; 31: 317-323
        • Moniz M.H.
        • Chang T.
        • Heisler M.
        • Admon L.
        • Gebremariam A.
        • Dalton V.K.
        • Davis M.M.
        Inpatient postpartum long-acting reversible contraception and sterilization in the United States, 2008-2013.
        Obstetrics and Gynecology. 2017; 129: 1078-1085
        • Moniz M.H.
        • Dalton V.K.
        • Davis M.M.
        • Forman J.
        • Iott B.
        • Landgraf J.
        • Chang T.
        Characterization of Medicaid policy for immediate postpartum contraception.
        Contraception. 2015; 92: 523-531
        • Oduyebo T.
        • Zapata L.B.
        • Boutot M.E.
        • Tepper N.K.
        • Curtis K.M.
        • D'Angelo D.V.
        • Whiteman M.K.
        Factors associated with postpartum use of long-acting reversible contraception.
        American Journal of Obstetrics and Gynecology. 2019; 221: 43.e1-43.e11
        • Potter J.E.
        • Coleman-Minahan K.
        • White K.
        • Powers D.A.
        • Dillaway C.
        • Stevenson A.J.
        • Grossman D.
        Contraception after delivery among publicly insured women in Texas: Use compared with preference.
        Obstetrics and Gynecology. 2017; 130: 393-402
        • Rodriguez M.I.
        • Caughey A.B.
        • Edelman A.
        • Darney P.D.
        • Foster D.G.
        Cost-benefit analysis of state- and hospital-funded postpartum intrauterine contraception at a university hospital for recent immigrants to the United States.
        Contraception. 2010; 81: 304-308
        • Rodriguez M.I.
        • Dissanayake M.
        • Swartz J.J.
        • Funkhouser S.
        • Baldwin M.K.
        Immediate postpartum, long-acting reversible contraceptive use among the Emergency Medicaid population: Continuation rates and satisfaction.
        American Journal of Obstetrics and Gynecology. 2020; 222: S913-S914
        • Rodriguez M.I.
        • Edelman A.
        • Wallace N.
        • Jensen J.T.
        Denying postpartum sterilization to women with Emergency Medicaid does not reduce hospital charges.
        Contraception. 2008; 78: 232-236
        • Rodriguez M.I.
        • Jensen J.T.
        • Darney P.D.
        • Little S.E.
        • Caughey A.B.
        The financial effects of expanding postpartum contraception for new immigrants.
        Obstetrics and Gynecology. 2010; 115: 552-558
        • Secura G.M.
        • Madden T.
        • McNicholas C.
        • Mullersman J.
        • Buckel C.M.
        • Zhao Q.
        • Peipert J.F.
        Provision of no-cost, long-acting contraception and teenage pregnancy.
        New England Journal of Medicine. 2014; 371: 1316-1323
        • Sommers B.D.
        Stuck between health and immigration reform--care for undocumented immigrants.
        New England Journal of Medicine. 2013; 369: 593-595
        • Swartz J.J.
        • Hainmueller J.
        • Lawrence D.
        • Rodriguez M.I.
        Expanding prenatal care to unauthorized immigrant women and the effects on infant health.
        Obstetrics and Gynecology. 2017; 130: 938-945
        • Tang J.H.
        • Dominik R.
        • Re S.
        • Brody S.
        • Stuart G.S.
        Characteristics associated with interest in long-acting reversible contraception in a postpartum population.
        Contraception. 2013; 88: 52-57
        • Thiel de Bocanegra H.
        • Braughton M.
        • Bradsberry M.
        • Howell M.
        • Logan J.
        • Schwarz E.B.
        Racial and ethnic disparities in postpartum care and contraception in California's Medicaid program.
        American Journal of Obstetrics and Gynecology. 2017; 217: 47.e41-47.e47
        • Thiel de Bocanegra H.
        • Chang R.
        • Menz M.
        • Howell M.
        • Darney P.
        Postpartum contraception in publicly-funded programs and interpregnancy intervals.
        Obstetrics and Gynecology. 2013; 122: 296-303
        • Tocce K.M.
        • Sheeder J.L.
        • Teal S.B.
        Rapid repeat pregnancy in adolescents: do immediate postpartum contraceptive implants make a difference?.
        American Journal of Obstetrics and Gynecology. 2012; 206 (481.e481-487)
        • United States Census Bureau
        American Community Survey, 2014-2018.
        • Verbus E.
        • Ascha M.
        • Wilkinson B.
        • Montague M.
        • Morris J.
        • Mercer B.M.
        • Arora K.S.
        The association of public insurance with postpartum contraception preference and provision.
        Open Access Journal of Contraception. 2019; 10: 103-110
        • White K.
        • Teal S.B.
        • Potter J.E.
        Contraception after delivery and short interpregnancy intervals among women in the United States.
        Obstetrics and Gynecology. 2015; 125: 1471-1477
        • Wilkinson B.
        • Ascha M.
        • Verbus E.
        • Montague M.
        • Morris J.
        • Mercer B.
        • Arora K.S.
        Medicaid and receipt of interval postpartum long-acting reversible contraception.
        Contraception. 2019; 99: 32-35


      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.


      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.


      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.


      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.