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Trends in Postpartum Contraceptive Use in 20 U.S. States and Jurisdictions: The Pregnancy Risk Assessment Monitoring System, 2015–2018

Published:December 01, 2022DOI:https://doi.org/10.1016/j.whi.2022.10.002

      Abstract

      Introduction

      In the last decade, state and national programs and policies aimed to increase access to postpartum contraception; however, recent data on population-based estimates of postpartum contraception is limited.

      Methods

      Using Pregnancy Risk Assessment Monitoring System data from 20 sites, we conducted multivariable-adjusted weighted multinomial regression to assess variation in method use by insurance status and geographic setting (urban/rural) among people with a recent live birth in 2018. We analyzed trends in contraceptive method use from 2015 to 2018 overall and within subgroups using weighted multinomial logistic regression.

      Results

      In 2018, those without insurance had lower odds of using permanent methods (adjusted odds ratio [AOR], 0.72; 95% confidence interval [CI], 0.53–0.98), long-acting reversible contraception (LARC) (AOR, 0.67; 95% CI, 0.51–0.89), and short-acting reversible contraception (SARC) (AOR, 0.61; 95% CI, 0.47–0.81) than those with private insurance. There were no significant differences in these method categories between public and private insurance. Rural respondents had greater odds than urban respondents of using all method categories: permanent (AOR, 2.15; 95% CI, 1.67–2.77), LARC (AOR, 1.31; 95% CI, 1.04–1.65), SARC (AOR, 1.42; 95% CI, 1.15–1.76), and less effective methods (AOR, 1.38; 95% CI, 1.11–1.72). From 2015 to 2018, there was an increase in LARC use (odds ratio [OR], 1.03; 95% CI, 1.01–1.05) and use of no method (OR, 1.05; 95% CI, 1.02–1.07) and a decrease in SARC use (OR, 0.97; 95% CI, 0.95–0.99). LARC use increased among those with private insurance (OR, 1.05; 95% CI, 1.02–1.08) and in urban settings (OR, 1.04; 95% CI, 1.02–1.07), but not in other subgroups.

      Conclusions

      We found that those without insurance had lower odds of using effective contraception and that LARC use increased among those who had private insurance and lived in urban areas. Strategies to increase access to contraception, including increasing insurance coverage and investigating whether effectiveness of existing initiatives varies by geographic setting, may increase postpartum contraceptive use and address these differences.
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      Biography

      Katharine Bruce, MPH, is a PhD student in Epidemiology at the University of North Carolina Gillings School of Public Health. Her research focuses on severe maternal morbidity, maternal mortality, postpartum patient safety, and contraception.

      Biography

      Andrei Stefanescu, PhD, MS, is an epidemiologist at the Los Angeles County Department of Public Health, leading the Data Analytics Team in the Acute Communicable Disease Control division. His work focuses on neonatal health, quality improvement, and most recently COVID-19 surveillance.

      Biography

      Lisa Romero, DrPH, MPH, is a Health Scientist in the Division of Reproductive Health, Centers for Disease Control and Prevention. Her work focuses on increasing contraception access, improving the management and care for pregnant and postpartum people, and health systems transformation.

      Biography

      Ekwutosi Okoroh, MD, is a Medical Officer and team lead in the Division of Reproductive Health, Centers for Disease Control and Prevention. Her work focuses on promoting and improving the health and well-being of women, children, and families by building MCH epidemiology and workforce capacity at state, local, and tribal levels.

      Biography

      Shanna Cox, MSPH, serves as the Associate Director for Science, for the Division of Reproductive Health, in the Centers for Disease Control and Prevention and is responsible for the management, monitoring, and evaluation of an expanding and diverse scientific portfolio.

      Biography

      Lyn Kieltyka, PhD, MPH, is the Senior Epidemiologist assigned to the Louisiana Department of Health through the Field Support Branch, Division of Reproductive Health, Centers for Disease Control and Prevention. Her work focuses on improving access to care and health outcomes.

      Biography

      Charlan D. Kroelinger, PhD, is the Chief of the Maternal and Infant Health Branch in the Division of Reproductive Health, Centers for Disease Control and Prevention. She supports work in maternal and infant health using implementation science and health services research.