Immediate Postpartum Long-Acting Reversible Contraception: Review of Insertion and Device Reimbursement Policies

Kroelinger, Charlan D.; Okoroh, Ekwutosi M.; Uesugi, Keriann; Romero, Lisa; Sappenfield, Olivia; Howland, Julia; Cox, Shanna

doi:10.1016/j.whi.2021.09.001

Cited by 10 publications

(10 citation statements)

References 54 publications

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“…There were 8.8% patients from the multigravida group that opted for LARC. Previous studies have reported the similar results where women from the multigravida and grand multigravida look for LARC more frequently as compared to other group [21][22][23] . Our study showed that 9 percent acceptance rate exist for LARC in the women that went through vaginal delivery and 7% acceptance rate for LARC is found in the cesarean group.…”

Section: Discussionsupporting

confidence: 67%

Immediate Postpartum and Post Abortion Long Acting Reversible Contraception in Referral Level Facility

Johar¹,

Riaz²,

Sabir³

et al. 2023

PJMHS

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Background: Despite the advances in the contraceptive technologies, still the unintended pregnancies are adding to the global health issues. The placement of a contraceptive device, such as an intrauterine device (IUD) or contraceptive implant, immediately after childbirth is termed as long-acting reversible contraceptives LARC. Study design: It is a retrospective study conducted at Lady Willingdon Hospital Lahore and Divisional Headquarters Teaching Hospital Mirpur, Azad Kashmir for the duration of six months from April 2022 to September 2022. Material and Methods: The study was approved by the health and ethical board committee of the hospital. The study was conducted on 102 patients that visited tertiary care center during a course of six months. The age of women ranged from 18 to more than 36 years. There were 51 women who belonged to age group 18-24 years, 32 were in the 25-35 year range and 49 were older than 35 years. Results: Standard deviation and p value was calculated and results were statistically significant. There were 8 women who were nulliparous, primipara women were 31 and 58 were multipara. There were 5 women that were included in the grand multipara group. There were 42 women that belonged to urban area and 60 lived in rural area. Most of the women 52 had primary level of education, however 24 had higher secondary level of education and 56 were working women. Conclusion: The acceptance rate was only 9% in the vaginal birth patients. The use of LARC could be an easy and cost effective contraceptive way. Keywords: Intrauterine device and family planning services.

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Section: Discussionsupporting

confidence: 67%

Immediate Postpartum and Post Abortion Long Acting Reversible Contraception in Referral Level Facility

Johar¹,

Riaz²,

Sabir³

et al. 2023

PJMHS

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“…8 Following state level advocacy 4 and recommendations from professional groups, 3 many state Medicaid programs began providing separate reimbursement for inpatient LARC in addition to the fixed global payment for delivery. 9 Population-based studies from South Carolina, the first state to begin such reimbursement, have shown that the policy increased the availability of immediate postpartum LARC, reduced short birth intervals among adolescents, and reduced adverse infant outcomes. [10][11][12] However, studies from other states, which have generally been limited to a subset of hospitals, provide evidence that hospitals have faced barriers to immediate postpartum LARC provision even after reimbursement policy changes.…”

Section: Introductionmentioning

confidence: 99%

“…As of 2018, more than half of state Medicaid programs had begun reimbursement for immediate postpartum LARC. 9 In this study, we examined whether Medicaid reimbursement policy changes for immediate postpartum LARC in 5 early-adopting states were associated with a change in immediate postpartum LARC provision. We hypothesized that Medicaid reimbursement for immediate postpartum LARC increased provision of this service, particularly among people with a Medicaid-paid childbirth.…”

Section: Introductionmentioning

confidence: 99%

“…As Medicaid pays for approximately 42% of childbirth hospitalizations annually, Medicaid hospital payment policies have important implications for maternal health nationally . Following state level advocacy and recommendations from professional groups, many state Medicaid programs began providing separate reimbursement for inpatient LARC in addition to the fixed global payment for delivery . Population-based studies from South Carolina, the first state to begin such reimbursement, have shown that the policy increased the availability of immediate postpartum LARC, reduced short birth intervals among adolescents, and reduced adverse infant outcomes .…”

Section: Introductionmentioning

confidence: 99%

“…As of 2018, more than half of state Medicaid programs had begun reimbursement for immediate postpartum LARC . In this study, we examined whether Medicaid reimbursement policy changes for immediate postpartum LARC in 5 early-adopting states were associated with a change in immediate postpartum LARC provision.…”

Section: Introductionmentioning

confidence: 99%

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Immediate Postpartum Long-Acting Reversible Contraceptive Use Following State-Specific Changes in Hospital Medicaid Reimbursement

et al. 2022

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ImportanceFacilitating access to the full range of contraceptive options is a health policy goal; however, inpatient provision of postpartum long-acting reversible contraceptive (LARC) methods has been limited due to lack of hospital reimbursement. Between March 2014 and January 2015, the Medicaid programs in 5 states began to reimburse hospitals for immediate postpartum LARC separately from the global maternity payment.ObjectiveTo examine the association between Medicaid policies and provision of immediate postpartum LARC, and to examine hospital characteristics associated with policy adoption.Design, Setting, and ParticipantsThis cross-sectional study used interrupted time series analysis. The setting was population-based in Georgia, Iowa, Maryland, New York, and Rhode Island. Participants included individuals who gave birth in these states between 2011 and 2017 (n = 3 097 188). Statistical analysis was performed from June 2021 to August 2022.ExposuresChildbirth after the start of Medicaid’s reimbursement policy.Main Outcomes and MeasuresImmediate postpartum LARC (outcome), teaching hospital, Catholic-owned or operated, obstetrical care level, and urban or rural location (hospital characteristics).ResultsThe study included a total of 1 521 491 births paid for by Medicaid and 1 575 697 paid for by a commercial payer between 2011 and 2017. Prior to Medicaid reimbursement changes, 489 389 of 726 805 births (67%) were to individuals between 18 and 29 years of age, 219 363 of 715 905 births (31%) were to non-Hispanic Black individuals, 227 639 of 715 905 births (32%) were to non-Hispanic White individuals, 155 298 of 715 905 births (22%) were to Hispanic individuals, and 113 605 of 715 905 births (16%) were to individuals from other non-Hispanic racial groups. Among Medicaid-paid births, the policies were associated with an increase in the rate of immediate postpartum LARC provision in all states, although results for Maryland were not consistent across sensitivity analyses. The change in trend ranged from a quarterly increase of 0.05 percentage points in Maryland (95% CI, 0.01-0.08 percentage points) and 0.05 percentage points in Iowa (95% CI, 0.00-0.11 percentage points) to 0.82 percentage points (95% CI, 0.73-0.91 percentage points) in Rhode Island. The policy was also associated with an increase in immediate postpartum LARC provision among commercially paid births in 4 of 5 states. After the policy, only 38 of 366 hospitals (10%) provided more than 1% of birthing people with immediate postpartum LARC. These adopting hospitals were less likely to be Catholic (0% [0 of 31] vs 17% [41 of 245]), less likely to be rural (10% [3 of 31] vs 33% [81 of 247]), more likely to have the highest level of obstetric care (71% [22 of 31] vs 29% [65 of 223]) and be teaching hospitals (87% [27 of 31] vs 43% [106 of 246]) compared with nonadopting hospitals.Conclusions and RelevanceThis cross-sectional study’s findings suggest that Medicaid policies that reimburse immediate postpartum LARC may increase access to this service; however, policy implementation has been uneven, resulting in unequal access.

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Trends in use of long-acting reversible contraception during delivery hospitalizations, 2000–2019

Biema¹,

Friedman²,

Cepin³

et al. 2022

American Journal of Obstetrics and Gynecology

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Immediate Postpartum Long-Acting Reversible Contraception: Review of Insertion and Device Reimbursement Policies

Cited by 10 publications

References 54 publications

Immediate Postpartum and Post Abortion Long Acting Reversible Contraception in Referral Level Facility

Immediate Postpartum and Post Abortion Long Acting Reversible Contraception in Referral Level Facility

Immediate Postpartum Long-Acting Reversible Contraceptive Use Following State-Specific Changes in Hospital Medicaid Reimbursement

Trends in use of long-acting reversible contraception during delivery hospitalizations, 2000–2019

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