Influence of Medicaid expansion on short interpregnancy interval rates in the United States

Patel, Kriya S.; Bakk, Juliana; Pensak, Meredith; DeFranco, Emily

doi:10.1016/j.ajogmf.2021.100484

Cited by 8 publications

(8 citation statements)

References 15 publications

(21 reference statements)

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“…Second, Approach 3 allows for multiple live births per year as long as those births are separated by at least 180 days. Neither approach developed by CMS allows multiple births per year, but people can and do have multiple births in this time frame 28–30 …”

Section: Methodsmentioning

confidence: 99%

“…Neither approach developed by CMS allows multiple births per year, but people can and do have multiple births in this time frame. [28][29][30] In Approach 3, we used the same list of 34 ICD-10 diagnosis codes used in Approach 2 (see Table 2 in the Methodological Appendix) to identify live births in the IP and OT files. For claims in the IP file, we used the header file to create a claims-level variable indicating if the claim included a qualifying code.…”

Section: Approach 3: Including Inpatient Hospital Claims In the Ot Filementioning

confidence: 99%

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Comparing approaches to identify live births using the Transformed Medicaid Statistical Information System

Auty,

Daw,

Admon

et al. 2023

Health Services Research

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ObjectiveTo evaluate the performance of different approaches for identifying live births using Transformed Medicaid Statistical Information System Analytic Files (TAF).Data SourcesThe primary data source for this study were TAF inpatient (IP), other services (OT), and demographic and eligibility files. These data contain administrative claims for Medicaid enrollees in all 50 states and the District of Columbia from January 1, 2018 to December 31, 2018.Study DesignWe compared five approaches for identifying live birth counts obtained from the TAF IP and OT data with the Centers for Disease Control and Prevention (CDC) Natality data—the gold standard for birth counts at the state level.Data Collection/Extraction MethodsThe five approaches used varying combinations of diagnosis and procedure, revenue, and place of service codes to identify live births. Approaches 1 and 2 follow guidance developed by the Centers for Medicare and Medicaid Services (CMS). Approaches 3 and 4 build on the approaches developed by CMS by including all inpatient hospital claims in the OT file and excluding codes related to delivery services for infants, respectively. Approach 5 applied Approach 4 to only the IP file.Principal FindingsApproach 4, which included all inpatient hospital claims in the OT file and excluded codes related to infants to identify deliveries, achieved the best match of birth counts relative to CDC birth record data, identifying 1,656,794 live births—a national overcount of 3.6%. Approaches 1 and 3 resulted in larger overcounts of births (20.5% and 4.5%), while Approaches 2 and 5 resulted in undercounts of births (−3.4% and −6.8%).ConclusionsIncluding claims from both the IP and OT files, and excluding codes unrelated to the delivery episode and those specific to services rendered to infants improves accuracy of live birth identification in the TAF data.

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Section: Methodsmentioning

confidence: 99%

Section: Approach 3: Including Inpatient Hospital Claims In the Ot Filementioning

confidence: 99%

Comparing approaches to identify live births using the Transformed Medicaid Statistical Information System

Auty,

Daw,

Admon

et al. 2023

Health Services Research

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“…1,2 However, up to one-third of all US pregnancies follow a short interpregnancy interval, 3 and disparities in access to postpartum care and contraception vary by race, ethnicity, and insurance coverage. 4,5 Improved access to postpartum care through Medicaid expansion is associated with lower rates of short interval pregnancy, 6 particularly for Black individuals. 7 Lactational amenorrhea (LAM) is the original form of postpartum contraception.…”

Section: Introductionmentioning

confidence: 99%

Understanding of Lactational Amenorrhea As a Contraceptive Method Among U.S. Pregnant Women

Hoyt-Austin

Chen

Iwuagwu

et al. 2023

Breastfeeding Medicine

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Introduction: The lactational amenorrhea method (LAM) of postpartum contraception is more effective than typical use of condoms or birth control pills. However, LAM may be underutilized due to incomplete perinatal counseling.Methods: We compared perceptions of the effectiveness of postpartum contraceptives including LAM among US-born nulliparous pregnant women recruited using social media for a trial (NCT 04601987). We used descriptive statistics to summarize data.Results: Of 760 individuals screened, 627 were invited to participate, and 451 (72%) enrolled.Most (81%) had a college degree; 79% intended to breastfeed for at least 1 month. Only 8% believed exclusive breastfeeding reduces the chance of pregnancy "a lot" within 6 months of delivery and 2% indicated that exclusive breastfeeding is typically more effective than birth control pills or condoms. Compared to those planning to use other postpartum contraceptives, the 17% of respondents who planned to use LAM were more likely to know that breastfeeding delays return of menses (84% vs 44%, p=<0.0001) and provides protection from pregnancy until menses return (54% versus 22%, p=<0.0001). Although 25% of those planning to use LAM believed exclusive breastfeeding reduces pregnancy risk by "a lot," only 5% thought LAM is more effective than birth control pills and only 9% that it is more effective than condoms.Conclusions/Implications: First-time US mothers are often unaware of breastfeeding's effects on menses and fertility. Clinicians providing counseling about postpartum contraceptive options should include more information on LAM.

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“…Outside of temporary insurance programs, expanding overall Medicaid eligibility or creating a single-payer system would further reduce access barriers. Following the passage of the Affordable Care Act, the rate of short interpregnancy intervals decreased in states participating in the 2014 Medicaid expansion (in states declining the expansion, the rate of short interpregnancy intervals increased) 77 Continue research to deepen our understanding of patient values and patient experiences in choosing and accessing postpartum contraception for populations experiencing disparities in access and outcomes. Future research is necessary to further elucidate patient decision-making, barriers to care surrounding contraception in the postpartum period, provider perceptions, counseling practices, and unconscious biases.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Achieving Equity in Postpartum Contraception Access

McAllister

Christensen

Dixit

et al. 2022

Clinical Obstetrics &Amp; Gynecology

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Equitable access to contraception and contraceptive education has the potential to mitigate health disparities related to unintended pregnancy. Pregnancy and the postpartum window frequently offer reduced insurance barriers to healthcare, increased interaction with healthcare systems and family planning providers, and an opportune time for many individuals to receive contraception; however, there are additional considerations in method type for postpartum individuals, and contraceptive counseling must be thoughtfully conducted to avoid coercion and promote shared decision-making. This commentary reviews method-specific considerations and suggests priorities for achieving equity in postpartum contraceptive access.

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Influence of Medicaid expansion on short interpregnancy interval rates in the United States

Cited by 8 publications

References 15 publications

Comparing approaches to identify live births using the Transformed Medicaid Statistical Information System

Comparing approaches to identify live births using the Transformed Medicaid Statistical Information System

Understanding of Lactational Amenorrhea As a Contraceptive Method Among U.S. Pregnant Women

Achieving Equity in Postpartum Contraception Access

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