Postpartum Visit Attendance in the United States: A Systematic Review

Attanasio, Laura B.; Ranchoff, Brittany L; Cooper, Michael I; Geissler, Kimberley H.

doi:10.1016/j.whi.2022.02.002

Cited by 38 publications

(33 citation statements)

References 94 publications

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“…course before the routine six-week postpartum visit [8], and the proportion of people who attend their postpartum visit is 72% [25]. Among patients in New Mexico who desired an IUD post-delivery, only 60% actually received a device [26].…”

Section: Percentages Of Larc Use At 60 Days Postpartum By Nc Medicaid...mentioning

confidence: 99%

Interpregnancy Care and Access to Long-Acting Reversible Contraception

Wise

Urrutia

2023

North Carolina Medical Journal

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Section: Percentages Of Larc Use At 60 Days Postpartum By Nc Medicaid...mentioning

confidence: 99%

Interpregnancy Care and Access to Long-Acting Reversible Contraception

Wise

Urrutia

2023

North Carolina Medical Journal

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“…43,44 Access to Postpartum Care Postpartum visit attendance is incredibly variable, with 25-96% of people attending a postpartum visit. 45 Among vulnerable populations, this can be as low as 30-50%, 46 with racial/ethnic minority populations, particularly Black women, having among the lowest rates due to structural racism and adverse social determinants of health. 47 Postpartum telehealth options that were introduced during the COVID-19 pandemic have been shown to mitigate existing disparities in postpartum care access and uptake, 48 but optimal implementation of postpartum telehealth, accounting for the need for a physical examination and potential placement of long-acting reversible contraceptives (LARC) has not been established.…”

Section: Treatmentmentioning

confidence: 99%

Perinatal Mental Health Disorders: A Review of Lessons Learned from Obstetric Care Settings

Ayala¹,

Lewkowitz²,

Whelan³

2023

NDT

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Perinatal mental health has garnered significant attention within obstetrics over the last couple of decades as the long- and short-term morbidities of untreated perinatal mental health disorders on both the mother and fetus/neonate have become increasingly apparent. There have been major strides in increasing screening for perinatal mental health disorders, clinician comfort with prescribing common psychiatric medications, and integrating mental health professionals into prenatal care via health services approaches such as the collaborative care model. Despite these advances, however, gaps still remain in the tools used for screening and diagnosis, obstetric clinician training in diagnosis and management of perinatal mood and anxiety disorders, as well as patient access to mental health care during pregnancy and especially postpartum. Herein we review the state of perinatal mental health from the perspective of the obstetric provider and identify areas of ongoing innovation.

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“…Studies that have examined postpartum care as a binary measure-visit attendance-suggest that postpartum visit attendance is lower among Medicaid-insured compared with privately insured patients 3,17 ; these findings are mixed regarding any differences by race and ethnicity. To our knowledge, no studies have examined rural vs urban residence as a variable.…”

Section: Findings In the Context Of What Is Knownmentioning

confidence: 99%

“…2 In the US, postpartum care is often limited to 1 visit, which is insufficient and not attended by many patients. 3,4 Half of postpartum patients report not receiving all of the care they wanted and 30% report feeling rushed. 1,5 The potential consequences of inadequate postpartum care and treatment are substantial.…”

Section: Introductionmentioning

confidence: 99%

“…4 Few studies have examined postpartum care beyond binary measures of receiving any vs no care. 3,17 Even less is known about variation in the quality and content of postpartum care across patient identities, largely because of a lack of data collection in the postpartum period as well as a paucity of research during this period that disaggregates along intersectional lines. 17,21 This study examines receipt of recommended components of postpartum care and describes variation in care across insurance type, rural or urban residence, and race and ethnicity, as well as the intersections of these patient identities.…”

Section: Introductionmentioning

confidence: 99%

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Association of Health Insurance, Geography, and Race and Ethnicity With Disparities in Receipt of Recommended Postpartum Care in the US

et al. 2022

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ImportanceLittle is known about the quality of postpartum care or disparities in the content of postpartum care associated with health insurance, rural or urban residency, and race and ethnicity.ObjectivesTo examine receipt of recommended postpartum care content and to describe variations across health insurance type, rural or urban residence, and race and ethnicity.Design, Settings, and ParticipantsThis cross-sectional survey of patients with births from 2016 to 2019 used data from the Pregnancy Risk Assessment Monitoring System (43 states and 2 jurisdictions). A population-based sample of patients conducted by state and local health departments in partnership with the Centers for Disease Control and Prevention were surveyed about maternal experiences 2 to 6 months after childbirth (mean weighted response rate, 59.9%). Patients who attended a postpartum visit were assessed for content at that visit. Analyses were performed November 2021 to July 2022.ExposuresMedicaid or private health insurance, rural or urban residence, and race and ethnicity (non-Hispanic White or racially minoritized groups).Main Outcomes and MeasuresReceipt of 2 postpartum care components recommended by national quality standards (depression screening and contraceptive counseling), and/or other recommended components (smoking screening, abuse screening, birth spacing counseling, eating and exercise discussions) with estimated risk-adjusted predicted probabilities and percentage-point (pp) differences.ResultsAmong the 138 073 patient-respondents, most (59.5%) were in the age group from 25 to 34 years old; 59 726 (weighted percentage, 40%) were insured by Medicaid; 27 721 (15%) were rural residents; 9718 (6%) were Asian, 24 735 (15%) were Black, 22 210 (15%) were Hispanic, 66 323 (60%) were White, and fewer than 1% were Indigenous (Native American/Alaska Native) individuals. Receipt of both depression screening and contraceptive counseling both significantly lower for Medicaid-insured patients (1.2 pp lower than private; 95% CI, –2.1 to –0.3), rural residents (1.3 pp lower than urban; 95% CI, –2.2 to –0.4), and people of racially minoritized groups (0.8 pp lower than White individuals; 95% CI, –1.6 to –0.1). The highest receipt of these components was among privately insured White urban residents (80%; 95% CI, 79% to 81%); the lowest was among privately insured racially minoritized rural residents (75%; 95% CI, 72% to 78%). Receipt of all other components was significantly higher for Medicaid-insured patients (6.1 pp; 95% CI, 5.2 to 7.0), rural residents (1.1 pp; 95% CI, 0.1 to 2.0), and people of racially minoritized groups (8.5 pp; 95% CI, 7.7 to 9.4). The highest receipt of these components was among Medicaid-insured racially minoritized urban residents (34%; 95% CI, 33% to 35%), the lowest was among privately insured White urban residents (19%; 95% CI, 18% to 19%).Conclusions and RelevanceThe findings of this cross-sectional survey of postpartum individuals in the US suggest that inequities in postpartum care content were extensive and compounded for patients with multiple disadvantaged identities. Examining only 1 dimension of identity may understate the extent of disparities. Future studies should consider the content of postpartum care visits.

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Postpartum Visit Attendance in the United States: A Systematic Review

Cited by 38 publications

References 94 publications

Interpregnancy Care and Access to Long-Acting Reversible Contraception

Interpregnancy Care and Access to Long-Acting Reversible Contraception

Perinatal Mental Health Disorders: A Review of Lessons Learned from Obstetric Care Settings

Association of Health Insurance, Geography, and Race and Ethnicity With Disparities in Receipt of Recommended Postpartum Care in the US

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