Unintended pregnancy, endemic in the United States (US), carries significant health
and economic consequences and disproportionately affects poor women and women of color
[
1
,
2
]. Rapid repeat pregnancy—defined as a pregnancy within 12 to 18 months after delivery—can occur if women are unsuccessful at initiating contraception
[
[3]
]. Improving postpartum initiation of effective contraception including long-acting
reversible contraception (LARC), the intrauterine device (IUD) and contraceptive implant,
is a key strategy to reduce unintended pregnancy and health inequities. However, nonreimbursement
by insurers for both LARC devices and the immediate insertion procedure, is a critical
barrier to the provision of postpartum LARC during the hospital admission for a birth.
Recently, coalitions in three states have successfully advocated for modification
of Medicaid policy to allow reimbursement for immediate postpartum placement, both
for the devices and the insertion procedure, separate from the global fee for delivery.
By removing a key financial barrier, these policy changes signal an important advance
in provision of the most effective forms of immediate postpartum contraception.To read this article in full you will need to make a payment
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References
- Disparities in family planning.Am J Obstet Gynecol. 2010; 202 ([PubMed PMID: 20207237. Pubmed Central PMCID: 2835625]): 214-220
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- Medicaid reimbursement for immediate post-partum LARC.([Accessed April 4, 2014])
- Long acting reversible contraception in postpartum adolescents: early initiation of etonogestrel implant is superior to IUDs in the outpatient setting.J Pediatr Adolesc Gynecol. 2012; 25 (PubMed PMID: 22051792. Epub 2011/11/05. eng.): 59-63
- Preventing repeat pregnancy in adolescents: is immediate postpartum insertion of the contraceptive implant cost effective?.Am J Obstet Gynecol. 2014; 211 ([PubMed PMID: 24631431]): 24.e1-24.e7
Article info
Publication history
Published online: July 08, 2014
Accepted:
July 1,
2014
Received in revised form:
June 29,
2014
Received:
March 25,
2014
Footnotes
☆Financial disclosures: MIR has no financial disclosures.
☆☆MLE received grant funding from Wyeth Pharmaceuticals for women's health policy research, specifically increasing LARC use in low-income populations.
★EE has no financial disclosures.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
