Abstract
Objective
We sought to evaluate the impact of insurance type on receipt of an interval postpartum
LARC, controlling for demographic and clinical factors.
Study design
This is a retrospective cohort study of 1072 women with a documented plan of LARC
for contraception at time of postpartum discharge. This is a secondary analysis of
8654 women who delivered at 20 weeks or beyond from January 1, 2012, through December
31, 2014, at an urban teaching hospital in Ohio. LARC receipt within 90 days of delivery,
time to receipt, and rate of subsequent pregnancy after non-receipt were compared
between women with Medicaid and women with private insurance. Postplacental LARC was
not available at the time of study completion.
Results
One hundred eighty-seven of 822 Medicaid-insured and 43 of 131 privately insured women
received a LARC postpartum (22.7% vs 32.8%, P=.02). In multivariable analysis, private insurance status was not significantly associated
with LARC receipt (OR 1.29, 95% C.I. 0.83–1.99) though adequate prenatal care was
(OR 2.33, 95% C.I. 1.42–4.00). Of women who wanted but did not receive a LARC, 208
of 635 (32.8%) Medicaid patients and 19 of 88 (21.6%) privately insured patients became
pregnant within 1 year (P=.02).
Conclusion
Differences in receipt of interval postpartum LARC were not significant between women
with Medicaid insurance versus private insurance after adjusting for clinical and
demographic factors. Adequate prenatal care was associated with LARC receipt. Medicaid
patients who did not receive a LARC were more likely to become pregnant within one
year of delivery than those with private insurance.
Implications
While insurance-related barriers have been reduced given recent policy changes, access
to care remains an important determinant of postpartum LARC provision and subsequent
unintended pregnancy.
Keywords
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Article info
Publication history
Published online: September 05, 2018
Accepted:
August 29,
2018
Received in revised form:
August 20,
2018
Received:
May 20,
2018
Footnotes
☆The authors report no conflicts of interest.
☆☆Funding Disclosure: Dr. Arora is funded by the Clinical and Translational Science Collaborative of Cleveland, KL2TR000440 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research. This manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
