Postpartum contraception in publicly-funded programs and interpregnancy intervals

Abstract

Objective: To assess the extent to which women received contraceptive services within 90 days after birth at their first or subsequent visits and whether contraceptive provision was associated with optimal interpregnancy intervals.

Method: We linked California's 2008 Birth Statistical Master File with Medicaid databases to build a cohort of women aged 15-44 years who had given birth in 2008 and received publicly-funded health care services in the 18 months after their previous live birth (N=117,644). We determined whether provision of contraception within 90 days after birth was associated with optimal interpregnancy intervals when controlling for covariates.

Result: Only 41% (n=48,775) of women had a contraceptive claim within 90 days after birth. To avoid short interpregnancy intervals, 6 women would need to receive contraception to avoid one additional short interval (number needed to treat=6.38). Receipt of a contraceptive method, receiving contraception at the first clinic visit, and being seen by Medi-Cal and its family planning expansion program were significantly associated with avoidance of short interpregnancy intervals. Receiving contraception at the first postpartum clinic visit had an additional independent effect on avoiding short interpregnancy intervals when controlling for the other variables. Although foreign-born women had 47% higher odds of avoiding short interpregnancy intervals than U.S.-born women, women of Asian and Pacific Islander ethnicity had 24% lower odds of avoiding short interpregnancy intervals than white women.

Conclusion: Findings of this study suggest that closer attention to provision of postpartum contraception in publicly-funded programs has the potential to improve optimal interpregnancy intervals among low-income women.

Level of evidence: II.