Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use

Abstract

Objectives: Although multi-component policy interventions can be important tools to increase access to contraception, we know little about how they may change contraceptive use among postpartum women. We estimate the association of the Delaware Contraceptive Access Now (DelCAN) initiative with use of postpartum Long-Acting Reversible Contraception (LARC). DelCAN included Medicaid payment reform for immediate postpartum LARC use, provider training and technical assistance in LARC provision, and a public awareness campaign.

Methods: We used a difference-in-differences design and data from the 2012 to 2017 pregnancy risk assessment monitoring system to compare changes in postpartum LARC use in Delaware versus 15 comparison states, and differences in such changes by women's Medicaid enrollment.

Results: Relative to the comparison states, postpartum LARC use in Delaware increased by 5.26 percentage points (95% CI 2.90-7.61, P < 0.001) during the 2015-2017 DelCAN implementation period. This increase was the largest among Medicaid-covered women, and grew over the first three implementation years. By the third year of the DelCAN initiative (2017), the relative increase in postpartum LARC use for Medicaid women exceeded that for non-Medicaid women by 7.24 percentage points (95% CI 0.12-14.37, P = 0.046).

Conclusions for practice: The DelCAN initiative was associated with increased LARC use among postpartum women in Delaware. During the first 3 years of the initiative, LARC use increased progressively and to a greater extent among Medicaid-enrolled women. Comprehensive initiatives that combine Medicaid payment reforms, provider training, free contraceptive services, and public awareness efforts may reduce unmet demand for highly effective contraceptives in the postpartum months.

Keywords: Long acting reversible contraceptives (LARCs); Medicaid; Postpartum contraceptive use; Provider training.

Fig. 1

Trends in the probability of using LARCs postpartum by Medicaid-coverage status, 2012–2017. Comparison states in sample were AK, IL, MA, MD, ME, MO, NJ, NM, OK, PA, UT, WA, WI, WV, and WY. The analytical sample is restricted to postpartum women who were not pregnant or trying to get pregnant, and who were sexually active at the time of the survey. Vertical bar indicates the start of the Delaware Contraceptive Access Now (DelCAN) initiative in 2015. Source: Authors’ analyses of data from the 2012 to 2017 Pregnancy Risk Assessment Monitoring System (PRAMS)