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. 2023 May 1;141(5):918-925.
doi: 10.1097/AOG.0000000000005130. Epub 2023 Apr 5.

Medicaid and Fulfillment of Postpartum Permanent Contraception Requests

Kavita Shah Arora  1 , Arzice Chua, Emily Miller, Margaret Boozer, Tania Serna, Brooke W Bullington, Kari White, Douglas D Gunzler, Jennifer L Bailit, Kristen Berg
Affiliations

Medicaid and Fulfillment of Postpartum Permanent Contraception Requests

Kavita Shah Arora et al. Obstet Gynecol. .

Erratum in

Abstract

Objective: To evaluate the association between Medicaid insurance and fulfillment of postpartum permanent contraception requests.

Methods: We conducted a retrospective cohort study of 43,915 patients across four study sites in four states, of whom 3,013 (7.1%) had a documented contraceptive plan of permanent contraception at the time of postpartum discharge and either Medicaid insurance or private insurance. Our primary outcome was permanent contraception fulfillment before hospital discharge; we compared individuals with private insurance with individuals with Medicaid insurance. Secondary outcomes were permanent contraception fulfillment within 42 and 365 days of delivery, as well as the rate of subsequent pregnancy after nonfulfillment. Bivariable and multivariable logistic regression analyses were used.

Results: Patients with Medicaid insurance (1,096/2,076, 52.8%), compared with those with private insurance (663/937, 70.8%), were less likely to receive desired permanent contraception before hospital discharge (P≤.001). After adjustment for age, parity, weeks of gestation, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index, private insurance status was associated with higher odds of fulfillment at discharge (adjusted odds ratio [aOR] 1.48, 95% CI 1.17-1.87) and 42 days (aOR 1.43, 95% CI 1.13-1.80) and 365 days (aOR 1.36, 95% CI 1.08-1.71) postpartum. Of the 980 patients with Medicaid insurance who did not receive postpartum permanent contraception, 42.2% had valid Medicaid sterilization consent forms at the time of delivery.

Conclusion: Differences in fulfillment rates of postpartum permanent contraception are observable between patients with Medicaid insurance and patients with private insurance after adjustment for clinical and demographic factors. The disparities associated with the federally mandated Medicaid sterilization consent form and waiting period necessitate policy reassessment to promote reproductive autonomy and to ensure equity.

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Conflict of interest statement

Financial Disclosure Emily Miller reports her institution received funding from Pfizer. Margaret Boozer reports that she is a board member for the Physicians for Reproductive Health Board and Planned Parenthood Southeast. The other authors did not report any potential conflicts of interest.

Figures

Figure 1:
Figure 1:
Study cohort flow chart of the pooled, multicenter retrospective cohort.
See this image and copyright information in PMC

References

    1. Daniels K, Abma JC. Current Contraceptive Status Among Women Aged 15–49: United States, 2015–2017. NCHS Data Brief. 2018;327. Accessed October 31, 2021. https://www.cdc.gov/nchs/data/databriefs/db327_tables-508.pdf#3. - PubMed
    1. Jensen JT. Permanent contraception: modern approaches justify a new name. Contraception. 2014;89(6):493–494. doi: 10.1016/J.CONTRACEPTION.2014.01.007 - DOI - PubMed
    1. Access to Postpartum Sterilization: ACOG Committee Opinion, Number 827. Obstetrics and gynecology. 2021;137(6):e169–e176. doi: 10.1097/AOG.0000000000004381 - DOI - PubMed
    1. Block-Abraham D, Arora KS, Tate D, Gee RE. Medicaid Consent to Sterilization Forms: Historical, Practical, Ethical, and Advocacy Considerations. Clin Obstet Gynecol. 2015;58(2):409–417. doi: 10.1097/GRF.0000000000000110 - DOI - PubMed
    1. Borrero S, Zite N, Potter J, Trussell J. Medicaid policy on sterilization--anachronistic or still relevant? N Engl J Med. 2014;370(2):102–104. doi: 10.1056/NEJMP1313325 - DOI - PMC - PubMed

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