Abstract
Objectives
To compare receipt of contraception and method effectiveness in the early postpartum period among women with and without a recent preterm birth (PTB).
Methods
We used data from North Carolina birth certificates linked to Medicaid claims. We assessed contraceptive claims with dates of service within 90 days of delivery among a retrospective cohort of women who had a live birth covered by Medicaid between September 2011 and 2012 (n = 58,201). To estimate the odds of receipt of contraception by PTB status (24–36 weeks compared to 37–42 weeks [referent]), we used logistic regression and tested for interaction by parity. To estimate the relationship between PTB and method effectiveness based on the Center for Disease Control and Prevention Levels of Effectiveness of Family Planning Methods (most, moderate and least effective [referent]), we used multinomial logistic regression.
Results
Less than half of all women with a live birth covered by Medicaid in North Carolina had a contraceptive claim within 90 days postpartum. Women with a recent PTB had a lower prevalence of contraceptive receipt compared to women with a term birth (45.7% vs. 49.6%). Women who experienced a PTB had a lower odds of receiving contraception. When we stratified by parity, women with a PTB had a lower odds of contraceptive receipt among women with more than two births (0.79, 95% CI 0.74–0.85), but not among women with two births or fewer. One-fourth of women received a most effective method. Women with a preterm birth had a lower odds of receiving a most effective method (0.83, 95% CI 0.77–0.88) compared to women with a term birth.
Conclusions for Practice
Contraceptive receipt was low among women with a live birth covered by Medicaid in North Carolina. To optimize contraceptive use among women at risk for subsequent preterm birth, family planning strategies that are responsive to women’s priorities and context, including a history of preterm birth, are needed.
Significance
Access to free or affordable highly effective contraception is associated with reductions in preterm birth. Self-report data indicate that women with a very preterm birth (PTB) are less likely to use highly or moderately effective contraception postpartum compared to women delivering at later gestational ages. Using Medicaid claims data, we found that less than half of all women with a Medicaid covered delivery in North Carolina in 2011–2012 had a contraceptive claim within 90 days postpartum, and one fourth received a most effective method. Women with a PTB and more than two children were least likely to receive any method. Family planning strategies that are responsive to women’s priorities and context, including a history of preterm birth, are needed so that women may access their contraceptive method of choice in the postpartum period.
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Acknowledgements
Special thanks to Jill Ruppenkamp, Analytics Manager at Community Care of North Carolina, for pulling the data and providing technical assistance and Gretchen Stuart, Associate Professor & Division Director, Family Planning at the University of North Carolina at Chapel Hill, and Lindsey Yates, Doctoral Candidate, Health Policy and Management, Gillings School of Global Public Health for reviewing a draft of the manuscript. This research received support from the Population Research Training Grant (T32 HD007168) and the Population Research Infrastructure Program (R24 HD050924) awarded to the Carolina Population Center at The University of North Carolina at Chapel Hill by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Funding was also provided by HRSA MCH Doctoral Training in Health Disparities Grant No. T03MC07643 and the University of North Carolina at Chapel Hill Dissertation Completion Award. The content presented in this report are of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by NC TraCS, HRSA, HHS or the U.S. Government.
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Tucker, C., Berrien, K., Menard, M.K. et al. Preterm Birth and Receipt of Postpartum Contraception Among Women with Medicaid in North Carolina. Matern Child Health J 24, 640–650 (2020). https://doi.org/10.1007/s10995-020-02889-4
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DOI: https://doi.org/10.1007/s10995-020-02889-4