Desired postpartum sterilization less likely with Medicaid vs. private insurance

Key takeaways :

• Women with Medicaid vs. private insurance were less likely to receive requested postpartum sterilization.
• Women with private insurance vs. Medicaid had higher sterilization odds at discharge and 42 and 365 days postpartum.

Among women who said they wanted permanent contraception after giving birth, those with Medicaid were less likely than those with private insurance to receive sterilization procedures, according to results of a retrospective cohort study.

“Even after adjusting for clinical and demographic factors that impact contraceptive desire and access, patients with Medicaid insurance were less likely to receive their desired permanent contraception procedures (ie, sterilization) postpartum than patients with private insurance,” Kavita Shah Arora, MD, MBE, MS, obstetrician and gynecologist in the department of obstetrics and gynecology and the department of epidemiology at the Gillings School of Global Public Health and the Carolina Population Center at the University of North Carolina at Chapel Hill, told Healio. “Developing and implementing hospital policies to coordinate postpartum permanent contraception for patients who undergo vaginal delivery may help to mitigate barriers at the provider and hospital level.”

Arora and colleagues assessed data from 43,915 women across four study sites in four states who delivered at or beyond 20 weeks gestation from 2018 to 2019. Of these women, 7.1% had a documented contraceptive plan of permanent contraception, or sterilization, at postpartum discharge. All women were on Medicaid insurance or private insurance.

The primary outcome was permanent contraception fulfillment before hospital discharge. Secondary outcomes included permanent contraception fulfillment within 42 and 365 days postpartum and the rate of subsequent pregnancy after nonfulfillment.

A total of 3,013 women desired sterilization postpartum, 68.9% with Medicaid insurance and 31.1% with private insurance. Compared with women with private insurance, those with Medicaid insurance were less likely to receive their desired permanent contraception before hospital discharge (52.8% vs. 70.8%; P < .001), within 6 weeks of delivery (54.1% vs. 71.4%; P < .001) or by 35 days postpartum (60.9% vs. 74.9%; P < .001).

When adjusting for age, parity, weeks’ gestation, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status and BMI, researchers noted higher fulfillment odds among women with private insurance at hospital discharge (adjusted OR = 1.48; 95% CI, 1.17-1.87), 42 days (aOR = 1.43; 95% CI, 1.13-1.8) and 365 days (aOR = 1.36; 95% CI, 1.08-1.71).

In addition, of the 980 women with Medicaid insurance who did not receive sterilization postpartum, 42.2% had valid Medicaid sterilization consent forms at the time of delivery, 32.6% did not have a signed form at delivery and 25% had signed forms at delivery but the required waiting period had not elapsed.

“It will be important to assess whether the length of the waiting period imposed by Medicaid prior to provision of permanent contraception is associated with disparities, and whether shortening that waiting period protects against coercion but also is less of a barrier to desired care,” Arora said.

For more information:

Kavita Shah Arora, MD, MBE, MS, can be reached at kavita.shah.arora@gmail.com.