Insurance loss after childbirth tied to lower odds of prescription contraception use

Key takeaways:

• Women who lost insurance more than 2 months postpartum had the lowest odds for prescription contraception.
• Spanish-speaking women were more likely to be uninsured or have insurance discontinuity.

Women who lost insurance more than 2 months after childbirth had lower odds of receiving prescription contraception, highlighting the need for greater contraception affordability, according to findings published in O&G Open.

“Postpartum contraception is an important part of pregnancy-related care, with a critical role in preventing unintended pregnancies and fostering reproductive autonomy. ... Although prescription contraceptive methods are not the optimal choice for every postpartum individual, there is no clinical basis for insurance status alone to influence use patterns,” Kimberly M. Schaefer, MD, MPP, resident physician in the department of obstetrics and gynecology at Oregon Health and Science University, and colleagues wrote. “However, given that insurance can be a considerable barrier to care, we hypothesized that discontinuous insurance coverage from pregnancy to more than 2 months after birth would be associated with lower rates of prescription contraceptive method use.”

Schaefer and colleagues conducted a retrospective cohort study using data from 223,430 women from 42 states from the Pregnancy Risk Assessment Monitoring System from 2012 to 2020. Researchers categorized insurance status at more than 2 months after delivery as continuous insurance (78.9%), insurance loss (10.2%), discontinuous Medicaid-to-private (6.51%), discontinuous private-to-Medicaid (4%), continuous uninsurance (0.26%) and gain of insurance (0.11%).

Odds for prescription postpartum contraception were lowest for women who lost insurance (adjusted OR = 0.74; 95% CI, 0.71-0.78), followed by those with discontinuous private-to-Medicaid (aOR = 0.9; 95% CI, 0.84-0.97) or discontinuous Medicaid-to-private (aOR = 1.04; 95% CI, 0.98-1.1) compared with women with continuous insurance.

Fewer women with vs. without Medicaid expansion lost insurance (6.8% vs. 14%). Nearly half of Hispanic Spanish-speaking women (47.5% vs. 14%) lost insurance and fewer had continuous insurance (37.4% vs. 71.9%) compared with Hispanic English-speaking women.

Researchers observed a significant interaction between race, ethnicity and language and insurance discontinuity (P < .001) but no evidence for interactions between residence in states with Medicaid expansion and insurance status.

“The increasingly widespread uptake of state plan amendments to expand postpartum Medicaid coverage from 60 days to 1 year with federal funding is a significant step toward improving continuity of postpartum insurance coverage. As the results of these policy changes unfold, future work will assess the effects of extended postpartum Medicaid coverage,” the researchers wrote. “For states that do not move in this direction, this study highlights the need for greater affordability of contraception to minimize cost barriers related to uninsurance.”