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The Association of Public Insurance with Postpartum Contraception Preference and Provision

Authors Verbus E, Ascha M, Wilkinson B, Montague M, Morris J, Mercer BM, Arora KS

Received 16 September 2019

Accepted for publication 7 December 2019

Published 19 December 2019 Volume 2019:10 Pages 103—110


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Igal Wolman

Emily Verbus,1 Mustafa Ascha,2 Barbara Wilkinson,1 Mary Montague,1 Jane Morris,3 Brian M Mercer,3 Kavita Shah Arora3

1School of Medicine, Case Western Reserve University, Cleveland, OH, USA; 2Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, USA; 3Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA

Correspondence: Kavita Shah Arora
Department of Obstetrics and Gynecology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
Tel +1 216-778-4444
Fax +1 216-778-8642

Background: Prior studies have noted that public insurance status is associated with increased uptake of postpartum contraception whereas others have pointed to public insurance as a barrier to accessing highly effective forms of contraception.
Objective: To assess differences in planned method and provision of postpartum contraception according to insurance type.
Study Design: This is a secondary analysis of a retrospective cohort study examining postpartum women delivered at a single hospital in Cleveland, Ohio from 2012–2014. Contraceptive methods were analyzed according to Tier-based effectiveness as defined by the Centers for Disease Control and Prevention. The primary outcome was postpartum contraception method preference. Additional outcomes included method provision, postpartum visit attendance, and subsequent pregnancy within 365 days of delivery.
Results: Of the 8281 patients in the study cohort, 1372 (16.6%) were privately and 6990 (83.4%) were publicly insured. After adjusting for the potentially confounding clinical and demographic factors through propensity score analysis, public insurance was not associated with preference for a Tier 1 versus Tier 2 postpartum contraceptive method (matched adjusted odds ratio [maOR] 0.89, 95% CI 0.69–1.15), but was associated with a preference for Tier 1/2 vs Tier 3/None (maOR 1.41, 95% CI 1.17–1.69). There was no difference between women with private or public insurance in terms of method provision by 90 days after delivery (maOR 0.94, 95% CI 0.75–1.17). Public insurance status was also associated with decreased postpartum visit attendance (maOR 0.54, 95% CI 0.43–0.68) and increased rates of subsequent pregnancy within 365 days of delivery (maOR 1.29, 95% CI 1.05–1.59).
Conclusion: Public insurance status does not serve as a barrier to either the preference or provision of effective postpartum contraception. Women desiring highly- or moderately effective methods of contraception should have these methods provided prior to hospital discharge to minimize barriers to method provision.

Keywords: postpartum contraception, disparities, insurance, Medicaid, sterilization, LARC

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