Insurance Loss Reduces Postpartum Contraception Access

TOPLINE:

Insurance loss more than 2 months after childbirth is associated with 26% lower odds of prescription contraception use, with Hispanic Spanish-language respondents experiencing higher rates of coverage loss. Pregnancy Risk Assessment Monitoring System (PRAMS) data from 223,430 respondents reveals that 78.9% maintained continuous insurance coverage postpartum.

METHODOLOGY:

• Researchers conducted a retrospective cohort study analyzing PRAMS survey data from 2012 to 2020 across 42 states, including 223,430 respondents who completed surveys between 2 months and 1 year postpartum.
• Analysis categorized insurance status as continuous insurance, insurance loss, discontinuous Medicaid-to-private, discontinuous private-to-Medicaid, continuous uninsurance, and gain of insurance.
• Investigators used logistic regression to estimate odds ratios (ORs) with 95% CIs for insurance status and prescription contraception use, adjusting for age, race, ethnicity, language, marital status, federal poverty level, education, and birth year.

TAKEAWAY:

• Among all respondents, 10.2% lost insurance coverage postpartum. Compared with continuous insurance, the adjusted OR for prescription postpartum contraception was 0.74 (95% CI, 0.71-0.78).
• Discontinuous private-to-Medicaid insurance showed decreased odds of prescription contraception (OR, 0.90; 95% CI, 0.84-0.97) compared with continuous insurance.
• In states without Medicaid expansion, 14.0% (95% CI, 13.6-14.3) of respondents experienced insurance loss compared to 6.8% (95% CI, 6.6-7.0) in expansion states.
• Nearly half (47.5%) of Hispanic Spanish-language respondents experienced postpartum insurance loss, significantly higher than Hispanic English-language respondents (14.0%).

IN PRACTICE:

“Medicaid expansion has been shown to be associated largely with improved perinatal health outcomes, including a 17% reduction in hospitalization during the first 60 days postpartum, decreased postpartum uninsurance and insurance, and decreased racial inequities in postpartum coverage. With regard to contraception, specifically, Medicaid expansion is associated with an increase in use of any postpartum contraception, especially more effective forms of contraception,” wrote the authors of the study.

SOURCE:

The study was led by Kimberly M. Schaefer, MD, MPP, Oregon Health & Science University in Portland, Oregon. It was published online in O&G Open.

LIMITATIONS:

The study excluded data from several major states including Arizona, California, Florida, Idaho, Indiana, Nevada, South Carolina, and Texas, which may limit generalizability. Additionally, researchers could not examine insurance discontinuity within the same insurance strata, potentially underestimating the discontinuity population. The analysis was also limited by incomplete income data, which may introduce sampling bias.

DISCLOSURES:

The authors did not report any potential conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.