PROVIDENCE, R.I. [Brown University] – A recent Medicaid reimbursement policy that allows hospitals to provide long-acting reversible contraception (LARC) immediately after childbirth has reduced the number of closely spaced births among young women in South Carolina, according to a new study led by Maria Steenland, a postdoctoral fellow at the Population Studies and Training Center.

Published this month in the Journal of the American Medical Association (JAMA), the research is the first to evaluate the South Carolina reimbursement program and demonstrates how the new policy can be an effective option to increase immediate postpartum LARC initiation and improve birth spacing among teens.  The American College of Obstetricians and Gynecologists (ACOG) reports that one-third of all US pregnancies are conceived less than 18 months after a prior birth.  These short intervals between pregnancies are often associated with increased risk factors for newborns, including preterm birth, low birth weight, and death.

“The new reimbursement policy increased the likelihood of immediate postpartum LARC use for both teens and adult women,” says Steenland. “By directly reimbursing hospitals for LARC, Medicaid is helping to support women and children by promoting access to contraceptive methods of choice.”

For the study, Steenland and coauthors analyzed inpatient Medicaid claims data for roughly 243,000 childbirth hospitalizations in South Carolina from 2010 through 2017. By the end of the study period, the percentage of women receiving an immediate postpartum LARC increased by 5.65 percentage for adults and 10.48 percentage for adolescents.  Moreover, the use of immediate postpartum LARCs reduced the rate of closely spaced births among adolescents – a number previously on the rise. With the new policy, teen short-interval pregnancies dropped approximately 5.3 percentage points.

While South Carolina was among the first, as many as 36 other state Medicaid programs now reimburse for an immediate postpartum LARC, a procedure that in recent years was almost exclusively offered and covered by Medicaid in regular out-patient appointments. In the healthcare industry, medical professional associations, including ACOG, are also increasing education and training for obstetricians and gynecologists on immediate postpartum LARC. 

Steenland presented the research findings earlier this month at the 2019 Academy Health Annual Research Meeting held in Washington DC. The study was supported by the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).