Medicaid reimbursement for postpartum contraception expands young women's access to LARCs

February 5, 2021

Assistant Professor of Population Studies Maria Steenland, a PSTC faculty associate, is the first author of a new article in Health Affairs. The article, “Medicaid Payments For Immediate Postpartum Long-Acting Reversible Contraception: Evidence From South Carolina,” uses data on Medicaid-insured South Carolina women who gave birth from 2010 to 2014 to examine the impact of a South Carolina Medicaid policy. 

The policy, implemented in 2012, made South Carolina the first state whose Medicaid program reimbursed hospitals for provision of immediate postpartum long-acting reversible contraception (LARC) separately from its global maternity payment. Steenland and her colleagues found that the policy succeeded in increasing the availability of immediate postpartum LARC methods, such as intrauterine devices and contraceptive implants. 

The researchers noted that the policy particularly benefited adolescents, for whom most pregnancies are unintended. They found that expanded access to LARC helped increase the use of effective postpartum contraception in an age group that is more likely to have closely spaced, higher-risk repeat pregnancies. 

“Before the policy, postpartum people had few options if they wanted a method before leaving the hospital, since LARCs were not available, and the combined oral contraceptive pill is not safe early in the postpartum period,” Steenland explained. “Contraceptive choice is based on many factors such as side effects, reversibility and effectiveness. Making these two new contraceptive methods available can make it easier for patients to find a method that meets their needs and preferences, and ultimately for them to decide whether and when to become pregnant again.” 

Nonetheless, Steenland and her co-authors recommend that further policy steps be taken to achieve wider availability of immediate postpartum LARC. “We also find that few hospitals began offering immediate postpartum LARC after the policy change, indicating that payment is only a first step to making these options available,” Steenland added.

The research reported in this study received support from the NICHD Population Dynamics Branch. Steenland joined the PSTC in 2018. Her research on maternal and reproductive health programs, and healthcare policy, has included work in sub-Saharan Africa and in the United States.