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The following is a summary of “Tennessee Medicaid patient immediate postpartum long-acting reversible contraception utilization,” published in the October 2024 issue of Obstetrics and Gynecology by Young et al.  

Immediate postpartum long-acting reversible contraception (IPP LARC) in the immediate postpartum period is underutilized among people covered by Medicaid, especially in states with healthcare barriers and high rates of closely spaced births.  

Researchers conducted a retrospective study to assess IPP LARC desire and utilization trends among publicly insured patients at an academic hospital.  

They reviewed publicly insured patients’ electronic delivery records (March 2018–June 2023). Patient demographics and trends in IPP LARC desire and utilization were compared using Chi-Square or Fisher’s exact tests, and logistic regression was applied to examine the relationships between demographics and IPP LARC utilization.  

The results showed 10,472 delivery encounters, with 2,459 (23.5%) requesting IPP LARC at admission, while 464 (4.4%) changed contraception to IPP LARC after admission. In total, 2,523 patients (24.1%) obtained IPP LARC, with 1,224 (48.5%) choosing arm implants and 1,299 selecting IUDs. Non-Hispanic Black patients and non-Hispanic Other or multiple races utilized IPP LARC less (aOR = 0.84, 95% CI: 0.72-0.98, aOR = 0.68, 95% CI: 0.48-0.97). Patients with cesarean delivery (aOR = 1.45, 95% CI: 1.31-1.61) or inadequate prenatal care (aOR = 1.54, 95% CI: 1.35-1.75) were more likely to use IPP LARC, while higher maternal age, more years of education, and primiparous status were inversely associated with utilization.  

They concluded that IPP LARC utilization was higher than national interval LARC rates, and understanding patient demographics could identify barriers to access.  

Source: contraceptionjournal.org/article/S0010-7824(24)00430-X/abstract