Postpartum Health Care Utilization and Contraception Uptake in Wisconsin

The postpartum visit is an opportunity to address health risks that may have arisen or worsened during pregnancy, postpartum depression, and women’s family planning goals. However, the proportion of Medicaid recipients that attend their postpartum visit is unclear. In many states, some women are only covered by Medicaid during pregnancy and through 60 days postpartum. To date, there have not been any published studies examining the effect of having continuous Medicaid eligibility versus pregnancy-only Medicaid eligibility on the use of postpartum care or postpartum contraception. This study used Medicaid data for women who delivered at least one live birth between 2011 and 2015 in Wisconsin, linked to the birth certificate of the infant and to the woman’s Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire, if applicable. The three aims were: 1) to triangulate postpartum health care utilization from Medicaid and PRAMS data; 2) to compare patterns of postpartum health care utilization for women with continuous eligibility versus pregnancy-only Medicaid; and 3) to compare postpartum contraception receipt for women with continuous eligibility versus pregnancy-only Medicaid. Most women in the sample had claims for postpartum care at some point in the first 12 weeks postpartum, but the timing of these visits was somewhat unclear due to the use of bundled codes. The agreement between Medicaid claims and PRAMS was poor, although it was substantially higher when bundled codes for postpartum care were included. Women with continuous Medicaid eligibility were more likely to receive routine postpartum care and most or moderately effective methods of postpartum contraception in the first 12 weeks postpartum than women with pregnancy-only Medicaid. These relationships persisted after adjusting for maternal characteristics of interest. Receiving no prenatal care was a strong predictor of not receiving postpartum care and postpartum contraception. The results of this study suggest the need for innovative ways to increase access to postpartum care and postpartum contraception for women with Medicaid-paid births. One such opportunity could be to expand Medicaid coverage from 60 days to one year postpartum. However, further research is needed to improve measurement of postpartum care and postpartum contraception utilization from Medicaid claims

Women’s informed choice and satisfaction with immediate postpartum long-acting reversible contraception in Georgia

Abstract Background Several state Medicaid agencies have recently started reimbursing for long-acting reversible contraception (LARC) placement immediately postpartum. Women’s perspectives are critical for ensuring that this change increases access to LARC while empowering women to choose the method and timing of contraception that best meets their needs. We conducted a pilot study in Georgia, which recently changed its Medicaid reimbursement policy, to assess women’s informed choice and satisfaction with immediate postpartum LARC. Methods We sampled all women with a live birth paid for by Georgia Medicaid during November 2015 through February 2017 who received an immediate postpartum LARC. We then used a one-to-one match to sample women who did not receive immediate postpartum LARC. Women were contacted via telephone for a 25–30 min interview regarding their knowledge, attitudes, and behaviors related to immediate postpartum LARC and their satisfaction with postpartum contraception. We calculated descriptive statistics and components of informed choice overall and by receipt of immediate postpartum LARC, using chi-square tests to calculate differences by group. Results We approached 470 women and completed interviews with 51; 25 (49%) received immediate postpartum LARC (24 implants, 1 intrauterine device). Two-thirds reported their provider discussed the option of receiving immediate postpartum LARC during prenatal care, with over 90% reporting they received all the information they needed to make a decision. Most women believed the ideal time to begin using birth control postpartum is in the hospital immediately after delivery, although this differed significantly by women’s receipt of immediate postpartum LARC. Most women who received immediate postpartum LARC reported they are very or extremely happy with their device, although 40% also reported wanting their device removed at some point. Conclusions Women on Medicaid in Georgia report making informed choices regarding immediate postpartum LARC. Among those who received immediate postpartum LARC, women report high levels of satisfaction

Using a multi-state Learning Community as an implementation strategy for immediate postpartum long-acting reversible contraception

Abstract Background Implementation strategies are imperative for the successful adoption and sustainability of complex evidence-based public health practices. Creating a learning collaborative is one strategy that was part of a recently published compilation of implementation strategy terms and definitions. In partnership with the Centers for Disease Control and Prevention and other partner agencies, the Association of State and Territorial Health Officials recently convened a multi-state Learning Community to support cross-state collaboration and provide technical assistance for improving state capacity to increase access to long-acting reversible contraception (LARC) in the immediate postpartum period, an evidence-based practice with the potential for reducing unintended pregnancy and improving maternal and child health outcomes. During 2015–2016, the Learning Community included multi-disciplinary, multi-agency teams of state health officials, payers, clinicians, and health department staff from 13 states. This qualitative study was conducted to better understand the successes, challenges, and strategies that the 13 US states in the Learning Community used for increasing access to immediate postpartum LARC. Methods We conducted telephone interviews with each team in the Learning Community. Interviews were semi-structured and organized by the eight domains of the Learning Community. We coded transcribed interviews for facilitators, barriers, and implementation strategies, using a recent compilation of expert-defined implementation strategies as a foundation for coding the latter. Results Data analysis showed three ways that the activities of the Learning Community helped in policy implementation work: structure and accountability, validity, and preparing for potential challenges and opportunities. Further, the qualitative data demonstrated that the Learning Community integrated six other implementation strategies from the literature: organize clinician implementation team meetings, conduct educational meetings, facilitation, promote network weaving, provide ongoing consultation, and distribute educational materials. Conclusions Convening a multi-state learning collaborative is a promising approach for facilitating the implementation of new reimbursement policies for evidence-based practices complicated by systems challenges. By integrating several implementation strategies, the Learning Community serves as a meta-strategy for supporting implementation

Deconstructing a disparity: explaining excess preterm birth among U.S.-born black women

PURPOSE: To determine components of excess preterm birth (PTB) rates for U.S.-born black women relative to both foreign-born black women and U.S.-born white women attributable to differences in observed sociodemographic, behavioral, and medical risk factors. METHODS: Using the 2013 U.S. natality files, we used Oaxaca-Blinder decomposition on the absolute scale to estimate the contribution of the group differences in the prevalence of PTB predictors between U.S.- and foreign-born black women and U.S.-born black and U.S.-born white women. RESULTS: U.S.-born blacks had a 3.2 (95% confidence interval: 3.0-3.5) and 4.4 (95% confidence interval: 4.3-4.5) percentage point higher risk of PTB than foreign-born blacks and U.S.-born whites, respectively. The variables in the models explained between 18% and 27% of the PTB disparities. Differences in paternal acknowledgment (about 12%), maternal hypertension (about 7%-11%), and maternal education (about 6%-10%) explained the largest proportion of these disparities. CONCLUSIONS: Programs and policies that address both distal and proximate factors, including the social determinants of health and the prevention and management of hypertension, may reduce the higher rates of PTB among U.S.-born black women compared to foreign-born black women and U.S.-born white women