Dorzin, Esther

Redd, Sara

Willis, Carla

Zhou, Mei

English

Georgia State University

Contraception Utilization Among Women and Girls At-Risk for Pregnancy in Georgia Medicaid

ScholarWorks @ Georgia State University

Georgia State University ScholarWorks @ Georgia State University GHPC Materials Georgia Health Policy Center 1-3-2018 Contraception Utilization Among Women and Girls At-Risk for Pregnancy in Georgia Medicaid Carla Willis Sara Redd Mei Zhou Esther Dorzin Follow this and additional works at: https://scholarworks.gsu.edu/ghpc_materials Recommended Citation Willis, Carla; Redd, Sara; Zhou, Mei; and Dorzin, Esther, "Contraception Utilization Among Women and Girls At-Risk for Pregnancy in Georgia Medicaid" (2018). GHPC Materials. 115. https://scholarworks.gsu.edu/ghpc_materials/115 This Article is brought to you for free and open access by the Georgia Health Policy Center at ScholarWorks @ Georgia State University. It has been accepted for inclusion in GHPC Materials by an authorized administrator of ScholarWorks @ Georgia State University. For more information, please contact scholarworks@gsu.edu. ANDREW  YOUNG SCHOOLO F  P O L I C Y  S T U D I E SContraception Utilization Among Women and Girls At-Risk for Pregnancy in Georgia MedicaidCarla Willis, Ph.D., Sara Redd, M.P.H., Mei Zhou, M.A., and Esther Dorzin, M.D., M.P.H.BACKGROUNDContraception allows women and couples to have healthier pregnancies, appropriately time pregnancies, and ensure adequate spacing between births.1 Long-acting reversible contraceptive methods are the most effective reversible contraceptives and have an excellent safety record.2 Approximately two-thirds of reproductive aged women at-risk for unintended pregnancy in the United States report using contraceptives consistently, while 18% report inconsistent use and the remaining 14% report nonuse or long gaps between use. The small proportion of women who use contraceptives inconsistently or not at all, account for 95% of unintended pregnancies.3 Multiple barriers prevent women from obtaining contraceptives or using them effectively and consistently.4 Increasing women’s access to contraceptives ultimately would promote the health and wellbeing of women of reproductive age, decrease the number of low birth weight and pre-term babies, as well as decrease the costs of unintended pregnancy faced by the Georgia Medicaid program, which financed 54% of all births in the state in 2014.5DATA AND METHODSWe used specifications from the Centers for Medicare and Medicaid Services (CMS) Maternal and Infant Health Initiative’s contraceptive utilization measures and administrative claims data from the Georgia Medicaid program to identify women and girls who were at-risk for pregnancy in 2014 and determined the proportion using most or moderately effective forms of contraception. Women at-risk for pregnancy were defined as females between the ages of 14 and 44, receiving Medicaid for at least 11 months of the study year, and fecund. Any member with an indication of pregnancy during the study year was excluded from this analysis. Per CMS definitions, the most effective forms of contraception include long-acting reversible contraceptives (i.e. contraceptive implant or IUD) and female sterilization. Moderately effective forms of contraception include contraceptive injection, oral pills, patch, vaginal ring, and diaphragms. We performed descriptive analyses on our sample of women and girls who were at-risk for pregnancy, including their use of most or moderately effective forms of contraception. We conducted further analysis on the at-risk group by determining the proportion with subsequent signs of pregnancy in 2015. Finally, we began an exploration of potential barriers to contraceptive utilization by determining whether significant differences exist in proximity to obstetrics and gynecology (ob/gyn) providers who could render long-acting reversible contraceptives.PARTICIPANTSDescriptive Analysis and Contraceptive UtilizationAn estimated 213,020 women or girls were at-risk for pregnancy in 2014 in Georgia, with an average age of 26 years. The majority of the at-risk population were African American (53%) and resided in urban areas (34%). Of the 213,020 women at-risk for pregnancy, 34% (71,909) adopted or continued use of effective contraception. Indications of Pregnancy18,031 (8%) of the 213,020 women and girls at-risk for pregnancy in 2014 had an indication of pregnancy in 2015. Of the 18,031 women and girls with an indication of pregnancy in 2015, approximately 65% did not use effective contraception (11,749) in the previous year, while approximately 35% did use effective contraception (6,282).Geo Access AnalysisAt-risk urban members who were using a most or moderately effective form of contraception travelled on average 5.6 miles to closest ob/gyn, while those not using a most or moderately effective form of contraception travelled on average 5 miles. At-risk rural members who were using a most or moderately effective form of contraception and those who were not doing so travelled on average 11 miles to closest ob/gyn.Frequency (Percent)Total At-Risk Members 213,020At-Risk Members Using Effective Contraception 71,909 (34%)At-Risk Members with Pregnacy in 2015 18,031 (8%)With Contraception in 2014 6,282Without Contraception in 2014 11,749Table 1:  Contraception Uti l izat ion for Georgia Medicaid Members At-Risk for Pregnancy in 2014DCH RegionAverage Distance to the Closest Provider (miles)Urban RuralWith ContraceptionWithout ContraceptionWith ContraceptionWithout Contraception1 8.3 7.9 16.0 14.8 2 8.3 7.7 8.5 8.7 3 3.2 3.2 4 6.8 6.5 4.5 5.1 5 8.5 8.6 15.9 15.3 6 6.5 6.4 9.8 9.7 7 10.9 9.8 25.0 23.8 8 4.4 4.3 8.6 9.4 9 14.8 15.2 10 3.7 3.9 7.4 7.8 11 7.1 7.0 7.3 7.3 12 5.3 5.4 12.8 12.1 Overall 5.6 5.0 11.1 11.0 Table 2:  Proximity to Closest OBGYN Provider for Georgia Medicaid Members At-Risk for Pregnancy in 2014CONCLUSIONThere are significant opportunities to encourage increased utilization of most or moderately effective forms of contraception as well as a need to ensure that contraception is used properly in order to avoid unintended pregnancy. Additional research is needed to understand which factors aid in choices to use effective contraception, since research here suggests that proximity to the closest ob/gyn provider does not explain the choice made by women and girls at risk for pregnancy.REFERENCES1Guttmacher Institute. (2011). Testimony to the Committee on Preventive Services for Women: The Preventive Benefit of Contraceptive Services and Supplies. Re-trieved from http://www.guttmacher.org/pubs/CPSW-testimony.pdf.2Obstet Gynecol. (2016). Clinical challenges of long-acting reversible contraceptive methods. Committee Opinion No. 672. American College of Obstetricians and Gynecologists. 128:e69–77.3Guttmacher Institute. (2015b). Unintended Pregnancy in the United States. Re-trieved from https://www.guttmacher.org/pubs/FB-Unintended-Pregnancy-US. html#13.4Obstet Gynecol. (2015). Access to contraception. Committee Opinion No. 615. American College of Obstetricians and Gynecologists.125:250–55Kaiser Family Foundation (2014). Birth Financed by Medicaid. Retrieved from https://www.kff.org/medicaid/state-indicator/births-financed-by-medicaid.For more information, please contact the Georgia Health Policy Center at 404.413.0314 or visit us online at www.ghpc.gsu.edu- -- -

https://scholarworks.gsu.edu/cgi/viewcontent.cgi?article=1114&amp;context=ghpc_materials

Contraception Utilization Among Women and Girls At-Risk for Pregnancy in Georgia Medicaid

Abstract

Similar works

Full text

Available Versions

Georgia State University

ScholarWorks @ Georgia State University