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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
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Postpartum contraception in publicly-funded programs and interpregnancy intervals.

Heike Thiel de Bocanegra1, Richard Chang, Mary Menz

  • 1Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Sacramento, California.

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Summary

Postpartum contraception provision is low, with only 41% of women receiving services within 90 days. Improving access to contraception can help achieve optimal interpregnancy intervals for low-income women.

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Area of Science:

  • Reproductive Health
  • Public Health
  • Maternal Health

Background:

  • Optimal interpregnancy intervals (IPIs) are crucial for maternal and child health outcomes.
  • Short IPIs are associated with increased risks, including preterm birth and low birth weight.
  • Postpartum care presents a critical opportunity to initiate or continue contraception.

Purpose of the Study:

  • To evaluate the rate of contraceptive service provision within 90 days postpartum.
  • To determine the association between postpartum contraceptive provision and optimal interpregnancy intervals.
  • To identify factors associated with achieving optimal interpregnancy intervals.

Main Methods:

  • A cohort of 117,644 women aged 15-44 who gave birth in 2008 and received publicly-funded healthcare was constructed using California Medicaid data.
  • Data from the 2008 Birth Statistical Master File were linked with Medicaid claims.
  • Statistical analysis controlled for covariates to assess the association between contraception provision and IPIs.

Main Results:

  • Only 41% of women received a contraceptive claim within 90 days postpartum.
  • Contraceptive provision within 90 days postpartum was associated with avoiding short interpregnancy intervals (Number Needed to Treat = 6.38).
  • Receiving contraception at the first postpartum visit, being seen by Medi-Cal, and its family planning program were significant predictors of optimal IPIs. Foreign-born women had higher odds of optimal IPIs, while Asian and Pacific Islander women had lower odds.

Conclusions:

  • Enhanced postpartum contraception provision in publicly-funded programs can improve optimal interpregnancy intervals for low-income women.
  • Targeted interventions during the first postpartum clinic visit may be particularly effective.
  • Addressing ethnic and birthplace disparities in contraceptive access is important for optimizing IPIs.