Patients' experiences with South Carolina's immediate postpartum Long-acting reversible contraception Medicaid policy

We sought to examine women's experiences with immediate postpartum LARC counseling and use in the context of South Carolina's Medicaid policy.

In 2016-18, we conducted semi-structured individual interviews with 25 women, ages 18-35, who gave birth within 2 years of the interview in South Carolina while insured by Medicaid and received contraceptive counseling about immediate postpartum LARC during their pregnancies. We analyzed the interviews using a combination of deductive and inductive coding approaches.

Participants were counseled on immediate postpartum LARC during prenatal care (n=23) and/or while in the hospital for childbirth (n=16). Some expressed dissatisfaction with providers' approaches to contraceptive counseling because they either did not receive enough information to make a fully informed decision or felt they were being pressured to use LARC. Among those who received in-hospital contraceptive counseling, some objected to the timing because they were in labor and/or already had a non-LARC postpartum contraceptive plan. Three out of the 10 participants who elected to receive immediate postpartum LARC later desired removal but encountered barriers.

Our findings suggest providers' timing, style, and content of contraceptive counseling about immediate postpartum LARC may not be sufficiently patient-centered. Additionally, lack of access to unfettered LARC removal limits patients' reproductive autonomy.

If providers use a patient-centered approach to immediate postpartum LARC counseling, consistently engage in comprehensive contraceptive counseling during prenatal care, avoid pressuring patients to choose LARC, and collaborate with hospital staff to increase care coordination, they can improve Medicaid recipients' contraceptive care experiences and facilitate informed contraceptive decision-making.