Inpatient postpartum contraception provision among individuals with opioid use disorder in Maine, 2016-2023

To compare trends in inpatient postpartum (IPP) long-acting reversible contraception (LARC) and permanent contraception provision among women with and without opioid use disorder (OUD) in Maine, which has recently seen a decrease in prevalence of maternal OUD.

We used diagnosis codes recorded in hospital discharge data to identify deliveries with and without OUD in Maine during 2016-2023. We calculated trends in annual rates per 1000 deliveries of IPP LARC or permanent methods of contraception (LAPM), permanent contraception, and LARC. We ran tests of coincidence to compare trends between deliveries with and without OUD.

Among the 87,339 delivery hospitalisations identified, 2604 (3.0%) had an OUD diagnosis code. Women with OUD had higher IPP contraception provision (LAPM: 12.1%, permanent contraception: 9.0% LARC: 3.1%) than those without OUD (LAPM: 6.2%, permanent contraception: 5.4%, LARC: 0.9%). Annual rate increases per 1000 deliveries were larger over the study period for women with OUD (LAPM: 11.8 [p = 0.02], permanent contraception: 3.96 [p = 0.20], LARC: 6.48 [p = 0.04]) as compared to those for women without OUD (LAPM: 0.46 [p = 0.25], permanent contraception: -0.91 [p = 0.05], LARC: 1.48 [p < 0.01]); all tests of coincidence were significant (p < 0.05).

Among deliveries in Maine during 2016-2023, provision of IPP LAPM, permanent contraception, and LARC were higher and increased at a greater rate over time among deliveries with OUD compared to those without OUD. Our findings suggest that IPP contraceptive use could be one of many factors in the recent decrease in maternal OUD and NAS rates in Maine.