Association of Insurance Changes With Postpartum Prescription Contraception Uptake.

Area of Science:

• Reproductive Health
• Health Services Research
• Health Policy

Background:

• Postpartum insurance churn, the loss of health coverage after childbirth, is a significant concern.
• Understanding the relationship between insurance continuity and postpartum contraception is crucial for maternal health outcomes.

Purpose of the Study:

• To examine the association between postpartum insurance churn and the use of postpartum contraception.
• To investigate how race, ethnicity, language, and Medicaid expansion status modify this association.

Main Methods:

• Retrospective cohort study using data from the Pregnancy Risk Assessment Monitoring System (2012-2020) across 42 states.
• Logistic regression analysis to determine the odds of prescription contraception use based on postpartum insurance status.
• Stratified analyses by race, ethnicity, language, and Medicaid expansion status to identify disparities.

Main Results:

• Insurance loss postpartum was associated with a 26% decrease in the odds of using prescription contraception (aOR=0.74; 95% CI, 0.71-0.78).
• Hispanic Spanish-language respondents experienced the highest rate of postpartum insurance loss (47.5%).
• Respondents in states without Medicaid expansion were more likely to experience insurance loss compared to those in expansion states.

Conclusions:

• Postpartum insurance loss is linked to reduced access to prescription contraception.
• Targeted interventions and policies are needed to address insurance discontinuity, particularly for Hispanic Spanish-language individuals and in non-Medicaid expansion states.
• Medicaid and insurance policies play a critical role in ensuring equitable contraceptive access for diverse populations postpartum.