Health Insurance and Racial and Ethnic Differences in Postpartum Contraception in the United States

To explore variations in postpartum contraception in the United States by race and ethnicity among patients receiving publicly versus privately funded health care.

We analyzed Phase 8 (2016-2021) Pregnancy Risk Assessment Monitoring System (PRAMS) data using multivariate logistic regression models with interaction terms to examine relationships between maternal race and ethnicity, health insurance, and postpartum contraceptive use, controlling for maternal age, education, marital status, parity, prepregnancy depression, and whether ever breastfed.

Of U.S. birthing individuals, 60.3% had privately funded births and 39.7% had publicly funded births. Tubal sterilization was more common after publicly funded than privately funded births (13.3% versus 7.0%, p < 0.001). Among postpartum patients with private insurance, tubal sterilization was more common among Black (10.6%) and Hispanic/Latine (9.6%) than White (6.4%) birthing people. However, with publicly funded insurance, tubal sterilization was less common among Black (12.3%) and Hispanic/Latine (13.7%) than White birthing people (14.6%). After publicly funded births, implant use (8.9% versus 2.8%, p < 0.001) and injectable contraception (11.4% versus 2.7%, p < 0.001) were more common, whereas reliance on vasectomy was less common (2.1% versus 5.5%, p < 0.001) than after privately funded births, for all racial/ethnic groups. Intrauterine device (IUD) use was less common with public than private insurance among Black birthing people (11.9% versus 16.0%, p < 0.001). Significant interactions between race and ethnicity and insurance type were observed. Adjusted odds ratios indicated that, compared with private insurance, public insurance was associated with higher odds of tubal sterilization, implant, and injectable use but lower odds of vasectomy for White individuals; higher implant and DMPA use but lower IUD and vasectomy use for Black individuals; and higher tubal sterilization, IUD, and implant use but lower vasectomy use for Hispanic/Latine individuals.

Racial and ethnic variation in postpartum contraception use differs for publicly and privately insured births in the United States.