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

Area of Science:

• Reproductive Health
• Public Health
• Health Services Research

Background:

• Postpartum contraception is crucial for birth spacing and maternal health.
• Understanding disparities in contraceptive method choice is essential for equitable care.
• Previous research indicates variations in contraceptive use, but specific breakdowns by race/ethnicity and insurance type are needed.

Purpose of the Study:

• To investigate how race and ethnicity influence postpartum contraceptive method selection among individuals with publicly versus privately funded healthcare.
• To identify disparities in postpartum contraception uptake based on insurance status and demographic factors.

Main Methods:

• Analysis of Phase 8 (2016-2021) Pregnancy Risk Assessment Monitoring System (PRAMS) data.
• Multivariate logistic regression models with interaction terms were used to assess associations.
• Controlled for maternal age, education, marital status, parity, prepregnancy depression, and breastfeeding history.

Main Results:

• Tubal sterilization was more common with public funding (13.3%) than private funding (7.0%).
• Among privately insured individuals, tubal sterilization was higher for Black (10.6%) and Hispanic/Latine (9.6%) than White (6.4%) individuals.
• Public insurance was associated with higher implant (8.9%) and injectable (11.4%) use, and lower vasectomy use (2.1%) across racial/ethnic groups compared to private insurance.
• Significant interactions between race/ethnicity and insurance type were observed, affecting method choice.

Conclusions:

• Racial and ethnic disparities in postpartum contraception use are evident and differ based on whether births are publicly or privately funded.
• Public insurance is associated with increased use of certain methods like implants and injectables, but decreased use of vasectomy, with variations across racial and ethnic groups.
• Tailored interventions are needed to address inequities in postpartum contraceptive access and choice.