Contraceptive Method Provision Patterns Among Rural and Urban Kentucky Medicaid Enrollees

To characterize contraceptive provision among the Kentucky Medicaid population and assess for rural-urban disparities.

Kentucky Medicaid claims from the calendar year 2019 were used to identify females at risk for unintended pregnancy (via a modified version of the criteria defined by the US Department of Health and Human Services Office of Population Affairs). Multinomial logistic regression was used to assess the impact of rural-urban residence on contraceptive outcomes, while adjusting for relevant covariates. Outcomes for the multinomial regression model were provision of a: (1) less effective method (i.e., condoms) or no contraceptive; (2) moderately effective method (oral, transdermal, injectable, or vaginal); (3) or long-acting reversible contraceptive (LARC) method.

A total of 239,160 enrollees at risk for unintended pregnancy were included for analyses. Adjusted odds of provision of a moderately effective method (vs. a less effective method or no method) were higher among both those residing in rural-adjacent to urban (aOR 1.17; 95% CI, 1.13-1.20) and rural-nonadjacent to urban (aOR 1.15; 95% CI, 1.12-1.18) locations compared to urban. Notably, adjusted odds of provision of an LARC method (vs. a less effective method or no method) were significantly lower among those residing in rural-nonadjacent to urban locations (aOR 0.81; 95% CI 0.77-0.85) compared to those in urban locations.

Despite high moderately effective contraceptive provision among Kentucky Medicaid enrollees in rural-nonadjacent to urban counties, adjusted odds of LARC provision are significantly lower, signaling significant barriers to access among this population.