Postpartum contraception receipt among Oregon Medicaid-funded births with stimulant and substance use disorder

To compare postpartum contraceptive receipt among (i) Medicaid beneficiaries with stimulant-related substance use disorder (SUD) to those without SUD; and (ii) Medicaid beneficiaries with other SUD to those without SUD.

This was a retrospective cohort study of birthing events using Oregon's linked Medicaid claims and vital statistics data 2012-2019 (N = 141,479). We described demographic characteristics, birth outcomes, and substances used, and compared rates of contraception receipt (i) immediately postpartum (IPP), (ii) within 60 days postpartum excluding IPP, and (iii) within 60 days postpartum including IPP.

Prevalence of stimulant-related and other SUD diagnosis was 3.8% and 9.4%, respectively. After adjusting for demographic and clinical factors, contraception receipt within 60 days postpartum including IPP and contraception receipt IPP were greater for birth events with a stimulant-related SUD compared to birth events without SUD (adjusted relative risk [aRR], 60-days postpartum including IPP: 1.12, 95% CI: 1.07-1.17; aRR, IPP: 1.32, 95% CI: 1.24-1.40). Adjusted rates of contraception receipt were also elevated for birth events with other SUD compared to birth events with no SUD (aRR, 60-days postpartum including IPP: 1.12, 95% CI: 1.09-1.15; aRR, IPP: 1.21, 95% CI: 1.16-1.26; aRR, 60-days postpartum excluding IPP: 1.09, 95% CI: 1.06-1.13).

Birthing people enrolled in Medicaid who misused stimulants were more likely than those without SUD, controlling for relevant factors, to receive postpartum contraception within 60 days due to elevated contraception receipt during the IPP period. Further research may examine whether these findings can be replicated outside of Oregon.