Initial Evaluation of the First State Medicaid Policy for Immediate Postpartum Insertions of Long Acting Reversible Contraceptives in Hospital Settings

In the United States, unintended pregnancy remains a significant public health issue.  Policies that support linking women in need to highly reliable contraceptives is crucial for prevention of unintended pregnancy. In 2012, South Carolina became the first state to enact a new Medicaid policy that covers the cost of immediate postpartum insertions of long-acting reversible contraceptives (LARCs) in hospital settings paid for by Medicaid.  The overall goal of this new policy was to increase access to reliable contraceptives for women wanting to delay a repeat pregnancy. This policy was informed by the experience of practitioners and supporting data that found new mothers commonly missed their postpartum appointments, lacked access to contraception, and had repeat pregnancies sooner than intended.  To date, South Carolina is the only state with a Medicaid policy that facilitates women’s and adolescents’ immediate access to highly reliable contraceptives postpartum for those who decided to delay having a repeat birth. This study examined the implementation process of the policy on LARC use.  Medicaid data from before implementation of the policy and after were examined for trends in postpartum LARC insertion in the 43 labor and delivery hospitals in the state.  In addition, survey methods and in-depth interviews were used to gather information on implementation with implementers, including health care providers and administrators.  Preliminary results show great variability across hospitals and challenges to implementation of the policy.  If the policy is to be successful in achieving the goal of reduced unintended repeat pregnancies, the quality of implementation is critical.