Insurance Loss After Pregnancy Tied to Less Postpartum Prescription Contraception

BALTIMORE — Women who lost insurance coverage shortly after pregnancy had lower odds of prescription contraception after giving birth than women with continuous insurance, survey data from nearly 250,000 people showed.

Compared with continuous insurance, the likelihood of postpartum prescription contraception was 26% lower with loss of insurance 2 months or more after delivery (adjusted odds ratio [OR] 0.74, 95% CI 0.71-0.78), reported Kimberly Schaefer, MD, MPP, of Oregon Health & Science University in Portland, in a poster presentation at the American College of Obstetricians and Gynecologists annual meeting.

The adjusted OR for women whose insurance changed from private to public insurance was 0.90 (95% CI 0.84-0.96), while no significant difference was observed for those whose insurance switched from Medicaid to private insurance.

Most women (76.4%) had continuous insurance; 11.9% lost insurance and 11.7% experienced insurance discontinuity. Among those with insurance discontinuity, 7.6% went from Medicaid to private insurance and 4.1% went the opposite way.

“What we found is that about three-quarters of patients had continuous insurance and about a quarter had a loss of insurance or a change between public and private after delivery,” Schaefer said. “This discontinuous insurance was associated with decreased rates of postpartum prescription birth control, especially with those who lost insurance.”

“I think these are findings that could be pretty expected, given that insurance status or not having insurance can make it pretty difficult to access care — especially prescriptive methods like IUDs or Nexplanon [contraceptive implant], which can have really high out-of-pocket costs without insurance,” Schaefer added.

The postpartum period is particularly vulnerable to insurance loss, partly because Medicaid’s higher income threshold during pregnancy lifts at 2 months postpartum, Schaefer noted. To date, 34 states, including the District of Columbia, have expanded Medicaid coverage to a year postpartum.

Of survey respondents in states and time periods without Medicaid expansion, 16.2% experienced insurance loss, compared with 7.9% of women in states with expansion.

“Several states have extended this 2-month postpartum Medicaid to a year. I think that’ll really help to increase access to contraceptive methods among many of the other very important things that can be provided [in] the postpartum period,” Schaefer told MedPage Today.

“I think this is just further evidence that we can help support postpartum patients by having more extensive Medicaid and public insurance,” she added.

Researchers used 2012-2020 data from the Pregnancy Risk Assessment Monitoring System survey, including 246,088 respondents across 42 states. At 2 or more months after childbirth, survey respondents were grouped into one of four categories: continuous insurance, insurance loss, discontinuous Medicaid-to-private, and discontinuous private-to-Medicaid.

The researchers adjusted for race, ethnicity, language, education, age, marital status, poverty level, and year. Stratifying the data by Medicaid expansion status yielded similar associations between insurance discontinuity and postpartum contraception.