DeSisto Carla L, Handler Arden, Haider Sadia, Caskey Rachel, Peacock Nadine, Kottke Melissa, Rankin Kristin
1University of Illinois at Chicago School of Public Health , 1603 W. Taylor St, Chicago, IL 60612 USA.
2Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637 USA.
Contracept Reprod Med. 2018 Dec 3;3:19. doi: 10.1186/s40834-018-0073-x. eCollection 2018.
Several state Medicaid agencies have recently started reimbursing for long-acting reversible contraception (LARC) placement immediately postpartum. Women's perspectives are critical for ensuring that this change increases access to LARC while empowering women to choose the method and timing of contraception that best meets their needs. We conducted a pilot study in Georgia, which recently changed its Medicaid reimbursement policy, to assess women's informed choice and satisfaction with immediate postpartum LARC.
We sampled all women with a live birth paid for by Georgia Medicaid during November 2015 through February 2017 who received an immediate postpartum LARC. We then used a one-to-one match to sample women who did not receive immediate postpartum LARC. Women were contacted via telephone for a 25-30 min interview regarding their knowledge, attitudes, and behaviors related to immediate postpartum LARC and their satisfaction with postpartum contraception. We calculated descriptive statistics and components of informed choice overall and by receipt of immediate postpartum LARC, using chi-square tests to calculate differences by group.
We approached 470 women and completed interviews with 51; 25 (49%) received immediate postpartum LARC (24 implants, 1 intrauterine device). Two-thirds reported their provider discussed the option of receiving immediate postpartum LARC during prenatal care, with over 90% reporting they received all the information they needed to make a decision. Most women believed the ideal time to begin using birth control postpartum is in the hospital immediately after delivery, although this differed significantly by women's receipt of immediate postpartum LARC. Most women who received immediate postpartum LARC reported they are very or extremely happy with their device, although 40% also reported wanting their device removed at some point.
Women on Medicaid in Georgia report making informed choices regarding immediate postpartum LARC. Among those who received immediate postpartum LARC, women report high levels of satisfaction.
最近，几个州的医疗补助机构已开始对产后立即放置长效可逆避孕法（LARC）进行报销。妇女的观点对于确保这一变化增加获得LARC的机会，同时使妇女能够选择最符合其需求的避孕方法和时机至关重要。我们在佐治亚州进行了一项试点研究，该州最近改变了其医疗补助报销政策，以评估妇女对产后立即放置LARC的知情选择和满意度。
我们对2015年11月至2017年2月期间由佐治亚州医疗补助支付费用且产后立即接受LARC的所有活产妇女进行了抽样。然后，我们采用一对一匹配的方式对未接受产后立即放置LARC的妇女进行抽样。通过电话联系妇女进行25 - 30分钟的访谈，了解她们与产后立即放置LARC相关的知识、态度和行为，以及她们对产后避孕的满意度。我们计算了总体以及根据是否接受产后立即放置LARC的知情选择的描述性统计数据和组成部分，使用卡方检验计算组间差异。
我们接触了470名妇女，完成了51人的访谈；其中25人（49%）接受了产后立即放置LARC（24例植入，1例宫内节育器）。三分之二的人报告说她们的医疗服务提供者在产前护理期间讨论了产后立即放置LARC的选择，超过90%的人报告说她们获得了做出决定所需的所有信息。大多数妇女认为产后开始使用避孕措施的理想时间是在分娩后立即在医院进行，尽管这因妇女是否接受产后立即放置LARC而有显著差异。大多数接受产后立即放置LARC的妇女报告说她们对自己的避孕器具非常满意或极其满意，尽管40%的人也报告说希望在某个时候取出器具。
佐治亚州参加医疗补助的妇女报告说，她们对产后立即放置LARC做出了知情选择。在那些接受产后立即放置LARC的妇女中，满意度很高。
