Department of Sociology, University of Maryland, College Park, 3143 Parren Mitchell Art-Sociology Building, 3834 Campus Drive, College Park, MD, 20742, USA.
Department of Health Policy and Management, University of Maryland, College Park, 4200 Valley Drive, Suite 2242, College Park, MD, 20742, USA.
Matern Child Health J. 2022 Aug;26(8):1657-1666. doi: 10.1007/s10995-022-03433-2. Epub 2022 Apr 30.
Although multi-component policy interventions can be important tools to increase access to contraception, we know little about how they may change contraceptive use among postpartum women. We estimate the association of the Delaware Contraceptive Access Now (DelCAN) initiative with use of postpartum Long-Acting Reversible Contraception (LARC). DelCAN included Medicaid payment reform for immediate postpartum LARC use, provider training and technical assistance in LARC provision, and a public awareness campaign.
We used a difference-in-differences design and data from the 2012 to 2017 pregnancy risk assessment monitoring system to compare changes in postpartum LARC use in Delaware versus 15 comparison states, and differences in such changes by women's Medicaid enrollment.
Relative to the comparison states, postpartum LARC use in Delaware increased by 5.26 percentage points (95% CI 2.90-7.61, P < 0.001) during the 2015-2017 DelCAN implementation period. This increase was the largest among Medicaid-covered women, and grew over the first three implementation years. By the third year of the DelCAN initiative (2017), the relative increase in postpartum LARC use for Medicaid women exceeded that for non-Medicaid women by 7.24 percentage points (95% CI 0.12-14.37, P = 0.046).
The DelCAN initiative was associated with increased LARC use among postpartum women in Delaware. During the first 3 years of the initiative, LARC use increased progressively and to a greater extent among Medicaid-enrolled women. Comprehensive initiatives that combine Medicaid payment reforms, provider training, free contraceptive services, and public awareness efforts may reduce unmet demand for highly effective contraceptives in the postpartum months.
尽管多组分政策干预措施可能是增加避孕措施可及性的重要工具，但我们对它们如何改变产后妇女的避孕措施使用情况知之甚少。我们评估了特拉华州避孕措施即刻获取（DelCAN）计划对产后长效可逆避孕（LARC）使用的影响。DelCAN 计划包括对即刻产后 LARC 使用的医疗补助支付改革、提供 LARC 服务的提供者培训和技术援助，以及一项公众意识运动。
我们使用差异法设计和 2012 年至 2017 年妊娠风险评估监测系统的数据，比较特拉华州与 15 个对照州产后 LARC 使用情况的变化，以及妇女医疗补助参与情况对这些变化的差异。
与对照州相比，在 2015 年至 2017 年 DelCAN 实施期间，特拉华州的产后 LARC 使用增加了 5.26 个百分点（95%置信区间 2.90-7.61，P<0.001）。在医疗补助覆盖的女性中，这一增长最大，并且在头三年的实施过程中持续增长。在 DelCAN 计划实施的第三年（2017 年），医疗补助女性产后 LARC 使用的相对增长超过非医疗补助女性 7.24 个百分点（95%置信区间 0.12-14.37，P=0.046）。
DelCAN 计划与特拉华州产后妇女 LARC 使用的增加有关。在计划的头 3 年，LARC 使用逐渐增加，在医疗补助参保女性中增加的幅度更大。将医疗补助支付改革、提供者培训、免费避孕服务和公众意识工作相结合的综合计划可能会减少产后几个月对高效避孕措施的未满足需求。
