The Influence of Social Determinants of Health on the Provision of Postpartum Contraceptives in Medicaid

Disparities continue to exist in the timely provision of postpartum contraception. This study aimed to identify prevalence and factors associated with postpartum contraception provision among women enrolled in Medicaid. A retrospective cohort study was conducted using the 2014 National Medicaid data, linked to county-level social vulnerability index (SVI) data. Women aged 15-44 with a live birth in 2014 were included. Multivariable logistic regression was used to predict 3-day provision of long-acting reversible contraception (LARC) and 60-day provision of most effective or moderately effective contraceptives (MMEC). Overall, 3-day LARC provision was 0.2% while 60-day MMEC was 36.3%. Significantly lower odds of receiving MMEC was found among women aged 15-20 (adjusted odds ratio [aOR] = 0.87; 95% CI:0.86-0.89) compared to women 20-44 years as well as among Asian women (aOR = 0.69; 95% CI:0.66-0.72) and Hispanic women (aOR = 0.73; 95% CI:0.72-0.75) compared to White women. The provision of postpartum contraception remains low, generally, and needs attention in communities experiencing poor maternal outcomes.