Over the last three years, a medical trend has quietly swept maternity wards across the United States: More women are getting the chance to insert an intrauterine device or contraceptive implant right after having a baby.
The procedure may seem like an unwanted distraction during a special moment, but it could have broad implications for the reproductive health of women and public services that cater to low-income mothers.
Within 10 minutes of delivering the placenta, a doctor can implant one of the long-acting reversible contraceptives, known as LARCs, which are widely considered to be the most effective form of birth control. A new mother wouldn’t have to schedule another appointment — or worry about conceiving again before she’s ready. A physician can be sure she's not pregnant, skipping prerequisite tests.
And taxpayers could save a lot of money.
That’s because Medicaid, the health insurance program for low-income Americans, now covers delivery room LARCs in 19 states, according to a new report in the journal Contraception. Eight more states are moving to adopt the measure.
Before 2012, none offered this kind of coverage.
The sudden shift came after medical research revealed a startling truth: Many women who say they want reliable birth control after a pregnancy never actually receive it — a missed opportunity, economists say, because an IUD, for example, is far cheaper than the costs of an unplanned pregnancy.
“Many of these children are born to women who did not intend to get pregnant, and who state that the pregnancy was either unwanted or mistimed,” according to the article in Contraception. “Reducing the number of children born to these mothers would significantly reduce the number of children born into poverty.”
Between 40 and 60 percent of new mothers who live in poverty and express interest in a LARC, however, don’t make it back to the doctor for a follow-up appointment, said co-author Michelle Moniz, a University of Michigan gynecologist.
“It's a lack of transportation, a lack of child care, unstable insurance, the inability to get time off work ...” said Moniz, whose research team called every state’s Medicaid agency to understand how coverage varied nationwide. “There’s a big discrepancy between women's voiced preference and what actually happens.”
LARCs are increasingly popular among women who use birth control. The share of U.S. women who use an IUD or implant has increased from 9 percent in 2009 to 12 percent in 2012, according to a report published last week by the Guttmacher Institute, a nonprofit research organization. (Only 2.4 percent used the method in 2002.)
A woman can choose a copper IUD, which lasts up to 10 years, or a plastic hormone-releasing IUD, which is good for at least three. A health-care provider inserts the flexible, T-shaped devices into the uterus, creating a hostile environment for sperm. It's 99.9 percent effective in preventing pregnancies — just like the pill, but without the possibility of user error. (IUDs implanted right after birth, however, carry a slightly higher risk of dislodging on their own.)
But barriers to care prevent more women from signing up. This phenomenon drives up health-care spending, Moniz said, and can endanger mother and baby. Implanting long-term contraception in the maternity ward can address both problems.
When conception occurs less than 18 months after giving birth, risk heightens for preterm labor, low birth weight and small gestational age. A Centers for Disease Control and Prevention report in April found 30 percent of American women don’t wait long enough between pregnancies.
Poor women, meanwhile, are more likely to experience these shorter intervals. And as Moniz suggested, a lack of transportation might play a big role in why poor women don't make the return trip to the gynecologist after giving birth.
Twice as many low-income patients who relied on buses in a New York City suburb reported missing doctor's appointments than those who drove cars, a 2012 survey found. A quarter of poor adults in a national survey said they'd had to miss or reschedule an appointment because of tenuous transportation, according to a 2013 report. Respondents also said they had trouble making it to the pharmacy for prescription refills.