Association of Insurance Changes With Postpartum Prescription Contraception Uptake.

objectiveTo assess the association between postpartum insurance churn and postpartum contraception, with specific attention to race, ethnicity, language, and Medicaid expansion status.

methodsWe conducted a retrospective cohort study with Pregnancy Risk Assessment Monitoring System survey data (2012-2020) from 42 states. Insurance status, assessed more than 2 months after childbirth, was categorized as continuous insurance, insurance loss, discontinuous Medicaid-to-private, discontinuous private-to-Medicaid, continuous uninsurance, and gain of insurance. We used logistic regression to estimate odds ratios with 95% CIs for insurance status and use of prescription contraception methods, compared with nonprescription and no method, and adjusted for age, race and ethnicity, language, marital status, percent of federal poverty level, education, and birth year. We considered the interaction between state Medicaid expansion and insurance status and stratified analyses by race, ethnicity, and language.

resultsOf 223,430 respondents, 78.9% held continuous insurance from childbirth to more than 2 months postpartum and 10.2% lost insurance. Compared with continuous insurance, the adjusted odds ratio (95% CI) for prescription postpartum contraception was 0.74 (0.71-0.78) for insurance loss, 0.90 (0.84-0.97) for discontinuous private-to-Medicaid, and 1.04 (0.98-1.10) for discontinuous Medicaid-to-private. There was no evidence for an interaction between living in states with Medicaid expansion and insurance status. Of respondents without Medicaid expansion, 14.0% (95% CI, 13.6-14.3) experienced insurance loss compared with 6.8% (95% CI, 6.6-7.0) with Medicaid expansion. There was a significant interaction between insurance discontinuity and race, ethnicity, and language. Nearly half of the Hispanic Spanish-language respondents (47.5%) experienced insurance loss postpartum.

conclusionInsurance loss more than 2 months postpartum was associated with decreased odds of prescription contraception. Populations that experience higher rates of insurance loss include respondents in states without Medicaid expansion and Hispanic Spanish-language respondents. Medicaid and insurance policies have important roles in enabling coverage for contraceptive access across racial and ethnic groups during the postpartum period.