Unintended pregnancy is endemic in Oregon, and across the United States, and carries significant health and economic consequences [1-3]. The postpartum period is a time of high unmet need for effective contraception. A study of Medicaid patients in California demonstrated the need for postpartum contraception to achieve healthy birth spacing: only 41% had a postpartum visit for contraception, and four out of 10 women had a repeat pregnancy in less than 18 months [4].

Long-acting reversible contraception [LARC, including intrauterine devices (IUDs) and contraceptive implants] are the most effective forms of contraception, up to 20 times more effective than short-acting methods [3]. LARC can be safely placed during the hospital admission for childbirth, including for breastfeeding mothers [4]. Immediate availability of postpartum LARC improves the health of infants and women by facilitating healthy birth spacing.

Improving postpartum initiation of effective contraception including long-acting reversible contraception (LARC), the intrauterine device (IUD) and contraceptive implant, is a key strategy to reduce unintended pregnancy and health inequities. Oregon has recently passed legislation to ensure access to immediate postpartum LARC for women enrolled in Medicaid, regardless of citizenship (Oregon Health Plan (OHP) and Citizen Alien Waved Emergent Medical (CAWEM) program recipients). The OPC has partnered with Oregon Health & Science University (OHSU) Family Planning and the American College of Obstetricians & Gynecologists (ACOG) to provide training in immediate postpartum LARC in Oregon to ensure access to this contraceptive choice across the state. Additional information for assistance with LARC is available from ACOG here.

This work has also been supported by the Reproductive Health Equity Act, which was passed in 2017 and began expanding reproductive health service in January, 2018. The OPC partnered with the Oregon Health Authority to communicate with providers what these changes meant for patients, providers and health systems in order to increase availability of LARC devices as well as other reproductive health services. Our fact sheet is available here.

1.  Sonfield A and Kost K, Public Costs from Unintended Pregnancies and the Role of Public Insurance Programs in Paying for Pregnancy-Related Care: National and State Estimates for 2010, New York: Guttmacher Institute, 2015, <http://www.guttmacher.org/pubs/public-costs-of-UP-2010.pdf>, accessed February 23, 2015.

2. Dehlendorf C, Rodriguez MI, Levy K, Borrero S, Steinauer J. Disparities in family planning. American journal of obstetrics and gynecology. 2010 Mar;202(3):214-20. PubMed PMID: 20207237. Pubmed Central PMCID: 2835625.

3. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives in Sexual and Reproductive Health.

4. Baldwin MK, Edelman AB. The effect of long-acting reversible contraception on rapid repeat pregnancy in adolescents: a review. J Adolesc Health 2013;52:S47-53.

5. Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception. N Engl J Med 2012;366:1998-2007.