Advance-CTR

Advance RI-CTR Pilot Projects Program (Cycle 7)

"Evaluating access to LARC removal services among Medicaid-covered postpartum women"

Multi-PI: Melissa Clark, PhD | Multi-PI: Adam Lewkowitz, MD, MPHS

To ensure that women can achieve their fertility desires, it is essential that they can freely choose from the full range of contraceptive methods and can discontinue their contraceptive method when they choose to do so. Long-acting reversible contraceptives, which have become much more common in the US in the past decade, are very effective but require a healthcare provider for removal. This project will contribute to public health and reproductive rights by identifying barriers to removal of long-acting reversible contraception among postpartum women.  

A critical method option for postpartum women is receipt of long-acting reversible contraception (i.e. the contraceptive implant and intrauterine device, or LARC) either while still in the hospital after childbirth (“immediately postpartum”), or during the 6-week postpartum visit. 
Nationally, LARC use by three months postpartum has increased from 6% in 2006 to 17% in 2019, suggesting that policy efforts over the past decade have increased access to this method for postpartum women. However, over the same time period, reproductive health scholars and advocates have begun to raise the concern that postpartum women may face difficulties accessing LARC removal services. However, very little evidence exists about the extent to which postpartum women in the US face barriers to LARC removal. 

Currently, no comprehensive data describing the LARC removal experiences of postpartum women exist. Therefore, to understand the extent to which postpartum people face barriers to LARC removal, primary data collection is needed. Dr. Steenland's study will sample approximately 500 individuals who had a postpartum LARC placed at Women & Infants Hospital over a yearlong period (August 2021 to July 2022). Sampled individuals will be contacted one year after their LARC placement and asked to complete a survey on their experienced with postpartum LARC. This study will be used to accomplish the following Specific Aims: Aim 1) to document the percent of women who desired or had LARC removal by one year postpartum and, Aim 2: Document barriers to LARC removal among women who received a postpartum LARC.

The long-term goal of this line of research is to ensure that postpartum women can freely choose from the full range of contraceptive methods and can easily access services to discontinue or switch contraceptive methods. By identifying barriers to LARC removal, the evidence generated by this research will inform family planning programming and policies. The expected outcome of this research is to generate data on desire for postpartum LARC removal in the first year after childbirth and on barriers to LARC removal among postpartum women with Medicaid insurance. The outcomes of this study will be widely relevant in the U.S. where provision of postpartum LARC is becoming increasingly common. 

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