Reducing short-interval births in South Carolina

The percentage of women and teen girls in South Carolina who received long-acting contraception shortly after giving birth increased after the state changed the way its Medicaid program reimbursed hospitals for the contraceptives, and short-interval births—subsequent childbirths within 21 months—decreased, according to a new study involving researchers from Harvard T.H. Chan School of Public Health.

In a June 3, 2019 research letter in JAMA, the study authors noted that intrauterine devices (IUDs) or contraceptive implants—known as “immediate postpartum long-acting reversible contraception” (IPP-LARC)—are recommended by experts to reduce short intervals between pregnancies.

The study found that, in 2012, after South Carolina’s Medicaid program began reimbursing hospitals for IPP-LARC separately from other pregnancy- and delivery-related services, the percentage of women and girls receiving IPP-LARC increased through 2017, by 5 percentage points among adults and 8.32 percentage points among adolescents, relative to what would have been expected without the policy change. In addition, short-interval births among teens decreased by 5.28 percentage points relative to what would have been expected.

“These findings suggest that IPP-LARC reimbursement could increase immediate postpartum contraceptive options and help adolescents avoid short-interval births,” the authors wrote.

Harvard Chan co-authors included Jessica Cohen, Bruce A. Beal, Robert L. Beal, and Alexander S. Beal Associate Professor of Global Health, and Anna Sinaiko, assistant professor of health economics and policy.

Read the JAMA research letter: Association Between South Carolina Medicaid’s Change in Payment for Immediate Postpartum Long-Acting Reversible Contraception and Birth Intervals