Do Rates of Obtaining Desired IPP LARC Differ by Maternal Care Access Levels and Demographics?

INTRODUCTION: This analysis aimed to determine whether rates of obtaining desired immediate postpartum long-acting reversible contraception (IPP LARC) differed by maternity care access level or maternal demographic characteristics to identify gaps in practice, specific to health equity among Tennessee Medicaid recipients. METHODS: Data were obtained from deliveries March 2018 to December 2022 at our institution. Only deliveries insured by TennCare Medicaid were included in the analysis. Maternal care access level was defined by March of Dimes 2022 designations based on location of maternal residence. Variables included contraception counseling, desired and obtained contraception type, late/limited prenatal care designation, and demographics including race, ethnicity, age, gravida, and maternity care access level. RESULTS: Of the 10,623 publicly insured deliveries from March 2018 to December 2022, 2,251 patients desired IPP LARC, and 84.5% obtained it. Among those who did not (15.5%), 4.9% lived in a designated maternity care desert (MCD); 15.6% had late, limited, or no prenatal care; 21.7% were Hispanic; and 14.2% were Black, non-Hispanic. There were no statistically significant differences in IPP LARC obtainment between maternal care access levels or the other maternal demographics considered. CONCLUSION: When individuals are unable to obtain their desired contraceptive option immediately following delivery, assessing factors that may prevent access, including systemic barriers and potential bias, should be important in the organization. Bias may be identified as gaps in rates of obtainment stratified by maternal characteristics. Although we do not currently see statistically significant differences in rates of obtaining desired IPP LARC based on maternal characteristics, ongoing assessment will continue.