(400) Patterns of Postpartum Contraceptive Use within an Academic Health Care Setting: A Descriptive Study

Background: : In the US, over 35% of pregnancies are short interval (within 18 months of birth), suggesting gaps in postpartum contraception care. Short interval pregnancies are associated with a myriad of adverse outcomes. Historically, immediate postpartum insertion (IPPI) of intrauterine device (IUD) has been disincentivized due to bundled payment structures. Recent Medicaid coverage has increased its utilization.

Objective: : To assess postpartum contraceptive utilization, with a focus on IPPI IUD placement.

Methods: : A retrospective cohort study of postpartum individuals from 1/1/2010 to 12/31/2023 was conducted within the University of Utah Health system. Contraception utilization was identified via CPT codes and medication orders, categorized as no contraception, short-acting reversible contraceptives (SARC), long-acting reversible contraceptives (LARC) comprised of IUD and subcutaneous implantation (implants), sterilization, and intramuscular (IM) injections. IUD placement was categorized as IPPI (within 3 days), postpartum (4 days to 6 weeks), or interval (7 to 14 weeks) after delivery. Descriptive statistics summarized study endpoints. IUD users with continual use and SARC users with sufficient follow-up were included in the pregnancy rate analysis. The UU IRB exempted this study.

Results: : Among 30,389 individuals, 67% were White, and the median age was 29 years. Of the 52% (n=15,963) with evidence of contraception within 14 weeks postpartum, 37% received IUDs, 29% received SARC, 8% underwent sterilization, 7% received SQ implants, 4% received IM injections, and 14% received multiple methods. Among the IUD users, 16%, 14%, and 70% received IPPI, postpartum, and interval placements, respectively. Among IUD recipients, IPPI had the highest proportion of Medicaid beneficiaries (31%), non-White racial and ethnic groups (34%), and rural residents (13%). Pregnancy rates were lower for IUD users compared to SARC users at 3 months (0% vs. 0.9%), 6 months (0.5% vs. 3.9%), 12 months (1.3% vs. 18.1%), and 18 months (1.8% vs. 42.8%) from index date. Among IUD users, IPPI, postpartum, and interval placement was associated with pregnancy rates of 0.4%. 0.6%, and 0.4%, respectively at 6 months; 2.2%, 1.1%, and 1.2%, respectively at 12 months; and 3.3%, 1.7%, and 1.6% at 18 months.

Conclusions: : Our findings suggest potential underutilization of postpartum contraception in general and specific gaps in access to IPPI-IUD. IPPI-IUD use is currently focused on minority groups, rural populations, and Medicaid plans. Use of IUD was associated with lower pregnancy rates compared to other forms of reversible contraceptives.

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