Inserting an intrauterine device (IUD) or long-term contraceptive implant immediately after a woman delivers a baby may seem like an oddly-timed procedure. But more states are offering this option through their Medicaid programs, according to a new study published today in the journal Contraception.
Experts say this is an important move, as postpartum women have a high risk of unintended pregnancy and many low-income mothers do not have the resources to get their preferred method of contraception after giving birth.
Specific Medicaid reimbursement for an IUD or implant right after a woman gives birth has gone from being available in no states to 19 states in just three years, researchers from the University of Michigan Health System found. Eight other states are also considering enhanced reimbursement.
The authors point to previous research that suggests between 40 and 60 percent of low-income women who say they want an IUD or implant -- which costs between $800 and $1,000 -- never make it to a follow-up office appointment to get the procedure done due to issues with childcare, transportation and other barriers.
"Many women's first choice for birth control is an IUD or implant, which we know are the safest and most effective forms of reversible contraception," lead study author Dr. Michelle Moniz, an assistant professor of obstetrics and gynecology and researcher at the University of Michigan Medical School, said in a statement. "The problem is that many postpartum women can't make it back to the office for an appointment to get one. Our findings suggest that more and more agencies recognize significant benefits to providing this service before women even leave the hospital."
Unplanned, repeat pregnancies come with a number of negative health impacts for both moms and babies, including the increased risk of miscarriage, preterm labor and stillbirth.
"Parental fatigue and parental recuperation from pregnancy and delivery are factors," Dr. Linda Bradley, a gynecologist and Vice Chair of Obstetrics, Gynecology, and Women's Health Institute at Cleveland Clinic, told CBS News. "There's also financial issues. Being ready to financially take off from work a second time in terms of maternity leave."
The study identifies Ohio as a state that offers Medicaid coverage for women seeking an IUD or implant immediately after giving birth, but Bradley said that within the clinic, most patients still know very little about this form of birth control.
"In the U.S. in general, the adoption of IUDs in particular, in terms of patient knowledge, is very low," she said. "This is a gap that doctors can fill, by telling patients, this is a very safe and very effective method of contraception. These conversations about postpartum contraception should begin at the very first prenatal visit."
The study authors note that while many insurance providers -- both private and government-funded -- cover permanent contraceptive options, such as getting the fallopian tubes tied, during hospitalization for childbirth many have not traditionally covered IUDs and implants.
For the study, the researchers conducted telephone interviews with 40 Medicaid agencies. They found that the most commonly-cited reasons states decided to provide coverage include perceived health benefits for mothers and children, and overall cost-savings. However, the agencies that don't currently provide payment for the service expressed concern about immediate budget costs and potential health risks.
But experts say these health concerns are not founded in research. While IUDs inserted immediately after birth have a slightly higher chance of falling out than when inserted eight to 10 weeks later, the risk of dangerous complications like infection or injury is exceedingly low with both immediate and delayed placement.
"For uncomplicated deliveries, the risks are so extremely low compared to the benefits of having an IUD present," Bradley said.
Contraceptive implants do not have any risk of falling out, the authors note, which makes them an attractive option for women immediately following delivery.
The study authors said they hope more states will adopt policies providing this type of contraceptive coverage and that private insurers will also begin providing the option.
"Reimbursement policies have been one barrier to providing a large group of high risk women with the safest and most effective forms of reversible birth control in a way that's most convenient for them," Moniz said. "We found that the landscape is changing rapidly, with more Medicaid agencies making it easier for women to get the kind of birth control they want, when they need it most. The majority of states, however, still do not provide this specific coverage, suggesting a great need to correct misinformation about immediate postpartum contraception and concerns about cost to help promote better access for more women."