{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T13:31:07Z","timestamp":1764077467789,"version":"3.41.2"},"reference-count":56,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,3,16]],"date-time":"2024-03-16T00:00:00Z","timestamp":1710547200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["P2C\u2010HD041041"],"award-info":[{"award-number":["P2C\u2010HD041041"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To examine the effects of a comprehensive, multiyear (2015\u20132020) statewide contraceptive access intervention in Delaware on the contraceptive initiation of postpartum Medicaid patients. The program aimed to increase access to all contraceptives, including long\u2010acting reversible contraceptives (LARC). The program included interventions specifically targeting postpartum patients (Medicaid payment reform and hospital\u2010based immediate postpartum (IPP) LARC training) and interventions in outpatient settings (provider training and operational supports).<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources and Study Setting<\/jats:title><jats:p>We used Medicaid claims data between 2012 and 2019, from Delaware and Maryland (a comparison state), to identify births and postpartum contraceptive methods up to 60\u2009days postpartum among patients aged 15\u201344\u2009years who were covered in a full\u2010benefit eligibility category.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Using difference\u2010in\u2010differences, we assessed changes in LARC, tubal ligation, and short\u2010acting methods (oral contraceptive, injectable, patch\/ring). LARC rates were assessed at 60\u2009days after delivery and on an immediate postpartum basis. Other methods were only assessed at 60\u2009days. Analyses were conducted separately for an early\u2010adopting high\u2010capacity hospital (that delivers approximately half of all Medicaid financed births) and for all other later\u2010adopting hospitals in the state.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Collection\/Extraction Methods<\/jats:title><jats:p>Data were extracted from administrative claims.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>The program increased postpartum LARC insertions by 60\u2009days after delivery by 11.7 percentage points (95% CI: 10.7, 12.8) in the early\u2010adopting hospital and 6.9 percentage points (95% CI: 4.8, 5.9) in later\u2010adopting hospitals. Increases in IPP versus outpatient LARC drove the change, but we did not find evidence that IPP crowded\u2010out outpatient LARC services. We observed decreases in short\u2010acting methods, suggesting substitution between methods, but the share of patients with any method increased at the early\u2010adopting hospital (5.2 percentage points; 95% CI: 3.5, 6.9) and was not statistically significantly different at the later\u2010adopting hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Direct reimbursement for IPP LARC, in combination with provider training, had a meaningful impact on the share of Medicaid\u2010enrolled postpartum women with LARC claims.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.14300","type":"journal-article","created":{"date-parts":[[2024,3,16]],"date-time":"2024-03-16T07:28:57Z","timestamp":1710574137000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Postpartum long\u2010acting reversible contraceptive adoption after a statewide initiative"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0782-0903","authenticated-orcid":false,"given":"Katie","family":"Gifford","sequence":"first","affiliation":[{"name":"Biden School of Public Policy &amp; Administration University of Delaware  Newark Delaware USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"McColl","sequence":"additional","affiliation":[{"name":"Biden School of Public Policy &amp; Administration University of Delaware  Newark Delaware USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Joan","family":"McDuffie","sequence":"additional","affiliation":[{"name":"Biden School of Public Policy &amp; Administration University of Delaware  Newark Delaware USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel","family":"Boudreaux","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management University of Maryland School of Public Health  College Park Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,3,16]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"American College of Obstetricians and Gynecologists.Long\u2010acting reversible contraception (LARC): Intrauterine devices (IUD) and implant. November 2021. Accessed August 22 2022https:\/\/www.acog.org\/womens-health\/faqs\/long-acting-reversible-contraception-iud-and-implant"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2021.05.006"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.02.036"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.11.1282"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.04.015"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40834\u2010018\u20100073\u2010x"},{"volume-title":"Committee Opinion: Immediate Postpartum Long\u2010Acting Reversible Contraception","author":"Borders AE","key":"e_1_2_10_8_1"},{"key":"e_1_2_10_9_1","unstructured":"Centers for Disease Control and Prevention.Evidence summary: Prevent unintended pregnancy. CDC's 6|18 Initiative: Accelerating Evidence into Action. 2022. 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