A medical worker explains a family planning method using the Intra Uterine device (IUD) to housewives in a local government health centre in Navotas, Metro Manila March 3, 2011. REUTERS/Erik de Castro (Copyright Reuters 2015)
For new mothers in the U.S. who receive government-sponsored health insurance, it's becoming easier to get intrauterine devices (IUDs) implanted immediately after giving birth, a study found.
"Immediate insertion is associated with more women who want an IUD implant actually getting it, higher use at three months postpartum, and lower rates of unplanned rapid repeat pregnancies within 12 to 24 months of delivery," said lead study author Dr. Michelle Moniz of the University of Michigan in Ann Arbor, in email to Reuters Health. "Furthermore, multiple analyses suggest that this strategy is cost-effective."
Just three years ago, no state Medicaid programs paid for these contraceptive devices to be implanted right after delivery. But over the past three years, Medicaid has added coverage for IUDs inserted right after birth in at least 19 states, the study found.
The shift reflects mounting evidence that providing IUDs during hospitalizations for delivery is a safe and effective way to increase contraceptive use among new mothers and discourage pregnancies in rapid succession that pose health risks to women and their babies, said Moniz.
Medicaid, the government health insurance program for the poor, pays for roughly half of U.S. births - and an even greater proportion of deliveries at most safety-net hospitals that treat many of the nation's poor and uninsured patients. States jointly finance the program with the federal government and have wide latitude to determine who qualifies for benefits and what services to cover.
For the current study, Moniz and colleagues interviewed Medicaid representatives from 39 states and the District of Columbia in 2014 and 2015. Officials in the remaining eleven states either declined to participate or didn't respond to interview requests.
Researchers asked about coverage for IUDs, which like many prescription contraceptives are generally available through a doctor visit rather than as part of a hospital stay.
IUDs are T-shaped devices about the size of a quarter that are inserted into the uterus. The devices can be used for several years, and can prevent pregnancy by stopping sperm from reaching fertilized eggs.
Doctors generally recommend inserting IUDs either right after the delivery of the placenta at the end of the birthing process or waiting until a postpartum visit at least six weeks later, Moniz said.
While placing the device immediately after birth carries a slightly increased risk that it may loosen and fall out, the risks of other complications, such as infections, are small and similar to the odds of side effects from an IUD placed later in the doctor's office.
One limitation of the study is that it focused on what's known as fee-for-service benefits, excluding Medicaid coverage provided via private insurers, the authors note in the journal Contraception.
Even so, the findings suggest that it's becoming clear to states that providing women with long-acting contraceptives while they have access to healthcare in the hospital can lead to fewer unintended pregnancies, said Dr. Amy Bryant, a family planning researcher at the University of North Carolina at Chapel Hill.
"For women who are not likely to follow up after they give birth, this means that they leave the hospital with effective contraception," Bryant, who wasn't involved in the study, said by email.
Waiting at least 18 to 24 months between deliveries allows women time to recover from childbirth and breastfeed, Bryant said. Shorter intervals between pregnancies have been linked to preterm deliveries and poor fetal and infant growth, she added.
"IUDs are a great option for women wanting to space births, since they are so easy to use and can be in place for several years at a time," Bryant added.
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