The Association of Public Insurance with Postpartum Contraception Preference and Provision

Figures & data

Figure 1 Flow chart of the study population.

Table 1 Clinical/Demographic Differences and Postpartum Contraception Plan Preference Differences Among Women with Private versus Public Insurance

	Private Insurance n=1372	Public Insurance n=6909	p-value
Mean maternal age at delivery (years)	28.9 (6.29)	25.4 (5.78)	<0.001
Parity			<0.001
0	678 (49.4)	2411 (34.9)
1	401 (29.2)	1902 (27.5)
2+	293 (21.4)	2596 (37.6)
Mean Gestational age at delivery (weeks)	38.4 (2.65)	38.1 (2.95)	<0.001
Adequate prenatal care	1274 (92.8)	5453 (78.9)	<0.001
Route of Delivery			0.005
Spontaneous vaginal	930 (67.8)	4975 (72.0)
Cesarean section	388 (28.3)	1713 (24.8)
Operative vaginal	54 (3.9)	221 (3.2)
Race/Ethnicity			<0.001
Black	315 (23.0)	3579 (51.8)
White	847 (61.7)	2103 (30.4)
Hispanic	90 (6.6)	874 (12.7)
Asian	45 (3.3)	113 (1.6)
Other	75 (5.5)	240 (3.5)
Married	756 (55.8)	969 (14.4)	<0.001
College education	994 (72.4)	1854 (26.8)	<0.001
Postpartum Contraception Plan
Tier 1	283 (20.6)	2025 (29.3)	<0.001
Tier 2	444 (32.4)	3483 (50.4)	<0.001
Tier 3	146 (10.6)	221 (3.2)	<0.001
None	499 (36.4)	1180 (17.1)	<0.001
Postpartum Contraception Plan Provision	1073 (78.2)	5076 (73.5)	<0.001
Postpartum Visit Attendance	1176 (85.7)	4331 (62.7)	<0.001
Subsequent Pregnancy	293 (21.4)	1952 (28.3)	<0.001

Notes: Presented as n (%) or mean (SD). Tier 1 – long-acting reversible contraception, female sterilization, male sterilization. Tier 2 – injectables, pills, patch, vaginal ring. Tier 3 – barrier methods, fertility awareness, withdrawal, abstinence. None – no method, lactational amenorrhea.

Table 2 Propensity Score Analysis of Differences in Contraceptive Plan, Provision by 90 Days Postpartum, Postpartum Visit Attendance, and Subsequent Pregnancy Within 365 Days of Delivery by Private versus Public Insurance Status.*

	Unmatched Univariable OR (95% CI)	Unmatched Multivariable aOR (95% CI)	Matched Univariable OR (95% CI)	Matched Multivariable maOR (95% CI)
Postpartum Contraception Plan – Tier 1 versus Tier 2	0.91 (0.77–1.06)	0.91 (0.74–1.12)	0.85 (0.68–1.07)	0.89 (0.69–1.15)
Postpartum Contraception Plan – Tier 1/2 versus Tier 3/None	3.34 (2.99–3.73)	1.43 (1.24–1.66)	1.40 (1.19–1.65)	1.41 (1.17–1.69)
Postpartum Contraception Plan Provision	0.88 (0.76–1.02)	1.01 (0.83–1.22)	0.95 (0.78–1.17)	0.94 (0.75–1.17)
Postpartum visit attendance	0.28 (0.24–0.33)	0.55 (0.45–0.67)	0.52 (0.42–0.64)	0.54 (0.43–0.68)
Subsequent Pregnancy (without provision as a covariate)	1.45 (1.26–1.67)	1.13 (0.96–1.35)	1.33 (1.09–1.63)	1.29 (1.05–1.59)
Subsequent Pregnancy (including provision as a covariate)	1.45 (1.26–1.67)	1.13 (0.96–1.34)	1.25 (1.02–1.54)	1.27 (1.03–1.56)

Notes: *Insurance status was recorded as private versus public (Medicaid, Medicare, or Champus/Tricare). Other covariates included maternal age at delivery in years, parity at admission, gestational age at delivery in weeks, adequacy of prenatal care, delivery type, race/ethnicity, marital status, and education level. Bold values indicate significant associations.

Abbreviations: OR, odds ratio; aOR, adjusted odds ratio; maOR, matched adjusted odds ratio; 95% CI, 95% Confidence Interval.