A statewide analysis of uptake of highly effective contraception offered immediately postpartum in Massachusetts, 2017 – 2021

Our study aims to evaluate trends in Massachusetts in provision of highly effective contraception, including contraceptive implant, intrauterine device (IUD) and permanent contraception, in the immediate postpartum (iPP) period. Deliveries from 2017-2021 were extracted from a Massachusetts Acute Hospital database, and the primary outcomes included permanent contraception, iPP implant, or iPP IUD provision during delivery admission. Covariates included race, ethnicity, insurance, and hospital type. Logistic regressions for iPP contraception procedures and comparing reversibility of methods were analyzed, as well as sub-analyses by delivery type. During the study period, 16,379 permanent contraception, 2,608 iPP implant, and 2,198 iPP IUD procedures were performed during delivery admissions in Massachusetts. In adjusted models, Hispanic patients or those with private insurance had higher odds of receiving any iPP method, whereas patients who delivered at a non-teaching hospital had lower odds of receiving any iPP method. Patients who identified as Hispanic, had public insurance, or delivered at a non-teaching hospital had lower odds of receiving a reversible compared to permanent method. These trends overall persisted when analyzed by delivery type. Many factors correlate with differential uptake of highly effective contraception during delivery admissions, suggesting policy and programming implications to meet the state’s unmet postpartum contraception need.