Date of Award

Spring 2019

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

First Advisor

Heather M. Brandt

Abstract

Offering contraceptives is essential to allow women the opportunity to plan for pregnancy and help prevent mistimed or unintended pregnancy. Intrauterine devices and implants, also known as long-acting reversible contraceptives (LARC), are the most effective methods of contraception. South Carolina Medicaid in 2012 launched an innovative policy expanding contraceptive access and coverage for women delivering in hospitals to have the option to receive a LARC immediately postpartum. However, in order for this policy to be successful, it relies on the capacity of hospitals and providers to adopt and implement without assistance. Identifying the provisions necessary in order for successful policy dissemination, adoption, and implementation will support current and future policy work.

Aim one of this study was to determine the uptake of immediate postpartum insertion of LARC in South Carolina hospitals. To establish the change in uptake of LARC in hospital settings, a retrospective analysis was completed of Medicaid claims data for all live births pre (2010-2011) and post (2012-2014) policy implementation for up to 60 days after delivery. The cross-sectional study sample included 86,941 births pre- policy and 158,381 births post-policy. The analyses identified that immediate postpartum LARC users were more likely to be White/Caucasian, Black/African American and 15-29 years. Overall, postpartum contraception use was low and post-policy findings found a decrease percentage of women receiving contraception within 60 days postpartum.

The second aim of this study explored how health care providers implemented the immediate postpartum insertion of LARC policy. An electronic survey was distributed to labor and delivery hospitals and a purposive recruitment from survey participants provided in-depth interviews with providers and key hospital staff. The analyses identified a delay in the adoption of the LARC policy within hospital settings due to two main challenges: the coordinating of internal policy systems and clinical practice concerns. These challenges highlight the need for establishing a system to enhance policy adoption and training for hospital implementation.

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Public Health Commons

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