Medicaid Family Planning Waiver Participation as Related to Birth to Conception Intervals

Background: Women with a short BCI at risk for delivering low birth weight, preterm, and small for gestational age infants. Women with a short BCI are also more likely to have an unplanned pregnancy. These risks are greater among low-income women. Medicaid family planning waivers help low-income women access reproductive health services by expanding the population eligible for services. In the 25 states with waivers, evidence suggests they have increased the number of women getting contraception, improved contraceptive use, and are cost-effective. However, there has been little research into how long-term participation affects health outcomes such as BCI.

Methods: Using an ecological framework, analysis of covariance was used to evaluate the relationship between family planning waiver participation and BCI. The study population included all women enrolled in the South Carolina waiver during July 1994-June 2003, excluding women who have not given birth and women who gave birth within 36 months of waiver enrollment (so that variation in service utilization before the first birth could be evaluated).

Results: Adjusting for demographic and behavioral covariates, there was a positive and significant (p<0.01) relationship between the total number of family planning visits and BCI.

Conclusions: Data indicate that greater utilization of family planning services translates to a longer BCI. It is important that policy evaluations move beyond process measures to provide behavioral change and health outcomes data to determine whether policy is an appropriate intervention. These findings support the intervention effect of this policy and underscore the need to expand this policy nationwide.