Identifying Missed Opportunities: Contraceptive dispensing at postpartum visits in publicly funded programs

In the U.S., over a third of pregnancies (35.3%) were conceived within 18 months of a previous birth. These suboptimal inter-pregnancy intervals (IPIs) are especially common among low-income women who receive publicly funded services. Women with suboptimal IPIs are at increased risk of preterm birth and adverse maternal and infant health outcomes. The provision of contraception immediately after birth helps to prevent premature conception and facilitates optimal birth spacing. We identified 2nd or higher order births from California's 2008 Birth Statistical Master File and calculated the inter-pregnancy interval between the birth in 2008 and the previous (index) birth. We assessed whether women had a visit to a publicly funded program (Medi-Cal or Family PACT, California's Medicaid family planning expansion) within 60 days of the birth and whether they received contraceptive services at those visits. Of the 98,836 women seen by a publicly-funded program provider within 60 days after delivery, only 41% received contraception (28% from Medi-Cal 28% and 13% from Family PACT). A significantly higher proportion of women who did not receive contraception had suboptimal IPIs (n=25,765; 44.2%) than women who received contraception (n=12,340; 30.4%). A total of 11.1% of women without contraception had very short IPIs (under 6 months between birth and conception) compared to 4.9% of women who received contraception. We will describe the demographic profile of women with suboptimal and extremely short IPIs. The findings suggest that identifying missed opportunities to dispense contraception during postpartum visits can be an efficient strategy to ensure optimal inter-pregnancy intervals.