Providing long-acting contraception after birth to facilitate optimal inter-pregnancy intervals

One of the Healthy People 2020 objectives is to reduce the proportion of women with inter-pregnancy intervals less than 18 months between the delivery of one infant and the conception of a next pregnancy (suboptimal IPIs). Women with suboptimal IPIs are at increased risk of preterm birth and of adverse maternal and infant health outcomes. We determined the proportion of California women with suboptimal IPIs, and the impact of contraceptive method provision by Medi-Cal or Family PACT in obtaining optimal IPIs. Using California's 2008 Birth Statistical Master File, we calculated the birth interval from the birth prior to 2008 and the 2008 birth. We identified second or higher order births of California's Birth Statistical Master File in 2008 and assessed whether women were seen by California's Medicaid, Medi-Cal, or its family planning expansion, Family PACT. A total of 101,761 women received Medi-Cal and 149,136 women received Family PACT services 18 months after delivery. A higher proportion of Family PACT clients (5.5%) received long-acting reversible contraception (LARC) than Medi-Cal women (2.1%). Overall, 35.79% of California women had suboptimal IPIs. In logistic regression analysis, receipt of LARC after delivery predicted optimal IPIs when controlling for age, parity, and race/ethnicity. Women who received a LARC were 3.56 times more likely, than not, to have an optimal IPI compared to women who received other methods of contraception. Optimal IPIs were also associated with higher age groups and lower parity. Contraceptive provision after delivery can contribute to optimal inter-pregnancy intervals among low-income women.