Advocating for immediate postpartum LARC: increasing access, improving outcomes, and decreasing cost.

Unintended pregnancy, endemic in the United States Expulsion rates appear to be lower with postplacental (within (US), carries significant health and economic consequences and disproportionately affects poor women and women of color [1,2]. Rapid repeat pregnancy—defined as a pregnancy within 12 to 18 months after delivery—can occur if women are unsuccessful at initiating contraception [3]. Improving postpartum initiation of effective contraception including long-acting reversible contraception (LARC), the intrauterine device (IUD) and contraceptive implant, is a key strategy to reduce unintended pregnancy and health inequities. However, nonreimbursement by insurers for both LARC devices and the immediate insertion procedure, is a critical barrier to the provision of postpartum LARC during the hospital admission for a birth. Recently, coalitions in three states have successfully advocated for modification of Medicaid policy to allow reimbursement for immediate postpartum placement, both for the devices and the insertion procedure, separate from the global fee for delivery. By removing a key financial barrier, these policy changes signal an important advance in provision of the most effective forms of immediate postpartum contraception. Immediate postpartum LARC insertion is safe and supported by recent clinical guidelines [4,10]. According to the US Medical Eligibility Criteria for Contraceptive Use, both the levonorgestrel (LNG) IUD and copper IUD may be inserted prior to hospital discharge after vaginal or cesarean delivery in both breastfeeding and nonbreastfeeding women.