Racial and ethnic disparities in postpartum care and contraception in California's Medicaid program

Heike Thiel de Bocanegra, Monica Braughton, Mary Bradsberry, Mike Howell, Julia Logan, Eleanor Schwarz

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background Considerable racial and ethnic disparities have been identified in maternal and infant health in the United States, and access to postpartum care likely contributes to these disparities. Contraception is an important component of postpartum care that helps women and their families achieve optimal interpregnancy intervals and avoid rapid repeat pregnancies and preterm births. National quality measurements to assess postpartum contraception are being developed and piloted. Objective To assess racial/ethnic variation in receipt of postpartum care and contraception among low-income women in California. Study Design We conducted a prospective cohort study of 199,860 Californian women aged 15−44 with a Medicaid-funded delivery in 2012. We examined racial/ethnic variation of postpartum care and contraception using multivariable logistic regression to control for maternal age, language, cesarean delivery, Medicaid program, and residence in a primary care shortage area (PCSA). Results Only one-half of mothers attended a postpartum visit (49.4%) or received contraception (47.5%). Compared with white women, black women attended postpartum visits less often (adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], 0.71−0.76), were less likely to receive any contraception (aOR, 0.83; 95% CI, 0.78−0.89) and were less likely to receive highly effective contraception (aOR, 0.64; 95% CI, 0.58−0.71). Women with Spanish as their primary language were more likely to get any contraception (aOR, 1.15; 95% CI, 1.11−1.19) but had significantly lower odds of receiving a highly effective method (aOR, 0.94; 95% CI, 0.90−0.99) compared with women with English as their primary language. Similarly, women in PCSAs had a greater odds of getting any contraception (aOR, 1.06; 95% CI, 1.03−1.09), but 24% lower odds of getting highly effective contraception than women not living in PCSAs (aOR, 0.76; 95% CI, 0.73−0.79). Conclusion Significant racial/ethnic disparities exist among low-income Californian mothers’ likelihood of attending postpartum visits and receiving postpartum contraception as well as receiving highly effective contraception.

Original languageEnglish (US)
Pages (from-to)47.e1-47.e7
JournalAmerican Journal of Obstetrics and Gynecology
Volume217
Issue number1
DOIs
StatePublished - Jul 1 2017

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Postnatal Care
Medicaid
Contraception
Odds Ratio
Confidence Intervals
Postpartum Period
Language
Mothers
Premature Birth
Maternal Age
Primary Health Care

Keywords

  • health disparities
  • highly effective contraception
  • Medicaid
  • postpartum care
  • postpartum contraception

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Racial and ethnic disparities in postpartum care and contraception in California's Medicaid program. / Thiel de Bocanegra, Heike; Braughton, Monica; Bradsberry, Mary; Howell, Mike; Logan, Julia; Schwarz, Eleanor.

In: American Journal of Obstetrics and Gynecology, Vol. 217, No. 1, 01.07.2017, p. 47.e1-47.e7.

Research output: Contribution to journalArticle

Thiel de Bocanegra, Heike ; Braughton, Monica ; Bradsberry, Mary ; Howell, Mike ; Logan, Julia ; Schwarz, Eleanor. / Racial and ethnic disparities in postpartum care and contraception in California's Medicaid program. In: American Journal of Obstetrics and Gynecology. 2017 ; Vol. 217, No. 1. pp. 47.e1-47.e7.
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abstract = "Background Considerable racial and ethnic disparities have been identified in maternal and infant health in the United States, and access to postpartum care likely contributes to these disparities. Contraception is an important component of postpartum care that helps women and their families achieve optimal interpregnancy intervals and avoid rapid repeat pregnancies and preterm births. National quality measurements to assess postpartum contraception are being developed and piloted. Objective To assess racial/ethnic variation in receipt of postpartum care and contraception among low-income women in California. Study Design We conducted a prospective cohort study of 199,860 Californian women aged 15−44 with a Medicaid-funded delivery in 2012. We examined racial/ethnic variation of postpartum care and contraception using multivariable logistic regression to control for maternal age, language, cesarean delivery, Medicaid program, and residence in a primary care shortage area (PCSA). Results Only one-half of mothers attended a postpartum visit (49.4{\%}) or received contraception (47.5{\%}). Compared with white women, black women attended postpartum visits less often (adjusted odds ratio [aOR], 0.73; 95{\%} confidence interval [CI], 0.71−0.76), were less likely to receive any contraception (aOR, 0.83; 95{\%} CI, 0.78−0.89) and were less likely to receive highly effective contraception (aOR, 0.64; 95{\%} CI, 0.58−0.71). Women with Spanish as their primary language were more likely to get any contraception (aOR, 1.15; 95{\%} CI, 1.11−1.19) but had significantly lower odds of receiving a highly effective method (aOR, 0.94; 95{\%} CI, 0.90−0.99) compared with women with English as their primary language. Similarly, women in PCSAs had a greater odds of getting any contraception (aOR, 1.06; 95{\%} CI, 1.03−1.09), but 24{\%} lower odds of getting highly effective contraception than women not living in PCSAs (aOR, 0.76; 95{\%} CI, 0.73−0.79). Conclusion Significant racial/ethnic disparities exist among low-income Californian mothers’ likelihood of attending postpartum visits and receiving postpartum contraception as well as receiving highly effective contraception.",
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AU - Howell, Mike

AU - Logan, Julia

AU - Schwarz, Eleanor

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N2 - Background Considerable racial and ethnic disparities have been identified in maternal and infant health in the United States, and access to postpartum care likely contributes to these disparities. Contraception is an important component of postpartum care that helps women and their families achieve optimal interpregnancy intervals and avoid rapid repeat pregnancies and preterm births. National quality measurements to assess postpartum contraception are being developed and piloted. Objective To assess racial/ethnic variation in receipt of postpartum care and contraception among low-income women in California. Study Design We conducted a prospective cohort study of 199,860 Californian women aged 15−44 with a Medicaid-funded delivery in 2012. We examined racial/ethnic variation of postpartum care and contraception using multivariable logistic regression to control for maternal age, language, cesarean delivery, Medicaid program, and residence in a primary care shortage area (PCSA). Results Only one-half of mothers attended a postpartum visit (49.4%) or received contraception (47.5%). Compared with white women, black women attended postpartum visits less often (adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], 0.71−0.76), were less likely to receive any contraception (aOR, 0.83; 95% CI, 0.78−0.89) and were less likely to receive highly effective contraception (aOR, 0.64; 95% CI, 0.58−0.71). Women with Spanish as their primary language were more likely to get any contraception (aOR, 1.15; 95% CI, 1.11−1.19) but had significantly lower odds of receiving a highly effective method (aOR, 0.94; 95% CI, 0.90−0.99) compared with women with English as their primary language. Similarly, women in PCSAs had a greater odds of getting any contraception (aOR, 1.06; 95% CI, 1.03−1.09), but 24% lower odds of getting highly effective contraception than women not living in PCSAs (aOR, 0.76; 95% CI, 0.73−0.79). Conclusion Significant racial/ethnic disparities exist among low-income Californian mothers’ likelihood of attending postpartum visits and receiving postpartum contraception as well as receiving highly effective contraception.

AB - Background Considerable racial and ethnic disparities have been identified in maternal and infant health in the United States, and access to postpartum care likely contributes to these disparities. Contraception is an important component of postpartum care that helps women and their families achieve optimal interpregnancy intervals and avoid rapid repeat pregnancies and preterm births. National quality measurements to assess postpartum contraception are being developed and piloted. Objective To assess racial/ethnic variation in receipt of postpartum care and contraception among low-income women in California. Study Design We conducted a prospective cohort study of 199,860 Californian women aged 15−44 with a Medicaid-funded delivery in 2012. We examined racial/ethnic variation of postpartum care and contraception using multivariable logistic regression to control for maternal age, language, cesarean delivery, Medicaid program, and residence in a primary care shortage area (PCSA). Results Only one-half of mothers attended a postpartum visit (49.4%) or received contraception (47.5%). Compared with white women, black women attended postpartum visits less often (adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], 0.71−0.76), were less likely to receive any contraception (aOR, 0.83; 95% CI, 0.78−0.89) and were less likely to receive highly effective contraception (aOR, 0.64; 95% CI, 0.58−0.71). Women with Spanish as their primary language were more likely to get any contraception (aOR, 1.15; 95% CI, 1.11−1.19) but had significantly lower odds of receiving a highly effective method (aOR, 0.94; 95% CI, 0.90−0.99) compared with women with English as their primary language. Similarly, women in PCSAs had a greater odds of getting any contraception (aOR, 1.06; 95% CI, 1.03−1.09), but 24% lower odds of getting highly effective contraception than women not living in PCSAs (aOR, 0.76; 95% CI, 0.73−0.79). Conclusion Significant racial/ethnic disparities exist among low-income Californian mothers’ likelihood of attending postpartum visits and receiving postpartum contraception as well as receiving highly effective contraception.

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