Postpartum Contraception Use

Introduction

This toolkit summarizes content from the Postpartum Contraception Use Evidence Accelerator and the MCHbest database. The peer-reviewed literature supporting this work can be found in the Established Evidence database. Use the resources below as you develop effective evidence-based/informed programs and measures.

Postpartum Contracention Use is related to the following topics; see these Accelerators for additional information: Postpartum Visit and Postpartum Mental Health Screening.

From the MCH Block Grant Guidance. Contraception is recognized as an effective strategy for reducing unintended pregnancies and achieving healthy birth spacing thereby improving maternal and child health outcomes. In the United States, nearly two-thirds of reproductive-aged women report currently using contraception.¹ However, those at greatest need for contraception may not be accessing or using it. In 2017-2019, 3 in 5 reproductive-aged women from 45 U.S. jurisdictions had an ongoing or potential need for contraceptive services; nearly one-third were not using a method of contraception at last sexual encounter.² Long- acting reversible contraception methods are considered the most effective at preventing pregnancy, while short-acting reversible methods are moderately effective. Improving the uptake and use of these effective contraception methods in the postpartum period can prevent unintended pregnancies and improve health outcomes. Contraceptive care for postpartum women is part of the Core Set of Maternal and Perinatal Health Measures for Medicaid and CHIP.

Goal. To increase the percent of women who are using postpartum contraception.

Note. Access other related measures in this Population Domain through the Toolkits page.

Detail Sheet: Start with the MCH Block Grant Guidance

DEFINITION

Numerator:

Number of women who reported they are using a most effective (long-acting reversible contraceptive such as contraceptive implants and intrauterine devices or systems as well as irreversible surgical contraception) or moderately effective (injectables, oral pills, patches, rings, or diaphragms) method of contraception

Denominator:

Number of women with a recent live birth, excluding those who are currently pregnant

Units: 100

Text: Percent

HEALTHY PEOPLE 2030 OBJECTIVE

Related to Family Planning (FP) Objective 10: Increase the proportion of women at risk for unintended pregnancy who use effective birth control. (Baseline: 60.3% in 2015-17, Target: 65.1%)

DATA SOURCES

Pregnancy Risk Assessment Monitoring System (PRAMS)

MCH POPULATION DOMAIN

Women/Maternal Health

MEASURE DOMAIN

Health Behavior

1. Accelerate with Evidence—Start with the Science

The first step to accelerate effective, evidence-based/informed programs is ensuring that the strategies we implement are meaningful and have high potential to affect desired change. Read more about using evidence-based/informed programs and then use this section to find strategies that you can adopt or adapt for your needs.

Evidence-based/Informed Strategies: MCHbest Database

The following strategies have emerged from studies in the scientific literature as being effective in advancing the measure. Use the links below to read more about each strategy or access the MCHbest database to find additional strategies.

Chart of Evidence-Linked Strategies and Tools
Evidence-Informed			Evidence-Based
Mixed Evidence	Emerging Evidence	Expert Opinion	Moderate Evidence	Scientifically Rigorous
	Peer Support and Community Programs (2020) Postpartum Contraceptive Counseling (2020) Quality Improvement Initiatives (2022)		Financial Barriers (2022) Group Prenatal Care (2024) Long-Acting Reversible Contraception Access (2019) Multi-Sectoral Collaboration (2022) Telemedicine (2023)	Early Childhood Home Visiting Programs (2018)

Field-Based Strategies: Resources and Programs

Resources from state-/community-based programs have been identified for advancing the NPM for specific communities or populations. They can be used as models to meet your program needs.

Medicaid Reimbursement for Postpartum LARC [by State/Jurisdiction] describes the pathways that states and jurisdictions can take to obtain reimbursement for funding immediate postpartum long-acting reversible contraception (IPP LARC) outside of the global obstetric payment.
Delaware Contraceptive Access Now (DelCAN) initiative is a statewide program and set of policy changes focusing on reducing unintended pregnancies and improving access to and delivery of family planning services and contraceptives, including LARCs.
Kansas Long-Acting Reversible Contraception (LARC) Clinical Components provides information on medical eligibility, different types of LARC products available, how to document insertions, managing side effects and complications, etc. Mostly clinical guidance, no external data or metrics
Maryland Immediate Postpartum Long-Acting Reversible Contraception (IPP LARC) toolkit addresses considerations for integration of IPP LARC into existing workflows and protocols. The toolkit aims to provide hospitals with technical assistance as they integrate IPP LARC into routine practice.
Virginia Postpartum LARC Toolkit provides guidance and resources for Virginia hospitals who want to begin offering immediate postpartum LARCs.
Immediate Postpartum Contraception Coverage in Washington summary describes how Washington State law requires commercial insurance plans to cover the cost of immediate postpartum contraception provided in hospital and birth center settings as a separate payment from the standard labor and delivery payment.

2. Think Upstream with Planning Tools—Lead with the Need

The second step in developing effective, evidence-based/informed programs challenges us to plan upstream to ensure that our work addresses issues early and is measurable in “turning the curve” on big issues that face MCH populations. Read more about moving from root causes to responsive programs and then use this section to align your work with the data and needs of your populations.

Move from Need to Strategy

Use Root-Cause Analysis (RCA) and Results-Based Accountability (RBA) tools to build upon the science to determine how to address needs.

Planning Tools: Use these tools to move from data to action

3. Work Together with Implementation Tools—Move from Planning to Practice

The third step in developing effective, evidence-based/informed programs calls us to work together to ensure that programs are implementable and moveable within the realities of Title V programs and lead to improved health outcomes for all people. Read more about implementation tools designed for MCH population change and then use this section to develop responsive strategies to bring about change that is responsive to the needs of your populations.

Additional MCH Evidence Center Resources: Access supplemental materials from the literature

Find field-based resources focused on increasing postpartum contraception use relevant to Title V programs in the MCH Digital Library.
Search the Established Evidence database for peer-reviewed research articles related to strategies for increasing postpartum contraception use.
Request Technical Assistance from the MCH Evidence Center
MCH Evidence Center Frameworks and Toolkits:

Implementation Resources: Use these field-generated resources to affect change

PRACTICE

The following tools can be used to translate evidence to action to advance this NPM:

Postpartum Contraception Guide (Partners in Contraceptive Choice and Knowledge). This decision aid helps provide patient-centered postpartum contraception counseling.
Immediate Postpartum Family Planning (Family Planning High Impact Practices). This issue brief provides practice information and implementation guidance for facility-based postpartum contraceptive counseling.

PARTNERSHIP

The following organizations focus on advancing postpartum contraception access:

Postpartum Contraception Access Initiative. ACOG training program for health care providers to deliver a full range of immediate postpartum contraceptive methods.
Society of Family Planning. Provides clinical guidance and resources on all types of family planning, including postpartum contraception.

References

Introductory References: From the MCH Block Grant Guidance

¹ Daniels K, Abma JC. Current Contraceptive Status Among Women Aged 15-49: United States, 2017-2019. NCHS Data Brief. 2020;(388):1-8.

² Zapata LB, Pazol K, Curtis KM, et al. Need for Contraceptive Services Among Women of Reproductive Age - 45 Jurisdictions, United States, 2017-2019. MMWR Morb Mortal Wkly Rep. 2021;70(25):910-915. Published 2021 Jun 25. doi:10.15585/mmwr.mm7025a2

Evidence Tools Postpartum Contraception Use