In the summer of 2017, Elizabeth gave birth to her first child, Maxine. She wanted just one child, so her preference was to receive an intrauterine device (IUD) immediately after birth, before she was discharged from the hospital. Her goal was to save time, energy, and, most importantly, cut down on her risk of unintentionally getting pregnant in the first several weeks after giving birth. However, when Elizabeth communicated this plan to her health care provider, she was told she would need to wait until her six-week postpartum follow-up visit to receive an IUD instead of getting it immediately after giving birth as she desired. The reason? That was the only way her insurance would cover the IUD.
Unfortunately, confusion on insurance coverage for immediate postpartum contraception (IPPC) — or receiving birth control before being discharged from the hospital or birthing center — can get in the way of patient-centered care.
Access to immediate postpartum contraception is critical to maternal and newborn health. Studies show that healthy birth spacing helps reduce adverse health outcomes for both parents and babies — yet at least 70% of pregnancies in the first year after a person gives birth are unplanned. This is in large part because 40 to 75% of people who plan to use an intrauterine device (IUD) after childbirth don’t obtain it.
On the flip side, access to IPPC is associated with higher patient satisfaction, longer contraceptive coverage, fewer unintended pregnancies, and cost savings for payers and healthcare systems compared to outpatient postpartum insertion.
Unfortunately, not every patient in Washington has the same access to IPPC.
Currently, there is no consistent form of payment for IPPC that’s offered across different types of insurance in Washington, which causes confusion for providers and patients. For patients who have private insurance, like Elizabeth, payment for IPPC can be included in the lump labor and delivery payment that providers receive for birth delivery. By including the cost of IPPC in the lump payment, insurers don’t account for how expensive IUDs and implants are, making it harder for providers to stock and provide them. This effectively limits patient choice by pushing birth control access back several weeks to the postpartum follow up visit, where insurance covers the costs differently.
Increasing immediate postpartum access to contraception has become a national priority to improve the reproductive health of people who have recently given birth. The American College of Obstetricians and Gynecologists (ACOG) recommends providing IUDs or implants for people who want them, before they are discharged after giving birth, to increase healthy birth spacing and cut down on the risk of patients not returning for the postpartum follow-up visit. Close to 40 states offer IPPC payment coverage for people on Medicaid before hospital discharge, including Washington, but not for people with private insurance.
Beyond limiting access for patients with private insurance, a consistent payment policy for IPPC would eliminate any perception or practice of one group of patients being targeted for certain forms of birth control over other groups. With the long history of bias and coercion in reproductive health care, all patients should have consistent access to IPPC no matter what type of insurance they have.
“Immediate postpartum contraception is critical to maternal and infant health,” said Sarah Prager, M.D. Professor of Obstetrics and Gynecology at UW Medicine. “Cost should not be a barrier to contraception when the consequences of inaccess generates greater financial risks and adverse health outcomes. Private insurers must revise their plans to better support patients across Washington by unbundling IPPC from maternity payments.”
Upstream is supporting HB 1651 “An Act Relating to Allowing Providers to Bill Separately for Immediate Postpartum Contraception” to increase access to IPPC for all Washingtonians.
Our goal is to support maternal and newborn health by increasing access to immediate postpartum contraception for all patients. As patients move through their lives, their family planning needs may evolve from preventing pregnancy to having a healthy pregnancy to assistance achieving optimal space between pregnancies. Washington has a long history of supporting reproductive health and no matter where a patient is on their journey, they should have access to insurance coverage to help them achieve their goals.
Upstream USA works to expand opportunity by reducing unplanned pregnancy across the U.S. We work in partnership with health centers to strengthen reproductive care and autonomy by increasing equitable access to the full range of contraceptive options.
For more info contact Cara Bilodeau, Director of State Policy, at cbilodeau@upstream.org
