As an organization, we have had the privilege of being welcomed into health centers that share our commitment to providing patient-centered care and access to the full range of contraceptive options. By working closely with each health center partner, we identify and address the various barriers that have impeded them from providing such care in one visit. At the same time, we are afforded up-close opportunities to see when system-wide change is needed.
As we first shared in our January blog post, we discovered a barrier to contraceptive care while working alongside a Tacoma provider interested in offering their patients immediate postpartum contraception (IPPC). As it turned out, patients in the state of Washington covered by private insurance were not guaranteed adequate coverage for this form of contraception, making it complicated for providers to roll out an accessible and equitable IPPC program. This reality hit home for one of our Upstreamers, Liz, who was confronted with this barrier after giving birth in 2017.
Research has shown that healthy birth spacing helps reduce adverse health outcomes for both parents and babies, and at least 70% of pregnancies in the first year after a person gives birth are unplanned. This is, in part, because 40 to 75% of people who plan to use an intrauterine device (IUD) after childbirth don’t obtain it. Liz wanted an IUD following the birth of her child but, because of her insurance, she was forced to wait until her six-week postpartum checkup.
However, we know from research and our own experience working with our partners that as many as 40% of women do not return for their six-week postpartum appointment, especially if they’re privately insured. There are often multiple barriers that stop them from returning. These barriers include exhaustion, postpartum depression, transportation issues, lack of support to care for their other children, the COVID-19 pandemic, and more. For some patients, the choice of receiving the IUD immediately after delivering knocks down those barriers and allows them the relief of knowing they can choose when, or if, they want to have another child.
Our discovery of this alarming gap in care led us to ask state Representative My-Linh Thai to file legislation that would help rectify this disparity in coverage. After enjoying bipartisan support from the state legislature, Governor Inslee signed this measure into law on March 24, 2022.
The Immediate Postpartum Contraception law will help increase access to the full range of contraceptive methods by requiring commercial insurance plans to cover the cost of IPPC provided in hospital and birthing center settings as a separate payment from the standard labor and delivery payment.
The new law is the first of its kind, incorporating recommendations of the American College of Obstetricians and Gynecologists (ACOG) and the Washington State Bree Collaborative. Other organizational supporters include the Midwives Association of Washington State, Washington Association for Community Health (WACH), Washington State Hospital Association (WSHA), Washington State Medical Association (WSMA), and the Washington State Nurses Association (WSNA).
We were fortunate to have early support from First Lady Trudi Inslee, Chair of Upstream Washington’s Advisory Committee:
“I am proud Washington state is setting an example for the nation by recognizing access to immediate postpartum contraception as critical to improving maternal health. As other states seek to support families and address healthcare inequities, I hope they also work to ensure that immediate postpartum contraception is available to any birthing person who asks for it.”
We share the First Lady’s enthusiasm and applaud Washington state leaders for addressing disparities in contraceptive care and increasing its commitment to the reproductive health needs of its residents. We will be closely monitoring the implementation of this new law and will update you as the law begins to bring a positive impact to the lives of Washingtonians.
But our IPPC advocacy does not begin and end in Washington. Other states serious about protecting patients’ ability to decide if and when to have a child should take similar measures to ensure that their residents have equitable access to the full range of contraceptive options. As our work takes Upstream inside new health centers, we will continue to take our on-the-ground experiences and observations to inform necessary policy change.
