4058 — Receipt of postpartum contraception among Veterans using VA maternity care benefits

Lead/Presenter: Lisa Callegari,  COIN - Seattle/Denver
All Authors: Callegari LS (HSR&D, VA Puget Sound; Department of Obstetrics and Gynecology and Department of Health Systems and Population Health, University of Washington), Kroll-Desrosiers AR (HSR&D, VA Central Western Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Amherst) Benson SK (HSR&D, VA Puget Sound) Copeland LA (HSR&D, VA Central Western Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Amherst) Mahorter SS (HSR&D, VA Puget Sound) Yogendran A (HSR&D, VA Puget Sound) Quinn, DA (HSR&D, VA Pittsburgh; Center for Innovative Research on Gender Health Equity, University of Pittsburgh) Borrero S (HSR&D, VA Pittsburgh; Department of General Internal Medicine and Center for Innovative Research on Gender Health Equity, University of Pittsburgh) Mattocks KM (HSR&D, VA Central Western Massachusetts; Department of Population and Quantitative Health Sciences and Department of Family Medicine and Community Health, University of Massachusetts Amherst)

Objectives:
Timely access to the full range of birth control options in the postpartum period is essential to prevent unwanted pregnancies and short interpregnancy intervals. This access is particularly critical as many states across the US are restricting or eliminating abortion access and Veterans using VA maternity benefits have a high burden of peripartum medical and mental health conditions. Veterans may face added challenges in accessing postpartum contraception relating to fragmentation of care (moving from community pregnancy care back to VA primary care). No data have been published on postpartum contraception among Veterans. We thus investigate receipt of contraception during the postpartum period among a cohort of Veterans using VA maternity care.

Methods:
We utilized data from the VA COMFORT study, which prospectively followed pregnant Veterans utilizing VA maternity care from January 2016 to March 2021. Participants were surveyed at 20-24 weeks of pregnancy and within 3 months post-delivery to obtain information about their demographics, physical and mental health, healthcare utilization, and pregnancy. Survey data were linked to VA pharmacy and billing codes to identify VA healthcare utilization as well as prescription methods (pill, patch, ring, injection or diaphragm) and procedural methods (intrauterine device (IUD), implant, or sterilization) provided or paid for by VA (including community care) within 90 days postpartum. We characterized contraceptive method mix and conducted bivariate and multivariate analyses to identify demographic and health characteristics associated with receipt of any contraception at 90 days postpartum.

Results:
Out of a total of 1,116 Veterans included in analyses, 20.1% had documentation of a prescription or procedural contraceptive method by 90 days postpartum. Among those with a documented method, just over half received a prescription method (52.7%), 21.0% received an IUD or implant, and 14.3% had a sterilization procedure. In bivariate analyses, Veterans who screened positive for postpartum depression symptoms on the Edinburgh Postpartum Depression Scale (score of > = 10) were significantly less likely to receive contraception (14.3% vs. 21.7%, p = 0.05). Those with a VA diagnosis code for depression during pregnancy trended towards less likely (15.9% vs. 21.2%, p = 0.07) and those with > = 2 primary care visits at VA during pregnancy trended towards more likely (21.7% vs. 17.1%, p = 0.06) to have a method. In multivariable analysis, those with a positive EPDS screen had lower odds of having a method (odds ratio 0.59, 95% CI: 0.35-0.99).

Implications:
Only a fifth of Veterans using VA maternity care received prescription or procedural contraception within 90 days postpartum; Veterans with active postpartum depression symptoms had the lowest likelihood of having a method. These results raise concern about barriers faced by Veterans in the postpartum period, although our data do not capture methods covered by non-VA insurance or incorporate patient needs or preferences for contraception.

Impacts:
Meeting Veterans postpartum contraceptive needs has become even more critical in the wake of widespread restrictions to reproductive health services across much of the US. Efforts are needed to address barriers to postpartum contraceptive access for Veterans, particularly those experiencing postpartum depression symptoms, both to protect their reproductive autonomy and to ensure healthy outcomes.