Chte-Level Access to Contraception [04J]

INTRODUCTION: To assess the influence of Medicaid on the rate of short interpregnancy intervals. We tested the hypothesis that Medicaid expansion and subsequent access to birth control would be associated with decreased short interpregnancy (IPIs) rates. METHODS: Using the US Birth Certificate data, we performed a population-based retrospective cohort study including all multiparous women who had a live birth in the US in 2016, after Medicaid expansion had been implemented. Multivariate logistic regression estimated the relative influence of Medicaid expansion on the outcome of short interpregnancy interval (<12 months). RESULTS: There were 3,956,112 live births in the US in 2016: 2,244,158 (56.7%) in multiparous women with data on IPI (n=1,077,411, 48% ME states, n=746,712, 33.3% non-ME states). The rate of short IPI was 18.1% in non-ME states compared to 16.4% in ME states, rate difference 1.68% (95% CI 1.57-1.79%). Living within a state that adopted ME was associated with a modestly decreased risk of a short interpregnancy interval (adjusted relative risk, 0.973; 95% CI 0.966-0.979), even after adjustment for coexisting risks for short IPI. The individual-level factors most strongly associated with short IPI in women who gave birth in states that did not adopt ME were black race, younger maternal age, unmarried, Medicaid enrollment and utilization of WIC, lack of early initiation of prenatal care initiation, and grand multiparity. CONCLUSION: The risk of short interpregnancy interval decreases with Medicaid expansion, even after adjusting for coexisting risk factors. This demonstrates the value of expanding Medicaid to women of child bearing ages.