2/3 Of Texas Low-Income Women Don't Get Preferred Contraception

AUSTIN, TEXAS — Two-thirds of low-income women in Texas who have delivered a baby are not getting their preferred contraception method, according to a new study.

The Texas Policy Evaluation Project (TxPEP) report shows two-thirds of women did not receive the contraception they wanted at their initial postpartum visit, commonly known as the “six-week checkup,” leaving them at risk for an unintended pregnancy. While some women (8 percent) left the visit with a less preferred form of contraception, more than half (58 percent) left with no contraception method at all, researchers found.

Women who wanted to use an intrauterine device (IUD) or the contraceptive implant, two highly effective methods, faced the greatest difficulty accessing what they wanted with only 10 percent of women who wanted them getting them at the first postpartum visit, accoding to the report.

The study results are based on a survey of 685 women administered three months after childbirth at eight hospitals across six Texas cities from 2014-2016, TxPEP officials said. The women either had no insurance or were covered by public insurance, and they did not want to have a baby within the two years following delivery.

By three months postpartum, the women who did not receive the contraception they wanted at the six-week visit were half as likely to be using it as the women who did receive it (41 percent versus 86 percent), indicating the crucial importance of the six-week checkup in establishing desired contraceptive use in postpartum women who wish to prevent pregnancy, according to the report. Women who were not using their desired method were frequently using less-effective methods of contraception, such as condoms, withdrawal, or natural family planning, researchers noted.

“The first postpartum visit, usually scheduled about six weeks after delivery, is extremely important for contraceptive access,” said study lead author Kate Coleman-Minahan, co-investigator at TxPEP, nurse practitioner, and assistant professor in the College of Nursing at the University of Colorado. “The time immediately after childbirth can be full of compounding stressors—lack of time, energy, sleep, money, support, or reliable transportation. The six-week checkup is an opportunity for clinicians to provide the support a woman needs to make decisions about if, when, and how to grow her family.”

When identifying the difficulties accessing the contraception they wanted, the report found that women pointed to clinic- and provider-level barriers. For example, 37 percent of women were told by physicians to schedule another visit to obtain their desired method. Nearly 1 in 5 women were told they were not eligible for their desired method due to health reasons, but in most cases the advice was not correct: only 28 percent of these instances were consistent with current evidence-based practice guidelines, researchers discovered.

Moreover, many women reported that providers told them they could not use a method because they were breastfeeding or they had not started menstruating, recommendations that do not align with the Center for Disease Control protocol and put women at risk for pregnancy. Other women reported their clinics did not stock more expensive contraceptive methods, such as the IUD.

Many women also described complex cost barriers, such as Pregnancy Medicaid insurance expiring after two months, which can place a time crunch on the initial postpartum visit and limit return visits outside of the two-month window. Filling out the clinic paperwork to access income-based discounts in a timely manner also created significant barriers for women, researchers found.

“The most effective method to prevent pregnancy is the method the woman wants to be using and will continue to use.” Coleman-Minahan said. “Expanding Pregnancy Medicaid contraception coverage to at least six months for all women, including immigrants, helping providers provide patient-centered, accurate contraceptive counseling, and supporting clinics in stocking and administering long-acting contraception would go a long way in ensuring women can access the contraception they want, when they want it.”

The study was recently published online in Perspectives on Sexual and Reproductive Health: https://onlinelibrary.wiley.com/doi/10.1363/psrh.12083. Read a TxPEP policy brief based on this research here: https://liberalarts.utexas.edu/txpep/research-briefs/ppc-six-week-checkup.php

About the Texas Policy Evaluation Project

The Texas Policy Evaluation Project, or TxPEP, is a comprehensive effort to document and analyze the impact of measures affecting reproductive health passed by the Texas Legislature. The project team includes researchers at The University of Texas Population Research Center; the University of California, San Francisco; Ibis Reproductive Health and the University of Alabama-Birmingham. The project is supported by grants from the Susan Thompson Buffett Foundation and the Society of Family Planning. Infrastructure support for the Population Research Center is provided by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Funders of the Texas Policy Evaluation Project have no role in the design and conduct of the research, interpretation of the data, approval of the final manuscript or decision to publish.

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