Postpartum contraceptive use among Medicaid beneficiaries following Idaho's abortion ban.

OBJECTIVES

Abortion bans have been associated with decreased reproductive health care access. We examined the association between Idaho's abortion ban and postpartum contraceptive use among Medicaid beneficiaries.

STUDY

DESIGN

This retrospective cohort study used Medicaid claims data from Idaho and Oregon with a difference-in-differences approach. We included Medicaid-enrolled women aged 15-44 who delivered a live birth between July 1, 2021, and September 30, 2023. Idaho's abortion ban, implemented August 25, 2022, criminalized abortion from fertilization with narrow exceptions; Oregon served as the comparison state. The primary outcome was receipt of most effective contraception (implant, intrauterine device, or tubal ligation) within 90 days of delivery. Secondary outcomes included most effective contraception within 3 days of delivery, most or moderately effective contraception within 3 days and within 90 days of delivery, and postpartum visit attendance within 60 days.

RESULTS

Analyzing 56,508 live births to 53,966 Medicaid beneficiaries in Idaho and Oregon, we found that Idaho's abortion ban was associated with a 1.52-percentage point decrease in receipt of the most effective contraception within 90 days postpartum (95% CI, -2.94 to -0.10; p = 0.04) and a 1.41-percentage point decrease within 3 days (95% CI, -2.29 to -0.52; p = 0.002). Postpartum visit attendance declined by 3.13 %age points (95% CI, -5.59 to -0.67; p = 0.01). Immediate postpartum declines coincided with decreased permanent contraception in Idaho (5.0% vs. 4.2%), while Oregon saw an increase (5.9% vs. 6.6%).

CONCLUSIONS

Idaho's abortion ban was associated with significant declines in most effective postpartum contraceptive use and visit attendance among Medicaid beneficiaries, suggesting abortion restrictions may have unintended consequences for postpartum care access.

IMPLICATIONS: Idaho's abortion ban was associated with reduced postpartum contraceptive use and visit attendance among Medicaid beneficiaries. Clinicians practicing in states with abortion restrictions should be aware of potential declines in postpartum care engagement and prioritize counseling and access to contraception throughout care.