The Financial Effects of Expanding Postpartum Contraception for New Immigrants

Rodriguez, Maria Isabel MD; Jensen, Jeffrey T. MD, MPH; Darney, Philip D. MD, Msc; Little, Sarah E. MD; Caughey, Aaron B. MD, PhD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3181d06f96
Original Research

OBJECTIVE: To estimate the costs of expanding Emergency Medicaid coverage to include postpartum contraception.

METHODS: A decision-analytic model was developed using three perspectives: the hospital, state Medicaid programs, and society. Our primary outcome was future reproductive health care costs due to pregnancy in the next 5 years. A Markov structure was use to analyze the probability of pregnancy over a 5-year time period. Model inputs were retrieved from the existing literature and local hospital and Medicaid data related to reimbursements. One-way and multiway sensitivity analyses were conducted. A Monte Carlo simulation was performed to incorporate uncertainty from all of the model inputs simultaneously.

RESULTS: Over a 5-year period, provision of contraception would save society $17,792 per woman in future pregnancy costs and incur a loss of $367 for hospitals. In states in which 49% of immigrants remain in the area for 5 years, such a program would save state Medicaid $108 per woman.

CONCLUSION: Under federal regulations, new immigrants are restricted to acute, hospital-based care only. Failure to provide the option of contraception postpartum results in increased costs for society and states with long-term immigrants.

In Brief

Postpartum contraception for new immigrants who are underinsured is a cost-beneficial practice for both state Medicaid programs and society.

Author Information

From the Department of Obstetrics, Gynecology, and Reproductive Sciences and the Center for Clinical and Policy Perinatal Research (C2P2R), University of California, San Francisco, San Francisco, California; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, Massachusetts.

Funded by an anonymous donor. Dr. Caughey is supported in part by a grant under the Robert Wood Johnson Foundation Physician Faculty Scholars Program (RWJF-61535).

Corresponding author: Maria Isabel Rodriguez, MD, San Francisco General Hospital, 1001 Potrero Ave, 6D15, San Francisco, CA 94110; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2010 The American College of Obstetricians and Gynecologists