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Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the United States, 2008–2013

Moniz, Michelle H. MD, MSc; Chang, Tammy MD, MPH; Heisler, Michele MD, MPH; Admon, Lindsay MD; Gebremariam, Acham MS; Dalton, Vanessa K. MD, MPH; Davis, Matthew M. MD, MPP

doi: 10.1097/AOG.0000000000001970
Contents: Original Research

OBJECTIVE: To measure rates of long-acting reversible contraception (LARC), including intrauterine devices and contraceptive implants, and tubal sterilization during delivery hospitalizations and correlates of their use.

METHODS: This retrospective cohort study used the 2008–2013 National Inpatient Sample, a publicly available all-payer database. We identified delivery hospitalizations with the International Classification of Diseases, 9th Revision, Clinical Modification codes for intrauterine device insertion, contraceptive implant insertion, and tubal sterilization. We used weighted multivariable logistic regression to examine associations between predictors (age, delivery mode, medical comorbidity, payer, hospital type, geographic region, and year) and likelihood of LARC and sterilization and to compare characteristics of LARC and sterilization users.

RESULTS: Our sample included 4,691,683 discharges, representing 22,667,204 delivery hospitalizations. Long-acting reversible contraception insertion increased from 1.86 per 10,000 deliveries (2008–2009) to 13.5 per 10,000 deliveries (2012–2013; P<.001); tubal sterilization remained stable (711–683 per 10,000 deliveries; P=.24). In multivariable analysis adjusting for all predictors, compared with neither LARC nor sterilization, LARC use was highest among women with medical comorbidities (count per 10,000 deliveries: 15.04, standard error 2.11, adjusted odds ratio [OR] 1.92, 95% confidence interval [CI] 1.72–2.13), nonprivate payer (13.50, standard error 2.14, adjusted OR 5.23, 95% CI 3.82–7.16), and at urban teaching hospitals (14.92, standard error 2.25, adjusted OR 20.85, 95% CI 12.73–34.15). Sterilization was least likely among women aged 24 years or younger (251.04, standard error 4.88, adjusted OR 0.12 95% CI 0.12–0.13, compared with 35 years or older) and most likely with cesarean delivery (1,568.74, standard error 20.81, adjusted OR 6.25, 95% CI 5.88–6.63). Comparing only LARC and sterilization users, LARC users tended to have nonprivate insurance (84.95% compared with 57.17%, adjusted OR 1.90, 95% CI 1.38–2.63) and deliver at urban teaching hospitals (94.65% compared with 45.47%, adjusted OR 38.39, 23.52–62.64) in later study years (2012–2013; 55.72% compared with 32.18%, adjusted OR 8.26, 95% CI 4.42–15.44, compared with 2008–2009).

CONCLUSION: Long-acting reversible contraception insertion increased from 1.86 to 13.5 per 10,000 deliveries but remained less than 2% of the sterilization rate. Inpatient postpartum LARC insertion is more likely among sicker, poorer women delivering at urban teaching hospitals.

From 2008 to 2013, the long-acting reversible contraception rate increased from 1.86 to 13.5 per 10,000 deliveries but remained less than 2% of the sterilization rate.

Departments of Obstetrics and Gynecology, Family Medicine, Internal Medicine, Pediatrics, and Communicable Diseases, the Institute for Healthcare Policy and Innovation, and the School of Public Health, University of Michigan, Ann Arbor, Michigan; and the Department of Pediatrics, Northwestern University, Chicago, Illinois.

Corresponding author: Michelle H. Moniz, MD, MSc, North Campus Research Complex, 2800 Plymouth Road, Building No. 16, Room G222, Ann Arbor, MI 48109-5276; email:

Supported by the Department of Obstetrics and Gynecology at the University of Michigan.

Financial Disclosure Dr. Dalton is a paid expert witness for Bayer Corporation. The other authors did not report any potential conflicts of interest.

Presented as a poster at the American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting, May 6–9, 2017, San Diego, California. Dr. Moniz thanks Drs. Dalton and Davis for their mentorship and guidance.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.