October 7, 2015

Coverage for Long-acting Contraception Needs to Change According to Dr. Chang

Though long-acting reversible birth control (LARC), such as an intrauterine device (IUD), is readily available, it is not always available to the women who want it, at the time they want it.


Tammy Chang, M.D., M.P.H, M.S.
Tammy Chang, M.D., M.P.H., M.S.

Tammy Chang, M.D., M.P.H., M.S., assistant professor, and her colleague, Michelle Moniz, M.D., assistant professor in U-M’s Department of Obstetrics and Gynecology, authored a poignant article, which appears in The Conversation.

In the article Drs. Chang and Moniz ask, “Why are 50% of pregnancies unintended in the US? Why are poor women more likely to have an unplanned pregnancy?”

They explain that although LARC options are highly effective and desired by many women, the payment system of Medicaid and many other insurers makes it more difficult for women to receive it. Currently, most women who want an IUD receive them at a follow up appointment rather than at the hospital after delivery. This added step is particularly cumbersome for low-income women who may lack transportation, childcare or time away from a job for an appointment. And, these women are the ones who would benefit most from preventing an unintended pregnancy.

Currently, most insurance companies, including Medicaid, pay an average bundled rate for hospital care surrounding a delivery, so the hospital would not receive any payment for LARC placement.

However, this barrier to care is starting to change. Drs. Moniz and Chang and other colleagues, recently completed a study that found many states have recently begun to provide Medicaid coverage of immediate postpartum LARC. See the complete publication in Contraception.  

Drs. Chang and Moniz assert that this change is a benefit to all. "Getting pregnant again too quickly is dangerous for women and children. LARC is a highly effective tool to prevent unintended pregnancy. It is time to make LARC more easily available to all women who want it."