1. Research & Evaluation
  2. Title X Services Research
  3. Contraceptive Care Measures
  4. Long-Acting Reversible Contraceptive Methods (Postpartum Women)

Long-Acting Reversible Contraceptive Methods (Postpartum Women)

Measure Description

Among women ages 15–44 years who had a live birth, the percentage who are provided a long-acting reversible contraceptive (LARC) method (implants or intrauterine devices or systems) within 3 days of delivery and within 90 days of delivery.

Rationale

The American College of Obstetricians and Gynecologists (ACOG) recommends that everyone at risk of unintended pregnancy receive counseling from their providers on all contraceptive options, including LARCs. Increasing access to contraceptives can reduce unintended pregnancies and promote healthy spacing between births. Provision of contraceptive services also improves people’s health and well-being.

The timing intervals used in this measure are based on several clinical recommendations. The 90-day period reflects ACOG’s recommendation that people should receive family and contraceptive counseling within 12 weeks of giving births.1 The three-day period reflects recommendations from the Centers for Disease Control and Prevention and ACOG that the immediate postpartum period (during post-delivery hospitalization) is a safe time to provide contraception; it might offer greater convenience to the client and prevent missing an opportunity to provide contraception, especially given that many people do not attend a postpartum visit.

ACOG recommends avoiding interpregnancy intervals shorter than 6 months and to provide counseling about the risks and benefits of repeat pregnancy sooner than 18 months.2 Interpregnancy intervals less than 6 months have been linked to adverse perinatal outcomes, including preterm birth, low birth weight, and small size for gestational age, as well as adverse maternal outcomes.2 All postpartum women can therefore be considered at risk for unintended pregnancy during that time.

How to Use the Measure

The Postpartum Women LARC Methods is an access measure. Very low measure results, below 1 or 2 percent, might signal barriers to LARC provision which may be explored and addressed through provider training, changes in reimbursement practices, or quality improvement initiatives. The barriers to obtaining LARC are well-documented and include lack of knowledge among eligible people or providers, financial constraints, and logistical issues.

Measure performance rates can also inform quality improvement initiatives by identifying and monitoring gaps in LARC provision. Specifically, they can help health care providers learn about their patient population, identify best practices in care, and track quality improvement progress, acting as a roadmap for enhancing the quality of care and patient satisfaction. The measure was CBE endorsed at the state, health plan, facility, and clinician group level. In addition, many states report this measure to the Centers for Medicare & Medicaid Services (CMS) Child and Adult Core Set program to drive improvement in the quality of contraceptive care provided to Medicaid beneficiaries.

The Postpartum Women Access to LARC measure has no specific benchmark and should not be used to encourage high rates of LARC use, as this could lead to coercive practices. This is especially important given the historical use of coercive practices related to contraception, especially among communities of color and people with low income. For the same reason, it is not appropriate to use the Postpartum Women Access to LARC measure in a pay-for-performance context.

Starting federal fiscal year (FFY) 2024, reporting of the Child Core Set, which includes OPA’s contraceptive care measures, is mandatory for all states. States should not interpret this mandatory reporting as a desire to reach higher rates of contraceptive provision, but rather as an aim to capture all contraceptive provision rates. Higher rates of contraceptive provision are not associated with higher quality of contraceptive care provided to patients because these rates do not necessarily reflect patient preferences or goals.

Measure performance rates can be used to help identify potential barriers to LARC access.

Measure Specifications

Instructions for Calculating the Measures

Technical Release Notes (TRN)

2023 Postpartum Women measure specifications (CCP)

2014 – 2022 Postpartum Women measure specifications (CCP) - Zip folder

Value sets, code lookup tables, and SAS code

2023 Postpartum Women (CCP) TRNs - Excel file

CCP: Contraceptive Care Postpartum Women measure.

Footnotes

1 American College of Obstetricians and Gynecologists. (2018). Optimizing postpartum care (Committee Opinion Number 736). https://pubmed.ncbi.nlm.nih.gov/29683911 back to top

2 American College of Obstetricians and Gynecologists. (2019). Interpregnancy care (Obstetric Care Consensus Number 8). https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2019/01/interpregnancy-care back to top