Most or Moderately Effective Contraceptive Methods (Postpartum Women)

Measure Description

Among women ages 15–44 who had a live birth, the percentage who are provided a most effective (sterilization, contraceptive implants, or intrauterine devices or systems [IUDs/IUSs]) or moderately effective (injectables, oral pills, patch, or ring) method of contraception 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. 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 to avoid 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 be considered at risk for unintended pregnancy during that time.

How to Use the Measure

The Postpartum Women Most or Moderately Effective Contraceptive Methods measure can be used to identify people who had a live birth and who receive a most or moderately effective method of contraception within 3 days of delivery and within 90 days of delivery. This measure is considered an intermediate outcome measure because it represents a decision made at the end of a clinical encounter about the type of contraception a person will use.

This measure was CBE endorsed at the state, health plan, facility, and clinician group level. Measure results can also be used to inform quality improvement initiatives by identifying and monitoring gaps in the provision of most and moderately effective methods in the postpartum period. 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. 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 Most or Moderately Effective Contraceptive Methods measure does not have a benchmark. Some people will make an informed decision to choose a lower-efficacy method or no method of contraception when providers offer them the full range of methods and there are no logistical or financial barriers to access. For the same reason, it is not appropriate to use the Contraceptive Care measures in a pay-for-performance context as these measures are designed to support quality improvement.

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 assess if there is room for improvement in provision of most or moderately effective contraceptive methods after childbirth.

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

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}