ORIGINAL RESEARCH
Allison Hoynes, MD; Brittany Cox, DO; Roma Amin, MD; Chelsea Marie Foster, MD; Annalise Celano, DO; Jonathan Yun, MD, MPH
Corresponding Author: Allison K Hoynes, MD; OhioHealth, Grant Family Medicine
Email: allison.hoynes@ohiohealth.com
DOI: 10.3122/jabfm.2025.250137R1
Keywords: Contraceptives, Counseling, Desogestrel, Drug Implants, Electronic Health Records, Etonogestrel, Health Education, Health Disparities, Health Policy, Long-Acting Reversible Contraception, Maternal Health Services, Medicaid, Obstetrics, Ohio, Perinatal Care, Population Health, Postpartum Period, Preconception Care, Pregnancy, Premature Birth, Preventive Medicine, Public Health, Reproductive Health, Women's Health
Dates: Submitted: 10-10-2024; Revised: 06-17-2025; Accepted: 06-30-2025
Status: In production.
INTRODUCTION: Immediate postpartum long-acting reversible contraception (IPP-LARC) after delivery may decrease rapid repeat pregnancy (RRP). RRP is associated with preterm birth, small for gestational age, low birth weight, and infant/maternal mortality. In April 2017, the Ohio legislature passed SB 332, mandating immediate postpartum LARC coverage. Later that year, our hospital made the IPP-LARC Nexplanon (and not IUDs) available to all delivering patients. This study aimed to see if SB 332 is associated with decreased RRP.
METHODS: Using electronic health record and state registry data, we examined sociodemographic and perinatal care variables for 726 pregnant adolescents and adults delivering at our hospital during the 12 months before and after IPP-LARC became available. We then determined the association between RRP and these variables.
RESULTS: After LARC became available, 62/368 patients chose Nexplanon. Gravidity (OR: 1.128) and vaginal delivery (OR: 1.682) were negatively associated with RRP while age at delivery was inversely associated (OR: 0.902, p<0.001). The adjusted mean probability of RRP was 6% for those who had IPP-LARC placement, compared to 20% for those who did not. LARC availability was positively associated with RRP but not significantly (OR: 1.287, p=0.195).
CONCLUSIONS: After SB 332’s passage, IPP-LARC availability was positively associated with RRP, but the percentage of patients who chose IPP-LARC was low. However, RRP occurred less often among patients who chose IPP-LARC placement. Hospital systems must actively invest in patient education and provider support to ensure interventions to reduce rapid repeat pregnancy are optimally utilized by vulnerable populations.